Mycoplasma genitalium, often referred to as Mgen, is a sexually transmitted infection (STI) caused by a very small bacterium. This infection can affect the urinary and genital tracts, including the cervix, urethra, and rectum. Mgen is transmitted through sexual contact. Timely and effective treatment is important to address the infection and prevent potential complications. This article provides guidance on recognizing, diagnosing, and treating Mycoplasma genitalium.
Recognizing the Signs
Many individuals infected with Mycoplasma genitalium experience no symptoms. When symptoms do appear, they are often similar to those of other common STIs like chlamydia or gonorrhea, which can sometimes lead to diagnostic challenges.
In men, symptoms can include urethritis, characterized by pain during urination, burning or itching in the urethra, or a watery discharge from the penis. Some men might also experience pain in their testicles. For women, signs include cervicitis, which may manifest as unusual vaginal discharge, bleeding between periods, or bleeding after sex. Women may also experience lower abdominal or pelvic pain, pain during sex, or discomfort when urinating. If the infection affects the rectum, individuals of any gender might notice anal pain or discharge.
Getting a Diagnosis
Diagnosing Mycoplasma genitalium typically involves specific laboratory tests, as the bacterium is difficult to culture in a lab setting. Nucleic Acid Amplification Tests (NAATs) are the standard and most accurate method for detection. These tests work by identifying the bacterium’s genetic material.
Samples for NAATs can be collected from various sites depending on the individual’s anatomy and symptoms. For men, a first-void urine sample is commonly used. For women, vaginal or cervical swabs are preferred, though urine samples can also be collected. If there are rectal symptoms or history of anal sex, an anal swab may be collected.
Effective Treatment Strategies
Treatment for Mycoplasma genitalium primarily involves antibiotics, but increasing resistance makes the approach complex. A two-step strategy is often recommended, especially in areas with high resistance rates. The initial step typically involves a seven-day course of doxycycline to reduce the bacterial load.
Following doxycycline, the second step depends on whether the infection is macrolide-susceptible or resistant. For macrolide-susceptible infections, an extended course of azithromycin is often prescribed (e.g., 1 gram on day one followed by 500 mg daily for three days). If the infection is macrolide-resistant, or if azithromycin treatment has failed, moxifloxacin (400 mg daily for 7-14 days) is typically used. Resistance to both azithromycin and moxifloxacin is a growing global concern.
Resistance testing, which identifies specific genetic mutations, can help guide treatment decisions and improve cure rates. Adhering to the full antibiotic regimen helps ensure eradication and minimize further resistance. Sexual partners of an infected individual should also be tested and treated, even if asymptomatic, to prevent reinfection and spread.
After Treatment Care and Prevention
After completing antibiotic treatment, a “test of cure” (TOC) is often recommended to confirm eradication. This test is usually performed 3 to 4 weeks after the last dose of medication to avoid false positive results from lingering bacterial genetic material. If initial treatment fails and the test of cure remains positive, alternative antibiotic regimens may be necessary, and a healthcare provider may consult with an infectious disease specialist.
Preventing future Mycoplasma genitalium infections involves practicing safer sex. Consistent and correct use of condoms during vaginal and anal sex significantly reduces transmission risk. Open communication with sexual partners about STI status and practicing mutual monogamy also contribute to prevention. Regular STI screening, especially for sexually active individuals or those with new partners, is a practical step in maintaining sexual health.