Mycoplasma genitalium infection is a potential cause of urethritis in men, cervicitis in women, and pelvic inflammatory disease. The prevalence rates of M. genitalium infection in the population of some countries such as New Zealand are unknown, but there is evidence that rates may be as high as chlamydia in some groups. Routine investigation for M.genitalium infection is not recommended, but testing may be indicated for patients with persistent urethritis or cervicitis, or severe pelvic inflammatory disease. Antibiotic treatment of M. genitalium infection depends on macrolide sensitivity and previous treatments.
Relationship between Mycoplasma Genitalium Infection, Urethritis, Cervicitis and Pelvic Inflammatory Disease
M. genitalium was first described in the 1980s and is increasingly recognized as an important cause of sexually transmitted urogenital and rectal infections. M. genitalium is extremely difficult to culture, takes weeks or months, limiting its detection in diagnostic settings. It can now be detected using the nucleic acid amplification test (NAAT), which is more commonly found in diagnostic laboratories in New Zealand.
The natural history of M. genitalium infection is not fully understood, but it is estimated to cause 15-30% cases of urethritis in men and less commonly cervicitis and pelvic inflammatory disease in women. M. genitalium is often found with other bacterial STIs such as chlamydia or trichomoniasis.
The population prevalence of M. genitalium infection in New Zealand is unknown, as the Institute for Environmental Sciences and Research (ESR) has not collected data on this STI. In studies conducted in Auckland and Northland, M. genitalium was detected in up to 10% of patients with urethritis or pelvic inflammatory disease. There are no national M.genitalium infection management guidelines available, as laboratory approval and resistance testing vary by region. However, testing and treatment recommendations are expected to be included in the next update of the New Zealand Sexual Health Association guidelines.
Routine Tests Not Recommended For Asymptomatic Mycoplasma Genitalium Infection
Although M.genitalium can cause urethritis, cervicitis, or pelvic inflammatory disease, the evidence suggests that most people with M.genitalium infection are asymptomatic and do not develop complications. 6 Therefore, routine testing for M. genitalium infection in asymptomatic persons is not recommended in international guidelines.
Patients with persistent urethritis or cervicitis or severe pelvic inflammatory disease, i.e. those who have been treated for these conditions and do not respond despite adhering to the prescribed regimen, should be discussed with or referred to a sexual health practitioner or discussed with a clinic. Microbiologist to advise on whether testing is appropriate for M.genitalium infection. Sexual contacts of a person with a confirmed M.genitalium infection may also need to be treated and tested.
NAAT is the preferred method for detecting M. genitalium from a first empty urine sample (males), a vulvovaginal swab (females), or a rectal swab. If possible, additional tests for macrolide resistance may be used to guide appropriate antimicrobial therapy.
Treatment of M. Genitalium Infection
Some treatment methods may be preferred when treating M. genitalium infection. These treatment options are as follows;
Macrolide Resistance Is Common
M. genitalium does not have a cell wall, so penicillins or cephalosporins that target cell wall synthesis are not effective treatments. Macrolides, for example azithromycin, are often very effective in treating M.genitalium infection, although resistance is common. Studies in New Zealand have found that 72-77% of M.genitalium samples are resistant to macrolides and 23% to fluoroquinolones. In addition, treatment of a macrolide-sensitive M. genitalium infection with azithromycin results in treatment failure and the development of macrolide resistance in approximately 10% of cases.
Patients with confirmed M.genitalium infection or those with an approved M.genitalium infection should be consulted or referred to a sexual health physician or discussed with a clinical microbiologist before starting treatment. The recommended treatment regimen for people with confirmed M.genitalium infection depends on the current situation, whether the infection is susceptible to macrolide, and previous antibiotic treatments given for the infection. Persistent urethritis is the most common manifestation of M. genitalium infection seen in primary care. The treatment regimen recommended in Australian and British guidelines is as follows:
• Doxycycline (to reduce the bacterial load); followed by one of the following:
• Azithromycin (if macrolide sensitive or resistance unknown); or
Moxifloxacin * (if macrolide resistant or azithromycin treatment failed)
If M.genitalium infection is confirmed and less than two weeks have passed since the patient completed the course of doxycycline, a repeat course is not required. 1 Doxycycline alone cures only a third of M. genitalium infections. For patients presenting with persistent cervicitis or severe pelvic inflammatory disease, a similar regimen is likely to be appropriate. A cure test is recommended at least two weeks after completing treatment. Unconfirmed indicator. Moxifloxacin can be fully subsidized for the treatment of M. genitalium infection with the approval of the Special Authority.
https://www.bashhguidelines.org/media/1198/mg-2018.pdf (Accessed April 2019)
Author: Ozlem Guvenc Agaoglu