Mycoplasma genitalium (MG) is a sexually transmitted infection. While antibiotics typically clear bacterial infections, MG presents unique challenges, making successful eradication and confirmation of cure a focus for healthcare providers and individuals. Understanding the nature of this bacterium, its treatment strategies, and factors influencing eradication is important for effective management.
Understanding Mycoplasma Genitalium
Mycoplasma genitalium is a small bacterium that causes sexually transmitted infections (STIs) in humans. It primarily infects the urinary and genital tracts. This bacterium is transmitted through sexual contact, including vaginal, anal, or oral sex, and can also spread through genital-to-genital contact even without penetration. While many individuals with MG experience no symptoms, it is an increasingly recognized cause of various urogenital issues. For instance, it can lead to urethritis in both men and women, and cervicitis or pelvic inflammation in women.
Treatment Strategies
Treatment for Mycoplasma genitalium infections typically involves antibiotics, and due to increasing antibiotic resistance, a phased approach is often employed, starting with one type and potentially switching if initial treatment is unsuccessful. Common first-line treatments include macrolides such as azithromycin, though resistance to this class of antibiotics is a growing concern. For macrolide resistance or treatment failure, fluoroquinolones like moxifloxacin may be used as a second-line option. Doxycycline is often used as an initial therapy to reduce the bacterial load before administering a second antibiotic. Adhering to the prescribed antibiotic regimen, including dosage and duration, is important for successful eradication.
Confirming Treatment Success
Confirming the successful eradication of Mycoplasma genitalium after antibiotic treatment is important due to the bacterium’s propensity for resistance. This is typically achieved through a “Test of Cure” (TOC), which involves retesting for the bacteria to ensure the infection has been cleared and to identify any persistent infection that may require further intervention. The recommended timing for a TOC is generally 3 to 4 weeks after completing the antibiotic regimen. Retesting too soon can lead to false positive results due to residual bacterial DNA, even if the bacteria are no longer viable. A Test of Cure is not always routinely recommended for asymptomatic individuals who received a standard treatment, but it is often advised if symptoms persist, treatment adherence is questionable, or reinfection is suspected.
Reasons for Persistence
Despite antibiotic treatment, Mycoplasma genitalium can sometimes persist. The primary reason for this persistence is the bacterium’s increasing ability to develop antibiotic resistance. Mycoplasma genitalium has shown significant resistance to commonly used antibiotics, particularly azithromycin. This resistance arises from genetic mutations within the bacteria, making the antibiotics ineffective. Another contributing factor to treatment failure is poor adherence to the prescribed medication regimen. Not taking the antibiotics exactly as directed, such as missing doses or stopping treatment prematurely, can lead to incomplete eradication of the bacteria. Re-infection is a possibility if an individual has sexual contact with an untreated partner, which can be mistaken for persistent infection. To avoid re-infection, it is recommended to avoid unprotected sexual contact until both the treated individual and their sexual partner(s) have confirmed negative test results.
Consequences of Ongoing Infection
If Mycoplasma genitalium infection persists despite treatment, it can lead to various health complications for both men and women. In women, untreated or persistent infection can result in cervicitis, an inflammation of the cervix, and pelvic inflammatory disease (PID). PID can cause long-term reproductive issues, including infertility, ectopic pregnancy, and chronic pelvic pain. For men, persistent Mycoplasma genitalium infection can lead to chronic urethritis, which is inflammation of the urethra, and epididymitis, an inflammation of the coiled tube at the back of the testicle. Follow-up testing and, if necessary, re-treatment are important to prevent these potential long-term health concerns.