What you should know about mycoplasma genitalium

Mycoplasma genitalium may not be as well known as other sexually-transmitted infections, but it’s no less concerning and requires expert treatment.

Here to tell us all about is leading London GP Dr Wayne Cottrell. He discusses just what this condition is in further detail, how it’s different from chlamydia and what can happen if it’s left untreated, alongside other essential information, in this comprehensive article.   

What is mycoplasma genitalium and how is it transmitted? 

Mycoplasma genitalium is a bacterium that can be passed on by sexual contact. It's one of the smallest bacteria known that can self-replicate, and unlike chlamydia it doesn't have a cell wall of a specific shape. 

There are many different species of mycoplasma but mycoplasma genitalium specifically infects the genital tract of both men and women, and is therefore classed as a sexually transmitted infection.

How different is mycoplasma genitalium from chlamydia? 

Chlamydia on the other hand, is a gram-negative bacterium and an intracellular parasite that hijacks the host cell to help it replicate. Chlamydia has a cell wall and is therefore susceptible to antibiotics that attack the cell wall. Therefore, mycoplasma genitalium is harder to treat than chlamydia and has high levels of resistance. 

Does mycoplasma genitalium have symptoms? What can happen if it is left untreated?

In men the majority of symptoms are asymptomatic, so there's no sign that you have the infection. If you do have signs, these could range from:

• Urethritis, so irritation in the urethra;
• Penile irritation;
• Sometimes burning while urinating;
• In severe cases it can also lead to penile discharge. 

In women, the majority of symptoms are asymptomatic. If they're going to get symptoms there may be:

• Stinging on urination;
• Post coital bleeding and;
• Sometimes intermenstrual bleeding is also possible in women. 

The complications of mycoplasma genitalium can cause sexually-acquired reactive arthritis both in men and women. In men you can also get epididymo-orchitis which is an infection or inflammation of the testes, and the cords leading down to the testes. 

In women it can cause pelvic inflammatory disease. There's also a possible link with tubal factor infertility, and pre-term delivery. 

What does treatment for mycoplasma genitalium involve? Can mycoplasma genitalium be antibiotic-resistant?

Treatment for mycoplasma genitalium, because of the known resistance it's really important to test all specimens that are positive for it to check the resistance profile, and see if there's macrolide resistance or not. 

In most people the treatment will consist of two sets of antibiotics; doxycycline, followed by a course of azithromycin depending on the resistance test. Obviously, there are different treatment regimens possible for people who are allergic, or can't take this combination of medication. 

It's vital that partners abstain from sexual intercourse at least 14 days after the start of treatment. It's also essential that we do a test to ensure that the antibodies have worked, and that the bacteria have been successfully eradicated in both partners.   

What steps can people take to protect themselves from reinfection? 

In terms of protecting oneself from mycoplasma genitalium, this is quite difficult as it doesn't have many symptoms so people don't always know they have the infection. It's always recommended to screen yourself for sexually transmitted diseases before you embark on a new sexual relationship, if that's possible. In terms of protecting yourself specifically from mycoplasma genitalium, barrier protection such as condoms will provide some level of protection. 

If you’re concerned you may have mycoplasma genitalium or would like to arrange GP appointment regarding sexual health services for men, women and the LGBTQIA community, visit Dr Cottrell’s Top Doctors profile.