Mycoplasma genitalium (MG) is a sexually transmitted infection (STI) that often goes unnoticed, yet it can lead to various health concerns if left untreated. Symptoms are frequently absent or easily mistaken for other conditions. This article clarifies how MG is transmitted, including through oral sex, and outlines its potential health impact, along with current approaches to testing, treatment, and prevention.
Understanding Mycoplasma Genitalium
Mycoplasma genitalium is a small bacterium that can cause infections in the genital tract, including the urethra, cervix, and rectum. It is one of the smallest known self-replicating prokaryotes. MG lacks a cell wall, which makes it resistant to certain common antibiotics like penicillin that target cell wall synthesis.
The bacterium has a specialized terminal organelle that allows it to attach firmly to host cells and move along mucous surfaces. This adherence mechanism contributes to its ability to establish infections in various locations.
How Mycoplasma Genitalium Spreads
Mycoplasma genitalium is primarily transmitted through unprotected sexual contact, including vaginal and anal intercourse. While less common for the infection to establish and cause noticeable symptoms in the throat, MG can be transmitted through oral sex.
Transmission can also occur through indirect contact, such as touching genitals with fingers that have infected fluids, or by sharing sex toys. Studies indicate that up to half of the sexual partners of individuals diagnosed with MG may also test positive.
Recognizing Symptoms and Potential Health Issues
When symptoms do occur, they can vary between men and women and often mimic those of other STIs. In men, common symptoms include a watery or cloudy discharge from the penis, pain or a burning sensation during urination, and sometimes pain in the testicles or during ejaculation. Inflammation in the rectum (proctitis), characterized by anal pain and discharge, can also occur.
For women, symptoms can include unusual vaginal discharge, pain during urination, lower abdominal or pelvic pain, and abnormal vaginal bleeding, particularly between periods or after sex. Untreated MG can lead to serious health problems. In women, it can cause cervicitis, an inflammation of the cervix, and pelvic inflammatory disease (PID), an infection of the reproductive organs. PID can result in long-term pelvic pain, ectopic pregnancy, and infertility due to scar tissue blocking the fallopian tubes. In men, untreated infection can lead to urethritis and epididymo-orchitis, which is a painful inflammation of the testicles and sperm-carrying tubes, potentially impacting fertility.
Testing, Treatment, and Prevention
Diagnosing Mycoplasma genitalium involves a nucleic acid amplification test (NAAT), which detects the bacterium’s genetic material. This test can be performed on urine samples or swabs taken from the urethra, vagina, cervix, or rectum. NAATs are highly sensitive and can provide results within 24 to 48 hours.
Treatment for MG usually involves antibiotics. Azithromycin is often the first-line treatment, sometimes given as an extended course. However, antibiotic resistance, particularly to azithromycin, is a growing concern, making treatment more challenging. If initial treatment fails or resistance is suspected, moxifloxacin may be prescribed as an alternative. After treatment, a test of cure is generally recommended to ensure the infection has been eradicated, usually 3 to 4 weeks after completing the antibiotics.
Prevention strategies include consistent and correct use of condoms during all sexual activity, including vaginal, anal, and oral sex, to reduce the risk of transmission. Regular STI testing, especially for sexually active individuals with new or multiple partners, is also important. Open communication with sexual partners about STI status can further help prevent spread.