Some names are more well-known than others in the realm of sexually transmitted infections (STIs). However, lesser-known pathogens can be just as significant, if not more so, regarding their impact on health. One such pathogen is Mycoplasma genitalium. Though it may not have the name recognition of chlamydia or gonorrhea, this bacterium has been increasingly recognized as a serious STI that warrants attention.

Understanding Mycoplasma Genitalium

Mycoplasma genitalium (M. genitalium) is a small bacterium that can infect the urogenital tract, leading to various health complications. Discovered in the 1980s, this microorganism has slowly gained recognition as a sexually transmitted pathogen. Despite its small size, M. genitalium has a significant impact on sexual health, often being linked to conditions such as urethritis, cervicitis, pelvic inflammatory disease (PID), and even infertility.

Unlike many other bacteria, M. genitalium lacks a cell wall, so it is naturally resistant to antibiotics like penicillin that interfere with forming cell walls. This characteristic complicates treatment options and underscores the importance of accurate diagnosis and tailored therapies.

The Symptoms of Mycoplasma Genitalium

The tricky aspect of Mycoplasma genitalium infections is that they are often asymptomatic. This means many infected people may not experience noticeable symptoms, allowing the bacterium to persist and be transmitted unknowingly. However, when symptoms do present, they can vary between men and women.

Symptoms in Men

In men, Mycoplasma genitalium is primarily associated with urethritis, an inflammation of the urethra. Symptoms can include:

• Painful urination (dysuria): A burning sensation during urination is a common sign of urethritis.
• Penile discharge: A clear or cloudy discharge from the penis may occur, often signaling an infection.
• Testicular pain: Though less common, some men may experience discomfort or pain in the testicles.
• Urethral discomfort: Persistent irritation or itching in the urethra can be a symptom of M. genitalium.

It’s important to note that these symptoms can overlap with those of other STIs, such as chlamydia and gonorrhea, making it essential to seek accurate diagnosis and treatment.

Symptoms in Women

For women, the symptoms of Mycoplasma genitalium can be more varied and may include:

• Vaginal discharge: An abnormal discharge, mainly if it is yellow or greenish, could indicate an infection.
• Pain during intercourse (dyspareunia): Some women may experience discomfort or pain during sexual activity.
• Pelvic pain: Lower abdominal or pelvic pain that doesn’t go away could indicate pelvic inflammatory disease (PID), a severe side effect of untreated M. genitalia.
• Painful urination: Like men, women may also experience a burning sensation during urination.
• Cervical inflammation (cervicitis): Inflammation of the cervix can lead to bleeding after intercourse or between menstrual periods.

It is worth emphasizing that many women with Mycoplasma genitalium infection may not exhibit any symptoms, leading to potential long-term complications if left untreated.

Complications of Untreated Mycoplasma Genitalium

While the symptoms of Mycoplasma genitalium can be uncomfortable, the complications of untreated infections are far more concerning. In men, untreated M. genitalium can lead to chronic urethritis, which may cause scarring and stricture formation in the urethra. This can lead to long-term discomfort and difficulties with urination.

In women, the potential complications are even more severe. Untreated Mycoplasma genitalium infections have been linked to:

• Pelvic Inflammatory Disease (PID): PID is a severe infection of the female reproductive organs. It may result in infertility, ectopic pregnancy, and chronic pelvic pain.
• Adverse Pregnancy Outcomes: Infections during pregnancy have been linked to a higher likelihood of miscarriage, lower birth weight, and premature birth.
• Infertility: Chronic inflammation and scarring of the reproductive organs can lead to infertility, making it crucial for women of childbearing age to be vigilant about their sexual health.

Given these potential complications, it’s clear that early detection and appropriate treatment of Mycoplasma genitalium are essential.

Testing Options for Mycoplasma genitalium

Given the often asymptomatic nature of M. genitalium infections, testing is a critical tool in managing this STI. However, testing for Mycoplasma genitalium is not as straightforward as it is for other STIs.

Nucleic Acid Amplification Tests (NAATs)

The gold standard for diagnosing Mycoplasma genitalium is the Nucleic Acid Amplification Test (NAAT). NAATs detect the bacterium’s genetic material (DNA or RNA), making them highly sensitive and specific.

Urethral or Cervical Swabs: For men, a swab from the urethra is typically used, while for women, a cervical swab is often collected. These samples are then tested for the presence of M. genitalium DNA.

Urine Samples: Sometimes, a first-catch urine sample can be used instead of a swab, particularly in men. This non-invasive option is more comfortable for patients but may be slightly less sensitive.

One of the challenges with NAATs is that only some laboratories offer this specific test for Mycoplasma genitalium, meaning it may only be available in some healthcare settings. As a result, healthcare providers must sometimes send samples to specialized labs, potentially delaying diagnosis.

Resistance Testing

As previously mentioned, Mycoplasma genitalium resists certain antibiotics, making treatment more complicated. Resistance testing has recently become essential to managing M. genitalium infections.

Resistance testing involves identifying whether the strain of M. genitalium is resistant to macrolides, which is the first-line treatment for this infection. If resistance is detected, alternative antibiotics, such as doxycycline or moxifloxacin, may be required.

This type of testing is essential because the overuse of antibiotics has increased rates of antibiotic-resistant strains of Mycoplasma genitalium. Tailoring treatment based on resistance patterns is crucial in effectively managing the infection and preventing the spread of resistant strains.

Who Should Get Tested?

Testing for Mycoplasma genitalium is recommended in several scenarios:

• Symptomatic Individuals: Anyone experiencing symptoms suggestive of an STI, such as urethritis, cervicitis, or pelvic pain, should consider getting tested.
• Sexual Contacts: If you have been notified that a sexual partner has tested positive for Mycoplasma genitalium, you should be tested, even if you do not have symptoms.
• Persistent Infections: If you have been treated for urethritis or cervicitis but symptoms persist, testing for M. genitalium may be warranted to identify a potential cause that has not responded to standard treatment.
• High-Risk Populations: Individuals with multiple sexual partners, those who engage in unprotected sex, or those with a history of other STIs should discuss testing options with their healthcare provider.

Steps to Take to Get Tested

To get tested for Mycoplasma genitalium, individuals can follow these steps:

• Consult a Healthcare Provider

The first step is to consult a medical expert, such as a general practitioner, gynecologist, urologist, or specialist at a sexual health clinic. They can assess your symptoms and risk factors and determine if testing for Mycoplasma genitalium is appropriate.

• Discuss Symptoms and Sexual History

During the consultation, be open about any symptoms you’re experiencing, such as painful urination, unusual discharge, or pelvic pain. Additionally, provide a detailed sexual history, including recent sexual partners and any unprotected sexual encounters, which can help the provider decide if testing is needed.

• Get the Appropriate Test

The healthcare provider may order a Nucleic Acid Amplification Test (NAAT), the most reliable method for detecting Mycoplasma genitalium. Depending on the situation, the provider may collect:

Urethral or Cervical Swab: A sample taken from the urethra in men or the cervix in women.

Urine Sample: A first-catch urine sample may be requested as a non-invasive alternative, particularly for men.

• Consider Resistance Testing

If Mycoplasma genitalium is detected, your healthcare provider may recommend resistance testing to determine if the strain is resistant to common antibiotics like azithromycin. This will guide the most effective treatment.

• Follow Up on Results

When the test findings are ready, the medical professional will review them with you. If the test is positive, they will discuss the appropriate treatment plan, including any necessary antibiotic therapy.

• Inform Sexual Partners

If you test positive for Mycoplasma genitalium, it’s essential to inform any recent sexual partners so they can also get tested and treated if necessary. This aids in stopping the virus from spreading.

• Complete the Treatment

Follow the prescribed treatment plan thoroughly, taking all medications as directed. Take the entire course of treatment—even if your symptoms go away before you finish it—to ensure the infection is thoroughly treated and reduce the likelihood of antibiotic resistance.

• Schedule a Follow-Up

After completing treatment, consider scheduling a follow-up appointment to ensure the infection has been eradicated. Sometimes, a test-of-cure might be recommended to confirm that the infection is gone.

Treatment Options for Mycoplasma genitalium

Treatment of Mycoplasma genitalium requires careful consideration of antibiotic resistance patterns. The first-line treatment has traditionally been a course of azithromycin, a macrolide antibiotic. However, due to increasing resistance, this may only sometimes be effective.

If macrolide resistance is detected, alternative treatments include:

Doxycycline: While doxycycline is not as effective as azithromycin as a first-line treatment, it is often used with other antibiotics.

Moxifloxacin: This fluoroquinolone antibiotic has shown effectiveness against resistant strains of M. genitalium. However, it is typically reserved for cases where other treatments have failed due to concerns about side effects and the potential for further resistance.

Patients must complete the course of antibiotics as prescribed, even if symptoms resolve before the medication is finished. This lowers the possibility of antibiotic-resistant strains emerging and helps guarantee the infection is completely eradicated.

Here’s a table outlining the estimated costs of testing and treating Mycoplasma genitalium. Please note that expenses might differ depending on your location, the healthcare provider, and your health insurance coverage.

Service	Estimated Cost (USD)	Notes
Initial Consultation with Healthcare Provider	$50 – $200	Costs differ based on geography and service. Telehealth consultations may be cheaper.
Nucleic Acid Amplification Test (NAAT)	$100 – $300	This is the most common and reliable test for detecting Mycoplasma genitalium.
Urine Sample Testing	$50 – $150	A non-invasive testing option, sometimes used in conjunction with a swab test.
Swab Test (Urethral/Cervical)	$75 – $200	Often used alongside NAAT for accurate detection.
Resistance Testing	$150 – $400	Additional testing to determine antibiotic resistance.
Azithromycin (Antibiotic)	$20 – $50	First-line treatment for Mycoplasma genitalium. Price can vary depending on the generic or brand name.
Doxycycline (Antibiotic)	$10 – $30	Alternative antibiotic treatment. Usually cheaper than azithromycin.
Moxifloxacin (Antibiotic)	$50 – $150	Used if the infection is resistant to macrolides.
Follow-Up Consultation	$50 – $200	Follow-up visit to ensure the infection is cleared.
Test-of-Cure (NAAT)	$100 – $300	Optional follow-up test to confirm the infection is cleared after treatment.

Total Estimated Costs

• Without Resistance Testing: $375 – $1,180
• With Resistance Testing: $525 – $1,580

Health insurance coverage can significantly lower these costs, and some clinics may offer sliding scale fees based on income. It’s also important to check if local health departments offer free or low-cost STI testing and treatment services.

Preventing Mycoplasma genitalium Infection

Prevention is always better than cure, and this adage holds for Mycoplasma genitalium. To reduce the risk of infection:

• Use Condoms: Condoms can significantly reduce the risk of contracting or spreading STIs like Mycoplasma genitalium during vaginal, anal, and oral intercourse when used appropriately and regularly.
• Limit Sexual Partners: Cutting back on the number of sexual partners can lessen the chance of coming into contact with an infected person.
• Regular STI Screening: Regular screenings, especially for those with multiple sexual partners or those in high-risk groups, can help detect infections early and prevent complications.

FAQs

What is Mycoplasma genitalium?

It’s a bacterium causing sexually transmitted infections, often with symptoms similar to chlamydia or gonorrhea.

How do I know if I have Mycoplasma genitalium?

Symptoms include painful urination, discharge, and pelvic pain, but testing is the only way to confirm.

What are the testing options?

The primary test is a Nucleic Acid Amplification Test (NAAT) using a urine sample or a swab.

Is Mycoplasma genitalium treatable?

Yes, but treatment may require specific antibiotics depending on resistance patterns.

How much does testing and treatment cost?

Costs can vary from $375 to $1,580, with factors like resistance testing affecting the total.

Resources

Information about Mycoplasma genitalium from the Centers for Disease Control and Prevention

American Sexual Health Association: Testing and Treatment Options

World Health Organization (WHO): Sexually Transmitted Infections Information

Conclusion

Despite not being as well known as other STIs, Mycoplasma genitalium has a significant effect on sexual health. With the potential to cause serious complications such as pelvic inflammatory disease and infertility, it is crucial to be aware of the symptoms and seek testing if you are at risk. Accurate diagnosis and appropriate treatment, particularly in the face of increasing antibiotic resistance, are essential in managing this infection and safeguarding long-term health.

People may safeguard their sexual health and stop the spread of this frequently disregarded infection by being aware of the signs, tests, and treatment choices for Mycoplasma genitalium.