Mycoplasma Genitalium

Mycoplasma genitalium, first identified in 1981, is an STI that causes few, and often no symptoms. This condition can be difficult to diagnose because the signs that point towards this STI also point towards other STIs, such as gonorrhoea and chlamydia. The condition is still not well understood, so much so, a hospital lab test for Mgen was only widely available in 2017. There aren't any obvious symptoms for mycoplasma genitalium, which means that it's vital you seek treatment to cure this infection if your STI test results come back as positive.

An M.genitalium infection is caused by a bacterium of the same name, mycoplasma genitalium. This bacteria infects the urogenital tract in both men and women. In women, it infects the vagina, the uterus (womb) and the Fallopian tubes. Whilst in men, the urethra and the epididymis (sperm-carrying tube) are affected. This bacteria is then spread through the genital tract by having unprotected sex. Bacteria can also spread through sexual contact or any contact with genital fluids.

Although Mgen presents similar symptoms to chlamydia and gonorrhoea, they are caused by infections of different bacteria, namely Chlamydia trachomatis and Neisseria gonorrhoeae.

This is an asymptomatic infection, which means the vast majority of infected individuals will not display any visible mycoplasma genitalium symptoms. In the UK, 7-8 out of 10 men and half to three quarters of women contract Mgen with no symptoms. However, an Mgen infection is one of the main causes of PID (pelvic inflammatory disease) in women and nongonococcal urethritis (NGU), or non-specific urethritis (NSU), in men. Therefore, if you develop one of these conditions it is likely you have an Mgen infection.

Symptoms usually develop 1-3 weeks after initial infection.

Male symptoms

In men, the main symptoms of Mgen include:

• urethritis - inflammation of the urethra, tube that carries urine from the bladder
• dysuria - pain whilst urinating
• pain on ejaculation
• watery or cloudy discharge from the tip of the penis
• proctitis - inflammation of the rectum
• inflammation of the foreskin and penis

Female symptoms

In women, the main symptoms include:

• urethritis - pain on urination, soreness in external genitalia
• increased or atypical vaginal discharge
• spotting - vaginal bleeding between periods
• pain or bleeding during or after intercourse
• cervicitis - inflammation of the cervix
• lower abdominal pain

This infection can be dangerous because it is asymptomatic, and a person may not realise they are infected for some time. Untreated Mycoplasma genitalium can lead to serious long-term health complications, so it is important to undergo STI testing if you have had unprotected sex.

In women, the main complication of an Mgen infection is PID. This is an infection and inflammation of the uterus and Fallopian tubes that can cause lower abdominal pain, pain during or after intercourse, a high temperature and can make you feel quite unwell. It can also cause the Fallopian tubes to become scarred and blocked, sometimes leading to tubal infertility.

The main complication of Mgen in men is a condition called epididymo-orchitis. This is where the testicles and the epididymis become infected and swollen. It has been suggested it can lead to infertility in men, but the link is not yet clear. Both men and women can also develop SARA (sexually acquired reactive arthritis). This is a type of arthritis caused by immune complexes, the antibodies that fight infection, being deposited in your joints.

Pregnancy

Not much is known about Mgen complications in pregnant women, however it has been linked to preterm birth, miscarriage and potential transmission to the baby on delivery. It is still not clear whether you can transmit Mgen to your baby in the uterus or whether this would harm your baby. Nevertheless, it’s important you let your midwife know if you test positive for an STI. You should equally inform your sexual health provider if you think you may be pregnant. This will also affect the treatment you are offered.

Unfortunately, isolation and detection of Mycoplasma genitalium can be difficult. It usually can be detected by laboratory tests performed on vaginal swabs or urine samples from men. This involves a specific laboratory test called nucleic acid amplification tests (NAATs). They are usually used to detect viruses or bacteria that act as pathogens. The tests detect and amplify genetic material rather than antigens or antibodies, meaning they can detect and therefore diagnose conditions much quicker. However due to the low prevalence of M.genitalium, it is not often a routine test offered at sexual health or GUM clinics. However, you will often be tested if you have PID or NGU, or have relevant symptoms as they are both commonly caused by Mgen.

It’s important to remember that the condition is still largely asymptomatic and you should still get tested for STIs regularly if you are sexually active. Fortunately, there are many free and confidential sexual health services in the UK. You can get tested on the NHS through sexual health clinics or genitourinary medicine (GUM) clinics. Alternatively, you can also purchase self-test kits online, from clinics or some pharmacies but you should speak to a healthcare professional beforehand to check whether it's suitable for you.

Mgen is a bacterial infection, so needs to be treated with a course of antibiotics.

We offer Doxycycline antibiotics, which are taken twice a day for seven days in a 100mg dose. Whilst this is a fast-acting and effective treatment for Mycoplasma genitalium, Doxycycline is deemed by medical professionals to be the preferred first-line treatment for this condition.

You may alternatively be prescribed a five-day course of Azithromycin tablets if the infection is found to be resistant to Doxycycline. For the medication to be most effective, you should take two 500mg Azithromycin tablets in a single dose treatment, by which the infection will take seven days to be fully treated.

Treating mycoplasma genitalium with prescription medication keeps you sexually healthy and significantly reduces the chances of this infection spreading. Treating this STI correctly also ensures that you can treat the uncomfortable or painful symptoms associated with it, including pain whilst urinating and itchiness.

Antimicrobial Resistance

Treatment guidelines for Mycoplasma genitalium have been changing over the past couple of years as it has become resistant to common treatments. It used to be treated with a single dose of azithromycin, however mutations of the bacterium have meant it has become resistant to some classes of antibiotics. These mutations have caused macrolide resistance, which includes antibiotics such as erythromycin, azithromycin and clarithromycin, and fluoroquinolone resistance, which includes antibiotics such as moxifloxacin. Mycoplasma bacteria are particularly resistant to antibiotics due to their microbiology (cell structure). Mycoplasmas lack a cell wall around their cell membranes, which makes them resistant to antibiotics that target cell wall synthesis.

Antibiotic resistance often occurs when people do not finish the full course of antibiotics or when antibiotics are overprescribed. It can lead to treatment failure, longer hospital stays as well as increased risk of mortality in the most severe conditions. The laboratory will test samples of Mgen for resistance, when people are tested for it.

Like other infectious diseases, preventing the spread of STIs is paramount. There are a number of methods that you can follow to successfully prevent contracting and spreading mycoplasma genitalium, as well as other STIs:

• use barrier contraceptives such as condoms (male or female) during sex
• get tested regularly for STIs, especially after completing a course of STI treatment, to ensure that it has completely cleared
• minimise the number of sexual partners you have to prevent the spread of this infection
• avoid sharing sex toys with sexual partners, if you do, ensure that they are cleaned thoroughly and covered with a fresh condom
• If you have a new sexual partner, regardless of gender, it’s important that you both get checked. Mgen and some other STIs are largely asymptomatic so it’s impossible to know without getting tested.

You can buy Doxycycline and Azithromycin oral tablets here at euroClinix to successfully treat this STI and relieve any uncomfortable symptoms caused by it. You will need to complete an online consultation, which is brief, confidential and free. This is an essential part of the process because it is assessed by one of our doctors, who will ensure that the medication is safe for you to use. Once this has been determined, a prescription will be issued, which will then be dispensed from our UK pharmacy with free next-day delivery.