Mycoplasma genitalium, known as MG, is a tiny bacterium causing a sexually transmitted infection (STI). It often goes unnoticed because it frequently causes no symptoms, earning it the designation of a “stealth” pathogen. Untreated MG infections can lead to a range of significant health complications, particularly affecting the reproductive system.
Untreated Persistence of Mycoplasma Genitalium
Mycoplasma genitalium can persist in the body for extended periods, often many months and potentially even years, without appropriate treatment. This prolonged presence is largely due to its asymptomatic nature, as individuals may be unaware they are infected and do not seek medical attention. Studies show MG can persist asymptomatically for many months, especially when macrolide resistance is present. For instance, in one study, the median duration of persistence for men without curative therapy was 143 days, ranging from 21 to 228 days.
Even when symptoms temporarily resolve after initial treatment for conditions like nongonococcal urethritis (NGU), the bacterium can remain in the body for months. Some individuals saw symptom resolution after azithromycin, yet MG persisted for 89 to 186 days before further treatment. This highlights that clinical improvement does not always equate to bacterial eradication, particularly when the infection has developed antibiotic resistance.
Health Consequences of Unresolved Infection
Untreated Mycoplasma genitalium infections can lead to various health problems affecting both men and women. In men, common complications include urethritis, an inflammation of the urethra, causing symptoms like burning during urination or discharge. Persistent or recurrent urethritis is frequently linked to MG. The infection can also lead to epididymitis, an inflammation of the coiled tube at the back of the testicle that stores and carries sperm.
For women, the consequences of unresolved MG infection are significant. It is a recognized cause of cervicitis, an inflammation of the cervix, and pelvic inflammatory disease (PID). PID is a serious condition that can involve inflammation of the uterus, fallopian tubes, and ovaries. Untreated PID can result in long-term reproductive issues, including chronic pelvic pain, an increased risk of ectopic pregnancy (where a fertilized egg implants outside the uterus), and tubal factor infertility.
Obstacles to Diagnosis and Effective Treatment
Diagnosing Mycoplasma genitalium presents challenges, contributing to its potential for long-term persistence. Unlike some other STIs, widely available, FDA-approved commercial tests for MG have been limited. While nucleic acid amplification tests (NAATs) are the preferred diagnostic method, their widespread availability and routine use have been limited, making it difficult for individuals to get tested.
A major obstacle in managing MG is the growing problem of antibiotic resistance. MG has developed resistance to commonly used antibiotics, especially macrolides like azithromycin, once a primary treatment. This resistance can lead to treatment failures, where the infection is not cleared despite antibiotic use, extending its duration in the body. Moxifloxacin, a fluoroquinolone, is often used as a second-line treatment, but resistance to this drug has also been reported, further complicating effective management.
Importance of Timely Intervention
Addressing Mycoplasma genitalium infections promptly is important for preventing long-term health complications. Early detection and appropriate treatment can significantly reduce the risk of developing conditions such as chronic urethritis or epididymitis in men. Similarly, timely intervention can help prevent the progression to cervicitis, pelvic inflammatory disease, and subsequent risks like infertility or ectopic pregnancy in women.
Prompt treatment also plays a role in controlling the spread of antibiotic-resistant strains of MG. When infections are left untreated or inadequately treated due to resistance, these resistant bacteria can continue to spread, making future infections more challenging to manage. Seeking medical advice for any concerns or symptoms helps mitigate these risks and ensures effective management of Mycoplasma genitalium.