Mycoplasma genitalium (Mgen) is a sexually transmitted infection (STI) caused by a bacterium that has gained increasing attention in public health. While commonly associated with genital infections, questions often arise regarding its potential for transmission through oral sexual contact.
Understanding Mycoplasma Genitalium
Mycoplasma genitalium is a type of bacterium smaller than most others, lacking a cell wall, which affects its susceptibility to certain antibiotics. It is distinct from other more commonly known STIs like chlamydia or gonorrhea. Mgen primarily infects the mucous membranes of the genitourinary tract, including the urethra, cervix, and rectum.
Oral Transmission of Mgen
While Mgen is predominantly transmitted through vaginal and anal sexual contact, its spread through oral sex is considered rare. Studies suggest that the presence of Mgen in the throat (oropharynx) is uncommon, with prevalence rates around 1% in men who have sex with men and 0.7% in women. Despite this low prevalence, one case study reported a high probability of Mgen transmission through receptive oral sex, and a modeling study estimated that oral sex could account for approximately 17.6% of incident Mgen transmission among men who have sex with men.
Recognizing Mgen Symptoms
Many individuals infected with Mgen experience no symptoms at all, making it a “silent” infection that can spread unknowingly. When symptoms do occur, they are often non-specific and can resemble those of other STIs. In individuals with a penis, symptoms may include discharge, a burning sensation during urination, or pain in the testicles.
For individuals with a vagina, symptoms can include unusual vaginal discharge, pain during urination, abdominal or pelvic pain, or bleeding between periods or after sexual intercourse. Mgen rarely affects the throat, and any oral symptoms are typically subtle or non-existent, similar to genital infections.
Diagnosis and Treatment for Mgen
Diagnosing Mgen typically involves nucleic acid amplification tests (NAATs), which detect the bacterium’s genetic material. These highly sensitive tests can be performed on urine samples or swabs taken from affected areas such as the vagina, cervix, urethra, or rectum. Oral swabs may also be considered in specific cases where pharyngeal infection is suspected.
Mgen infections are treated with antibiotics, but successful treatment has become increasingly challenging due to widespread antibiotic resistance. Azithromycin is often a first-line treatment, but resistance to macrolides like azithromycin is high, exceeding 50% globally and even 80% in some populations. Moxifloxacin is a common alternative for resistant cases, though resistance to fluoroquinolones is also rising. If initial treatment fails, further testing for antibiotic resistance is important to guide subsequent therapy.
Preventing Mgen Transmission
Preventing the transmission of Mgen involves adopting safer sexual practices. Consistent and correct use of condoms during vaginal and anal sex significantly reduces the risk of infection. Avoiding unprotected sexual contact with new or multiple partners also helps minimize exposure.
Regular STI testing, especially if you have new partners or experience symptoms, is an important step in early detection and treatment. Open communication with sexual partners about STI status and testing can help prevent further spread. It is recommended to avoid any sexual activity until both you and your partner(s) have completed treatment and confirmed cure.