Mycoplasma genitalium (Mgen) is a bacterial infection primarily transmitted through sexual contact. It often causes no noticeable symptoms. Despite its silent nature, Mgen is recognized as a sexually transmitted infection (STI) that can have various health implications if left unaddressed.
Understanding Mgen Infection
Mycoplasma genitalium is a distinct type of bacterium and one of the smallest self-replicating organisms. It primarily infects the mucous membranes of the genitourinary tract, including the urethra and cervix, and can also be found in the rectum. Transmission occurs through vaginal or anal sexual contact. While oral transmission is still being studied, direct genital-to-genital contact, even without penetration, can facilitate its spread.
Many people with Mgen do not experience any symptoms. When symptoms do appear, they can resemble those of other common STIs like chlamydia or gonorrhea. In men, symptoms may include a burning sensation during urination or discharge from the penis. Women might experience abnormal vaginal discharge, pain during urination, bleeding after sex, or pelvic discomfort.
Why Mgen Persists Without Treatment
Mgen infections typically do not resolve on their own without medical intervention. Its unique characteristics contribute to its persistence. One significant factor is its lack of a rigid cell wall, which makes it resistant to certain common antibiotics, such as penicillin, that target cell wall synthesis. This structural difference necessitates specific antibiotic classes for effective treatment.
The bacterium also has the ability to adhere to and potentially hide within host cells, making it more challenging for the body’s immune system to clear the infection naturally. This intracellular or adherent lifestyle can protect the bacteria from immune responses. Another growing concern is the increasing development of antibiotic resistance in Mgen strains. This resistance, particularly to macrolide antibiotics like azithromycin, means that alternative drug regimens are often required.
Diagnosis and Treatment Approaches
Diagnosing Mycoplasma genitalium infection primarily relies on highly sensitive laboratory tests called Nucleic Acid Amplification Tests (NAATs). These tests detect the genetic material of the bacterium from samples, typically urine or swabs taken from the cervix, vagina, or rectum. NAATs are preferred because Mgen is a fastidious organism, meaning it is difficult to culture in a laboratory setting.
Treatment for Mgen involves specific antibiotic regimens, often starting with a macrolide like azithromycin. However, due to rising rates of antibiotic resistance, particularly to azithromycin, alternative antibiotics such as moxifloxacin may be used, especially in cases of suspected macrolide resistance or treatment failure. It is important to complete the full course of prescribed medication to ensure eradication and minimize further resistance.
After treatment, re-testing is recommended to confirm that the infection has been successfully cleared. This re-testing typically occurs three to four weeks after completing the antibiotic course, as testing too soon might detect residual bacterial DNA, leading to a false positive result. Partner notification and treatment are also important to prevent re-infection and further spread.
Health Consequences of Untreated Mgen
Leaving Mycoplasma genitalium untreated can lead to significant and lasting health problems in both men and women. In women, untreated Mgen can ascend from the lower genital tract to cause Pelvic Inflammatory Disease (PID). PID is an infection of the uterus, fallopian tubes, or ovaries that can result in chronic pelvic pain, scar tissue formation that blocks fallopian tubes, and an increased risk of ectopic pregnancy, where a fertilized egg implants outside the uterus. PID can also contribute to female infertility.
For men, untreated Mgen can cause persistent urethritis, an inflammation of the urethra causing discharge and painful urination. Although less commonly documented, Mgen has also been associated with epididymitis, an inflammation of the coiled tube at the back of the testicle that stores and carries sperm. This can impact male reproductive health. Beyond these direct complications, untreated Mgen may also increase the risk of acquiring or transmitting other sexually transmitted infections, including HIV, by causing genital tract inflammation that increases susceptibility to infection.