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By: RSC Editorial Team

January 5, 2022

Guide to Mycoplasma Genitalium Testing, Symptoms, and Treatment

Mycoplasma genitalium, or MG, is a common STD responsible for a wide range of varying symptoms in both men and women. Because Mycoplasma genitalium is so prevalent, many doctors assume that their patients have MG simply based on symptoms and thus treat for it without testing.

For example, if a patient suffers from cervicitis or urethritis and their healthcare provider rules out gonorrhea and chlamydia, they may receive presumptive treatment for MG since it’s very likely that their symptoms result from Mycoplasma genitalium infection. A rapid STD test can help rule out other common STDs.

So what does MG look like, and how does Mycoplasma genitalium testing work?

What Is Mycoplasma Genitalium?

M. genitalium is a small, pathogenic, sexually transmitted bacteria that can lead to an STD. MG typically lives and multiplies in human mucous epithelial cells in the genital and urinary tract.

Although health care providers don’t often diagnose MG, various studies show that over 1 in 100 adults may harbor this sneaky bacteria.

Some details of M. genitalium’s life cycle and spreading mechanism remain partially unclear to science. However, doctors do know that these bacteria pass through bodily secretions, similar to gonorrhea and chlamydia. They do not spread across the patient’s skin like HPV and herpes.

You can contract MG through:

  • Unprotected vaginal, anal, or oral sex
  • Sexual touching and rubbing
  • Sharing sex toys with an infected person

Scientists first isolated Mycoplasma genitalium in 1981 and in 1983 identified the new urogenital bacteria as a species of Mycoplasma. In 1995, researchers mapped out the full genome sequence of M. genitalium.

In recent years, medical reports point out that M. genitalium is becoming increasingly common, most likely due to resistance to antibiotics such as azithromycin. According to the CDC, up to 30% of females with clinical cervicitis and up to 40% of males with recurring or persistent urethritis may have MG.

The comparatively late discovery and lack of total clarity about M. genitalium’s mode of spreading stem from this bacterium’s characteristics. MG grows slowly and is difficult to detect and isolate in clinical specimens. Moreover, since mycoplasma has no cell wall, it resists widely used antibiotics that target bacterial cell wall synthesis.

The challenge of testing, nonspecific and inconsistent infection symptoms, and macrolide resistance have lately placed M. genitalium high on CDC’s list of public health concerns.

Mycoplasma Genitalium Symptoms

One of the problems with diagnosing an M. genitalium infection is lack of consistent symptoms. Asymptomatic individuals can pass MG to their sexual partners without even knowing it. Mycoplasma genitalium can live and multiply in your system undetected for a long time, while you and your partner mistakenly consider yourselves safe.

The symptoms of MG vary between men and women. Men with MG may experience:

  • Watery urethral discharge
  • Urethral swelling and pain
  • A painful, burning, or stinging sensation while urinating

In women, MG symptoms may incude:

  • Pain during intercourse
  • Bleeding after intercourse
  • Mid-cycle spotting
  • Pelvic pain

As you see, these symptoms are nonspecific and can present in a whole range of different conditions, from UTI to hormonal disruptions. At most, they can indicate that you have contracted some type of infection.

A diagnosis may become even more complicated if you are unlucky enough to contract more than one STD at once. For example, a quick STD test may reveal that you have chlamydia, after which your health care provider would prescribe an antibiotic treatment course. But if you have MG as well as chlamydia and if your M. genitalium infection resists antibiotics, your symptoms may recur after a while.

Unlike gonorrhea and chlamydia, M. genitalium rarely causes flu-like symptoms such as diarrhea. If you’re suffering from bowel movement disruptions and have ruled out other reasons, one of several common STDs may be the culprit. Learn about STDs that cause diarrhea.

Not sure whether what you’re experiencing fits the description of MG or another STD? Learn the most common signs and symptoms of STD.

How Do You Test for Mycoplasma Genitalium?

Although targeted FDA-approved Mycoplasma genitalium testing is beginning to emerge, providing a definite MG diagnosis is still a challenge. Culture tests don’t work with MG because of the slow-growth nature of M. genitalium. Without a clear diagnosis, treatment of persistent cervicitis or urethritis may prove ineffective or, in some cases, may even lead to higher bacterial resistance.

Often, health care providers will first rule out other STDs, like gonorrhea and chlamydia. If the patient’s symptoms indicate MG testing, their health care provider will usually recommend a NAAT (Nucleic Acid Amplification Test).

NAAT tests use a sample of the patient’s urine, a urethral or vaginal swab, or an endometrial biopsy, to locate the genetic material of M. genitalium. NAAT employs the PCR (Polymerase Chain Reaction) technology to facilitate detection. NAAT usually returns an accurate result within 24-48 hours.

The main drawback of NAAT Mycoplasma genitalium testing is a certain percentage of false-negative results. To avoid this, a diagnosis should include both a Mycoplasma genitalium urine test and a test based on a urethral, vaginal, or cervical swab. This practice helps prevent errors and doubles the chance of correct diagnosis.

Samples that test positive for M. genitalium in a NAAT should also undergo testing for macrolide resistance mutations. Macrolide resistance testing can help avoid treatment failures that result from resistance to antibiotics like azithromycin and second-line antimicrobials such as fluoroquinolone.

Complications From Mycoplasma Genitalium

Without proper Mycoplasma genitalium testing and treatment, M. genitalium can lead to a range of serious complications in both men and women. In men, M. genitalium can cause orchitis (testicular inflammation), epididymitis (inflammation of the tubes that carry sperm), or combined epididymo-orchitis. This type of infection is not just very painful, but may increase the risk of male infertility.

In women, MG complications can lead to PID (Pelvic Inflammatory Disease). This occurs when M. genitalium spreads across the female reproductive system. Several meta-analysis studies confirm the association between MG, cervicitis, and PID with all its associated complications. 

PID can cause persistent pelvic pain, difficulties in conceiving, a higher risk of ectopic pregnancy, and female infertility. If the fallopian tubes become infected, they can no longer transport eggs. In other cases, the fallopian tubes may become blocked due to scarring.

It’s important to note that PID may also occur due to other undiagnosed and untreated STDs, such as chlamydia or gonorrhea.

Pregnant women may experience even more serious adverse effects from an M. genitalium infection. MG may lead to miscarriage, stillbirth, or premature birth. M. genitalium may also pass to babies of infected mothers during birth, leading to dangerous complications in newborns.

Not all antibiotics used to treat M. genitalium are safe to use during pregnancy. If you are pregnant and test positive for MG, your health care provider can help you choose a safe treatment course.

Finally, health authorities believe that individuals with M. genitalium are more susceptible to other types of STIs like HIV.

Mycoplasma Genitalium Treatment and Prevention

Sexually active individuals have a higher risk of contracting M. genitalium if they:

  • Frequently change sexual partners
  • Engage in unprotected sex or sexual contact, even without penetration
  • Tested positive for other sexually transmitted infections
  • Have a partner who tested positive for MG

Fortunately, it appears that MG does not spread as easily as other types of pathogens, such as herpes for example. There is currently no evidence of people who have contracted M. genitalium through kissing, sharing eating or drinking utensils, or using the same toilet seat as an infected person.

Although no type of protection is bulletproof, condoms confer a very high degree of protection against MG. If you and your partner wish to stop using condoms, e.g. because you are in a long-term monogamous relationship or because you are planning a pregnancy, you should both get tested and have an open and honest conversation about your sexual health.

It's important to keep in mind that MG can remain under wraps for many months, possibly years. If one of you tests positive, it doesn’t mean you or your partner cheated or knowingly concealed the infection.

So what happens if you contract MG? The CDC recommends a two-stage therapy approach, ideally starting with macrolide resistance testing and followed by resistance-guided therapy, which has success rates of over 90%.

If resistance testing is available and the M. genitalium strain proves macrolide sensitive, the infection usually responds well to a 100 mg dose of doxycycline orally twice a day for 7 days, after which the patient will receive a 1-gr dose of azithromycin orally and three more 500 mg oral doses of azithromycin for three subsequent days.

If the MG strain is macrolide-resistant, the health care provider will follow doxycycline treatment with a 400-mg oral dose of moxifloxacin for 7 days.

In cases where resistance testing is unavailable, the infected person will undergo a treatment course of doxycycline and moxifloxacin as if they have contracted a macrolide-resistant strain.

If your Mycoplasma genitalium testing reveals an infection, your sexual partner should also get tested for M. genitalium and, if appropriate, undergo treatment to minimize the risk of re-infection for both of you.

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By: RSC Editorial Team
January 5, 2022

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