Mycoplasma genitalium (Mgen) is a sexually transmitted bacterium that can infect the reproductive tracts of both men and women. It has gained more attention in recent years as a cause of genital infections, and a frequent question is whether it can lie dormant in the body. The answer involves understanding its ability to persist without causing any noticeable problems.
The Concept of Asymptomatic Infection
While “dormant” is a common term, the more accurate description for Mycoplasma genitalium is asymptomatic. This means the infection is active but produces no symptoms, distinguishing it from a truly dormant state where a pathogen is biologically inactive. The bacterium can live within cells of the urinary and genital tracts for weeks, months, or longer. Research indicates that over 90% of men and more than 50% of women with Mgen experience no symptoms at all.
The bacterial load, or the amount of Mgen present, can fluctuate over time. The bacteria can multiply within the urogenital tract without triggering an immune response significant enough to cause symptoms. This quiet persistence means someone could have acquired the infection from a partner long ago and only discover it much later.
Progression from Asymptomatic to Symptomatic
An asymptomatic Mgen infection can become symptomatic at any point, though the specific triggers are not always clear. Potential factors include shifts in a person’s immune system, changes in the vaginal microbiome, or the presence of other sexually transmitted infections (STIs).
When symptoms develop, they mimic other common STIs. In men, Mgen is a recognized cause of urethritis (inflammation of the urethra), causing a burning sensation during urination, penile irritation, and discharge.
In women, the infection can cause cervicitis (inflammation of the cervix), resulting in unusual vaginal discharge, pain during intercourse, and bleeding between periods or after sex. If the infection travels to the upper reproductive tract, it can lead to pelvic inflammatory disease (PID), a condition affecting the uterus, fallopian tubes, and ovaries that may cause lower abdominal pain.
Transmission and Testing Challenges
The high rate of asymptomatic cases is the primary challenge in controlling the spread of Mycoplasma genitalium. An individual without symptoms can unknowingly transmit the bacteria to sexual partners through unprotected contact. This silent transmission is a public health concern because people are not prompted to seek testing or treatment when they feel healthy.
Testing for Mgen also presents difficulties. It is not included in routine STI screenings for infections like chlamydia and gonorrhea, and many clinics only test for it when a person shows symptoms. Therefore, even individuals who get regular sexual health check-ups may not be tested for this bacterium.
The most reliable detection method is a nucleic acid amplification test (NAAT), similar to the technology used for other STIs. A NAAT can be performed on a urine sample or a vaginal or urethral swab and works by identifying the bacterium’s genetic material.
Treatment of Mycoplasma Genitalium
Treatment for Mycoplasma genitalium involves antibiotics, but the bacterium has shown a growing resistance to these medications. This antibiotic resistance is a significant problem that makes some infections difficult to cure. As a result, treatment may require a two-stage process to be effective.
Initially, a course of doxycycline is prescribed, followed by a different antibiotic like azithromycin or moxifloxacin. However, resistance to azithromycin is widespread, and moxifloxacin is reserved for cases where other treatments fail due to its side effects. It is important for individuals to complete the full course of prescribed medication to combat this resistance.
After treatment, follow-up testing, known as a “test of cure,” is recommended to ensure the infection is cleared and prevent further transmission. Anyone with symptoms or who believes they were exposed should seek medical advice for a proper diagnosis and a treatment plan that accounts for local resistance patterns.