Mycoplasmas are the smallest free-living microorganisms. In the urogenital tract, the relevant species are M. genitalium, Ureaplasma urealyticum, U. parvum and M. hominis. Mycoplasma genitalium infection contributes to 10–35% of non-chlamydial non-gonococcal urethritis in men. In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID).
Transmission of M. genitalium occurs through direct mucosal contact. Asymptomatic infections are frequent. This organism has the smallest genome known for any free-living micro-organism, grows very slowly, and cannot be readily detected by culture.
• Mycoplasma genitalium is a sexually transmissible infection caused by bacteria M. genitalium. Both men and women can become infected.
• In men, Mycoplasma can infect the inside lining of the penis (urethra).
• In women, Mycoplasma can infect the neck of the womb (cervix) and possibly the womb (uterus) itself and fallopian tubes.
How is it transmitted?
Mycoplasma can be passed from one person to another during vaginal sexual intercourse or foreplay (genital touching or rubbing).
Are there any symptoms?
Men might notice
• Discharge from the penis
• Burning pain or irritation when urinating
Women might notice
• Unusual vaginal discharge
• Pain during sex
• Bleeding after sex and between periods
• Lower pelvic pain
Some women and men may have NO symptoms.
Recommended treatment for uncomplicated M. genitalium infection in the absence of macrolide resistance mediating mutations
• Azithromycin 500 mg on day one, then 250 mg od days 2–5 (oral).
• Josamycin 500 mg three times daily for 10 days.
Recommended treatment for uncomplicated macrolide resistant M. genitalium infection
• Moxifloxacin 400 mg od for 7–10 days (oral). The optimal duration of treatment is uncertain and a few observational studies have found higher cure rate after longer treatment in cervicitis.
Recommended second-line treatment for uncomplicated persistent M. genitalium infection
• Moxifloxacin 400 mg od for 7–10 days (oral).
Recommended third-line treatment for persistent M. genitalium infection after azithromycin and moxifloxacin
• Doxycycline 100 mg two times daily for 14 days can be tried and will eradicate M. genitalium from approximately 30% of the patients, but the patient must be informed about the poor eradication rate and accept to comply with advice regarding sexual abstinence or condom use.
• Pristinamycin 1 g four times daily for 10 days (oral). The patient should be informed about the need to comply strictly with the dosage scheme.
Recommended treatment for complicated M. genitalium infection (PID, epididymitis)
• Moxifloxacin 400 mg od for 14 days (oral).
Information, explanation and advice for the patient
• Patients with M. genitalium infection should be advised to abstain from unprotected sexual contact until they and their partners have completed treatment, their symptoms have resolved, and their test of cure (TOC) is negative.
• Patients with M. genitalium infection (and their sexual contacts) should be given information about the infection, including details about transmission, prevention and complications. It is recommended that both verbal and written information be provided.
• Patients with anal infection including MSM should be informed about the risk of transmission from this site and that the infection may be more difficult to eradicate. Consequently, a TOC is important.
• M. genitalium infections during pregnancy may be associated with a modest increase in the risk of spontaneous abortion and preterm birth. In macrolide susceptible infections, a 5-day-course of azithromycin is generally acceptable.
The choice of drugs for macrolide-resistant infections is difficult, and risk associated with treatment with the available antibiotics may outweigh the risk of adverse pregnancy outcome.
Thus, treatment, especially in women with infection with a macrolide-resistant M. genitalium strain, may be considered postponed until after delivery. Pristinamycin is considered safe in pregnancy and may be considered in symptomatic women after consultation with an experienced microbiologist. Although little is known about transmission during birth, the neonate should be observed for signs of infection, primarily conjunctivitis and respiratory tract infection
When can I have unprotected sex again?
• A negative test after 1 month indicates you have cleared the infection. Avoid unprotected sex until your repeat test is negative.
• Until this second test is negative, use condoms 100% of the time, or don’t have sex at all.
• If the repeat test is positive again, you will need more treatment.
• However, use condoms with all new and casual partners or you can be reinfected with Mycoplasma.