Mycoplasma genitalium infection: Difference between revisions

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{{SI}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].'''<br>
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].'''<br>
{{CMG}}; {{AE}} {{DN}}
{{CMG}}; {{AE}} {{DN}} {{Mohamed riad}}


==Overview==
==Overview==
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==Historical Perspective==
==Historical Perspective==
*''Mycoplasma genitalium'' is the 11th ''[[Mycoplasma]]'' species of human origin.<ref name="pmid21734246">{{cite journal |vauthors=Taylor-Robinson D, Jensen JS |title=Mycoplasma genitalium: from Chrysalis to multicolored butterfly |journal=Clin. Microbiol. Rev. |volume=24 |issue=3 |pages=498–514 |year=2011 |pmid=21734246 |pmc=3131060 |doi=10.1128/CMR.00006-11 |url=}}</ref>
*''Mycoplasma genitalium'' is the 11th ''[[Mycoplasma]]'' species of human origin.<ref name="pmid21734246">{{cite journal |vauthors=Taylor-Robinson D, Jensen JS |title=Mycoplasma genitalium: from Chrysalis to multicolored butterfly |journal=Clin. Microbiol. Rev. |volume=24 |issue=3 |pages=498–514 |year=2011 |pmid=21734246 |pmc=3131060 |doi=10.1128/CMR.00006-11 |url=}}</ref>
*In 1980, 13 men were tested for non-gonoccal [[urethritis]] (NGU). ''Mycoplasma genitalium'' was isolated from 2 of those 13 men.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid26975162">{{cite journal |vauthors= |title=Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines |journal=J Miss State Med Assoc |volume=56 |issue=12 |pages=372–5 |year=2015 |pmid=26975162 |doi= |url=}}</ref><ref name="pmid12599082">{{cite journal |vauthors=Manhart LE, Critchlow CW, Holmes KK, Dutro SM, Eschenbach DA, Stevens CE, Totten PA |title=Mucopurulent cervicitis and Mycoplasma genitalium |journal=J. Infect. Dis. |volume=187 |issue=4 |pages=650–7 |year=2003 |pmid=12599082 |doi=10.1086/367992 |url=}}</ref>
*In 1980, 13 men were tested for non-gonoccal [[urethritis]] (NGU). ''Mycoplasma genitalium'' was isolated from 2 of those 13 men.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid26975162">{{cite journal |vauthors= |title=Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines |journal=J Miss State Med Assoc |volume=56 |issue=12 |pages=372–5 |year=2015 |pmid=26975162 |doi= |url=}}</ref><ref name="pmid12599082">{{cite journal |vauthors=Manhart LE, Critchlow CW, Holmes KK, Dutro SM, Eschenbach DA, Stevens CE, Totten PA |title=Mucopurulent cervicitis and Mycoplasma genitalium |journal=J. Infect. Dis. |volume=187 |issue=4 |pages=650–7 |year=2003 |pmid=12599082 |doi=10.1086/367992 |url=}}</ref>
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==Classification==
==Classification==
''Mycoplasma genitalium'' infection can be divided based on the clinical presentation into:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid15295128">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis |journal=Sex Transm Infect |volume=80 |issue=4 |pages=289–93 |year=2004 |pmid=15295128 |pmc=1744873 |doi=10.1136/sti.2003.006817 |url=}}</ref><ref name="pmid7721285">{{cite journal |vauthors=Jensen JS, Orsum R, Dohn B, Uldum S, Worm AM, Lind K |title=Mycoplasma genitalium: a cause of male urethritis? |journal=Genitourin Med |volume=69 |issue=4 |pages=265–9 |year=1993 |pmid=7721285 |pmc=1195084 |doi= |url=}}</ref><ref name="pmid16326846">{{cite journal |vauthors=Anagrius C, Loré B, Jensen JS |title=Mycoplasma genitalium: prevalence, clinical significance, and transmission |journal=Sex Transm Infect |volume=81 |issue=6 |pages=458–62 |year=2005 |pmid=16326846 |pmc=1745067 |doi=10.1136/sti.2004.012062 |url=}}</ref><ref name="pmid17448398">{{cite journal |vauthors=Tosh AK, Van Der Pol B, Fortenberry JD, Williams JA, Katz BP, Batteiger BE, Orr DP |title=Mycoplasma genitalium among adolescent women and their partners |journal=J Adolesc Health |volume=40 |issue=5 |pages=412–7 |year=2007 |pmid=17448398 |pmc=1899169 |doi=10.1016/j.jadohealth.2006.12.005 |url=}}</ref><ref name="pmid16533338">{{cite journal |vauthors=Korte JE, Baseman JB, Cagle MP, Herrera C, Piper JM, Holden AE, Perdue ST, Champion JD, Shain RN |title=Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium |journal=Am. J. Reprod. Immunol. |volume=55 |issue=4 |pages=265–75 |year=2006 |pmid=16533338 |doi=10.1111/j.1600-0897.2005.00359.x |url=}}</ref>
''Mycoplasma genitalium'' infection can be divided based on the clinical presentation into:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid15295128">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis |journal=Sex Transm Infect |volume=80 |issue=4 |pages=289–93 |year=2004 |pmid=15295128 |pmc=1744873 |doi=10.1136/sti.2003.006817 |url=}}</ref><ref name="pmid7721285">{{cite journal |vauthors=Jensen JS, Orsum R, Dohn B, Uldum S, Worm AM, Lind K |title=Mycoplasma genitalium: a cause of male urethritis? |journal=Genitourin Med |volume=69 |issue=4 |pages=265–9 |year=1993 |pmid=7721285 |pmc=1195084 |doi= |url=}}</ref><ref name="pmid16326846">{{cite journal |vauthors=Anagrius C, Loré B, Jensen JS |title=Mycoplasma genitalium: prevalence, clinical significance, and transmission |journal=Sex Transm Infect |volume=81 |issue=6 |pages=458–62 |year=2005 |pmid=16326846 |pmc=1745067 |doi=10.1136/sti.2004.012062 |url=}}</ref><ref name="pmid17448398">{{cite journal |vauthors=Tosh AK, Van Der Pol B, Fortenberry JD, Williams JA, Katz BP, Batteiger BE, Orr DP |title=Mycoplasma genitalium among adolescent women and their partners |journal=J Adolesc Health |volume=40 |issue=5 |pages=412–7 |year=2007 |pmid=17448398 |pmc=1899169 |doi=10.1016/j.jadohealth.2006.12.005 |url=}}</ref><ref name="pmid16533338">{{cite journal |vauthors=Korte JE, Baseman JB, Cagle MP, Herrera C, Piper JM, Holden AE, Perdue ST, Champion JD, Shain RN |title=Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium |journal=Am. J. Reprod. Immunol. |volume=55 |issue=4 |pages=265–75 |year=2006 |pmid=16533338 |doi=10.1111/j.1600-0897.2005.00359.x |url=}}</ref>
*Asymptomatic ''Mycoplasma genitalium'' infection
*Asymptomatic ''Mycoplasma genitalium'' infection
*Symptomatic ''Mycoplasma genitalium'' infection: symptoms are related to [[PID]] or [[cervicitis]] in women and [[urethritis]] or [[epididymitis]] in men
*Symptomatic ''Mycoplasma genitalium'' infection: symptoms are related to [[PID]] or [[cervicitis]] in women and [[urethritis]] or [[epididymitis]] in men
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===Pathogenesis===
===Pathogenesis===
====Mode of Transmission====
====Mode of Transmission====
*''Mycoplasma genitalium'' is recognized as a sexually transmitted disease ([[STD]]) with the mode of transmission being through direct [[genital]]-to-[[genital]] contact and subsequent inoculation of infected secretions. Transmission of ''Mycoplasma genitalium'' has also been implicated in [[penis|penile]]-[[anal]] intercourse.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>  
 
*''Mycoplasma genitalium'' is less likely to be transmitted via oro-genital contact, as carriage in the [[oropharynx]] is low.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>  
*''Mycoplasma genitalium'' is recognized as a sexually transmitted disease ([[STD]]) with the mode of transmission being through direct [[genital]]-to-[[genital]] contact and subsequent inoculation of infected secretions. Transmission of ''Mycoplasma genitalium'' has also been implicated in [[penis|penile]]-[[anal]] intercourse.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
*''Mycoplasma genitalium'' is less likely to be transmitted via oro-genital contact, as carriage in the [[oropharynx]] is low.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
*Whether or not ''Mycoplasma genitalium'' is vertically transmitted from mother to [[newborn]] is yet to be studied. However, the [[bacterium]] has been isolated from the respiratory tract of [[newborns]].<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
*Whether or not ''Mycoplasma genitalium'' is vertically transmitted from mother to [[newborn]] is yet to be studied. However, the [[bacterium]] has been isolated from the respiratory tract of [[newborns]].<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>


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====Factors facilitating the pathogenesis of ''Mycoplasma genitalium''====
====Factors facilitating the pathogenesis of ''Mycoplasma genitalium''====
The following virulence factors have been implicated in the pathogenesis of ''Mycoplasma genitalium'':<ref name="pmid21734246">{{cite journal |vauthors=Taylor-Robinson D, Jensen JS |title=Mycoplasma genitalium: from Chrysalis to multicolored butterfly |journal=Clin. Microbiol. Rev. |volume=24 |issue=3 |pages=498–514 |year=2011 |pmid=21734246 |pmc=3131060 |doi=10.1128/CMR.00006-11 |url=}}</ref><ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid23391789">{{cite journal |vauthors=Sethi S, Singh G, Samanta P, Sharma M |title=Mycoplasma genitalium: an emerging sexually transmitted pathogen |journal=Indian J. Med. Res. |volume=136 |issue=6 |pages=942–55 |year=2012 |pmid=23391789 |pmc=3612323 |doi= |url=}}</ref>
The following virulence factors have been implicated in the pathogenesis of ''Mycoplasma genitalium'':<ref name="pmid21734246">{{cite journal |vauthors=Taylor-Robinson D, Jensen JS |title=Mycoplasma genitalium: from Chrysalis to multicolored butterfly |journal=Clin. Microbiol. Rev. |volume=24 |issue=3 |pages=498–514 |year=2011 |pmid=21734246 |pmc=3131060 |doi=10.1128/CMR.00006-11 |url=}}</ref><ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid23391789">{{cite journal |vauthors=Sethi S, Singh G, Samanta P, Sharma M |title=Mycoplasma genitalium: an emerging sexually transmitted pathogen |journal=Indian J. Med. Res. |volume=136 |issue=6 |pages=942–55 |year=2012 |pmid=23391789 |pmc=3612323 |doi= |url=}}</ref>
*Adhesion molecules: ''Mycoplasma genitalium'' has the ability to attach to different types of cells, including [[red blood cells]], [[respiratory]] cells, [[fallopian tube]] cells, as well as [[sperm]] cells. It is believed that the attachment to sperm cells facilitates the spread of ''Mycoplasma genitalium'' to the [[female]] [[genital tract]]. MgPa, a major adhesion in attachment protein complex, facilitates not only [[adhesion]] to [[epithelial]] cells, but also the motility of ''Mycoplasma genitalium''.  
 
*[[Intracellular]] localization: ''Mycoplasma genitalium'' is a facultative intracellular organism and this allows for its survival both inside and outside of cells.  
*Adhesion molecules: ''Mycoplasma genitalium'' has the ability to attach to different types of cells, including [[red blood cells]], [[respiratory]] cells, [[fallopian tube]] cells, as well as [[sperm]] cells. It is believed that the attachment to sperm cells facilitates the spread of ''Mycoplasma genitalium'' to the [[female]] [[genital tract]]. MgPa, a major adhesion in attachment protein complex, facilitates not only [[adhesion]] to [[epithelial]] cells, but also the motility of ''Mycoplasma genitalium''.
*[[Antigenic]] variation: ''Mycoplasma genitalium'' is able to generate surface lipoprotein with high frequency, which helps it evade the human [[immune system]].  
*[[Intracellular]] localization: ''Mycoplasma genitalium'' is a facultative intracellular organism and this allows for its survival both inside and outside of cells.
*Toxins: ''Mycoplasma genitalium'' has a [[calcium]]-dependent membrane associated nuclease known as MG-186. MG-186 is capable of degrading [[host]] cell [[nucleic acid]], hence providing a source of [[nucleotides]] for the growth and pathogenesis of ''Mycoplasma genitalium''.  
*[[Antigenic]] variation: ''Mycoplasma genitalium'' is able to generate surface lipoprotein with high frequency, which helps it evade the human [[immune system]].
*Toxins: ''Mycoplasma genitalium'' has a [[calcium]]-dependent membrane associated nuclease known as MG-186. MG-186 is capable of degrading [[host]] cell [[nucleic acid]], hence providing a source of [[nucleotides]] for the growth and pathogenesis of ''Mycoplasma genitalium''.
*Enzymes: Glyceraldehyde 3-phosphate dehydrogenase [[(GADPH)]] acts as a [[ligand]] to the [[receptors]] [[mucin]] and [[fibronectin]], found on [[vaginal]] and [[cervical]] [[epithelium]].
*Enzymes: Glyceraldehyde 3-phosphate dehydrogenase [[(GADPH)]] acts as a [[ligand]] to the [[receptors]] [[mucin]] and [[fibronectin]], found on [[vaginal]] and [[cervical]] [[epithelium]].
*Immunological response: ''Mycoplasma genitalium'' possesses an immunogenic protein, MG-309, which secretes pro-inflammatory [[cytokines]], such as [[IL-6]] and [[IL-8]]. MG-309 exerts its effect via attaching to a [[toll-like receptor]], hence activating nuclear factor kappa B ([[NF-kB]])
*Immunological response: ''Mycoplasma genitalium'' possesses an immunogenic protein, MG-309, which secretes pro-inflammatory [[cytokines]], such as [[IL-6]] and [[IL-8]]. MG-309 exerts its effect via attaching to a [[toll-like receptor]], hence activating nuclear factor kappa B ([[NF-kB]])
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===Associated Conditions===
===Associated Conditions===
''Mycoplasma genitalium'' infection is associated with co-infection with other [[sexually transmitted diseases]], such as:<ref name="pmid27307460">{{cite journal |vauthors=Getman D, Jiang A, O'Donnell M, Cohen S |title=Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States |journal=J. Clin. Microbiol. |volume=54 |issue=9 |pages=2278–83 |year=2016 |pmid=27307460 |pmc=5005488 |doi=10.1128/JCM.01053-16 |url=}}</ref>
''Mycoplasma genitalium'' infection is associated with co-infection with other [[sexually transmitted diseases]], such as:<ref name="pmid27307460">{{cite journal |vauthors=Getman D, Jiang A, O'Donnell M, Cohen S |title=Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States |journal=J. Clin. Microbiol. |volume=54 |issue=9 |pages=2278–83 |year=2016 |pmid=27307460 |pmc=5005488 |doi=10.1128/JCM.01053-16 |url=}}</ref>
*''[[Chlamydia trachomatis]]''
*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Trichomonas vaginalis]]''
*[[HIV]]
*[[HIV]]: Studies have reported an increased risk for [[HIV AIDS|HIV infection]] among women with Mycoplasma genitalium, evidenced by noticing that HIV shedding occurs more frequently among individuals with Mycoplasma genitalium and [[HIV AIDS|HIV infection]] who are not being treated than among individuals without this [[infection]].<ref name="pmid:24687129">{{cite journal| author=Vandepitte J, Weiss HA, Bukenya J, Kyakuwa N, Muller E, Buvé A | display-authors=etal| title=Association between Mycoplasma genitalium infection and HIV acquisition among female sex workers in Uganda: evidence from a nested case-control study. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 7 | pages= 545-9 | pmid=:24687129 | doi=10.1136/sextrans-2013-051467 | pmc=4215342 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687129  }}</ref>


===Gross Pathology===
===Gross Pathology===
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==Differentiating Mycoplasma genitalium Infection from Other Diseases==
==Differentiating Mycoplasma genitalium Infection from Other Diseases==
''Mycoplasma genitalium'' infection must be distinguished from other [[sexually transmitted diseases]], which may have a similar presentation. These include:
''Mycoplasma genitalium'' infection must be distinguished from other [[sexually transmitted diseases]], which may have a similar presentation. These include:
*''[[Chlamydia trachomatis]]''
*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Neisseria gonorrhea]]''
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==Epidemiology and Demographics==
==Epidemiology and Demographics==
*The incidence and prevalence of ''Mycoplasma genitalium'' is not well established, because more than half of the women who tested positive were asymptomatic.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
 
*The [[incidence]] and [[prevalence]] of ''[[Mycoplasma genitalium]]'' is not well established, because more than half of the women who tested positive were asymptomatic.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
*In the United States, the prevalence of ''Mycoplasma genitalium'' was estimated as follows:<ref name="pmid27307460">{{cite journal |vauthors=Getman D, Jiang A, O'Donnell M, Cohen S |title=Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States |journal=J. Clin. Microbiol. |volume=54 |issue=9 |pages=2278–83 |year=2016 |pmid=27307460 |pmc=5005488 |doi=10.1128/JCM.01053-16 |url=}}</ref>
*In the United States, the prevalence of ''Mycoplasma genitalium'' was estimated as follows:<ref name="pmid27307460">{{cite journal |vauthors=Getman D, Jiang A, O'Donnell M, Cohen S |title=Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States |journal=J. Clin. Microbiol. |volume=54 |issue=9 |pages=2278–83 |year=2016 |pmid=27307460 |pmc=5005488 |doi=10.1128/JCM.01053-16 |url=}}</ref>
**The prevalence of ''Mycoplasma genitalium'' in all females aged 14-70 years old is 16.3%.  
**The prevalence of ''Mycoplasma genitalium'' in all females aged 14-70 years old is 16.3%.
**The prevalence of ''Mycoplasma genitalium'' in all males aged 18-78 years old is 17.2%.  
**The prevalence of ''[[Mycoplasma genitalium]]'' in all males aged 18-78 years old is 17.2%.
**Infection in both males and females was more prevalent in those younger than 30 years of age.  
**Infection in both males and females was more prevalent in those younger than 30 years of age.
**The overall prevalence of ''Mycoplasma genitalium'' infection is 1%, which makes it more prevalent than ''[[Neisseria gonorrhea]]'' (0.4%), but less common than ''[[Chlamydia trachomatis]]'' (4.2%).<ref name="pmid17463380">{{cite journal |vauthors=Manhart LE, Holmes KK, Hughes JP, Houston LS, Totten PA |title=Mycoplasma genitalium among young adults in the United States: an emerging sexually transmitted infection |journal=Am J Public Health |volume=97 |issue=6 |pages=1118–25 |year=2007 |pmid=17463380 |pmc=1874220 |doi=10.2105/AJPH.2005.074062 |url=}}</ref>
**The overall prevalence of ''Mycoplasma genitalium'' infection is 1%, which makes it more prevalent than ''[[Neisseria gonorrhea]]'' (0.4%), but less common than ''[[Chlamydia trachomatis]]'' (4.2%).<ref name="pmid17463380">{{cite journal |vauthors=Manhart LE, Holmes KK, Hughes JP, Houston LS, Totten PA |title=Mycoplasma genitalium among young adults in the United States: an emerging sexually transmitted infection |journal=Am J Public Health |volume=97 |issue=6 |pages=1118–25 |year=2007 |pmid=17463380 |pmc=1874220 |doi=10.2105/AJPH.2005.074062 |url=}}</ref>
*Between the years 2002-2011, the prevalence of ''Mycoplasma genitalium'' worldwide ranged between 4%-42%.<ref name="pmid23391789">{{cite journal |vauthors=Sethi S, Singh G, Samanta P, Sharma M |title=Mycoplasma genitalium: an emerging sexually transmitted pathogen |journal=Indian J. Med. Res. |volume=136 |issue=6 |pages=942–55 |year=2012 |pmid=23391789 |pmc=3612323 |doi= |url=}}</ref>
*Between the years 2002-2011, the prevalence of ''Mycoplasma genitalium'' worldwide ranged between 4%-42%.<ref name="pmid23391789">{{cite journal |vauthors=Sethi S, Singh G, Samanta P, Sharma M |title=Mycoplasma genitalium: an emerging sexually transmitted pathogen |journal=Indian J. Med. Res. |volume=136 |issue=6 |pages=942–55 |year=2012 |pmid=23391789 |pmc=3612323 |doi= |url=}}</ref>
*''Mycoplasma genitalium'' is the cause of about 15%–20% of [[nongonococcal urethritis]] and 40% of persistent or recurrent [[urethritis]].<ref name="pmid217342462">{{cite journal| author=Taylor-Robinson D, Jensen JS| title=Mycoplasma genitalium: from Chrysalis to multicolored butterfly. | journal=Clin Microbiol Rev | year= 2011 | volume= 24 | issue= 3 | pages= 498-514 | pmid=21734246 | doi=10.1128/CMR.00006-11 | pmc=3131060 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21734246  }}</ref>
*[[Rectal]] infection with Mycoplasma genitalium was detected in 1%–26% of men who had sex with men and among approximately 3% of women; however, [[rectal]] infections are usually [[Asymptomatic condition|asymptomatic]].<ref name="pmid31055469">{{cite journal| author=Cina M, Baumann L, Egli-Gany D, Halbeisen FS, Ali H, Scott P | display-authors=etal| title=Mycoplasma genitalium incidence, persistence, concordance between partners and progression: systematic review and meta-analysis. | journal=Sex Transm Infect | year= 2019 | volume= 95 | issue= 5 | pages= 328-335 | pmid=31055469 | doi=10.1136/sextrans-2018-053823 | pmc=6678058 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31055469  }}</ref><ref name="pmid29440466">{{cite journal| author=Baumann L, Cina M, Egli-Gany D, Goutaki M, Halbeisen FS, Lohrer GR | display-authors=etal| title=Prevalence of Mycoplasma genitalium in different population groups: systematic review andmeta-analysis. | journal=Sex Transm Infect | year= 2018 | volume= 94 | issue= 4 | pages= 255-262 | pmid=29440466 | doi=10.1136/sextrans-2017-053384 | pmc=5969327 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29440466  }}</ref>
*[[Macrolide|Macrolides]] [[Drug resistance|resistance]] and treatment failure have been reported between 44% and 90% in the United States, Canada, Australia, and Western Europe due to frequent use of azithromycin as a single treatment for ''Mycoplasma genitalium''.<ref name="pmid32185385">{{cite journal| author=Bachmann LH, Kirkcaldy RD, Geisler WM, Wiesenfeld HC, Manhart LE, Taylor SN | display-authors=etal| title=Prevalence of Mycoplasma genitalium Infection, Antimicrobial Resistance Mutations, and Symptom Resolution Following Treatment of Urethritis. | journal=Clin Infect Dis | year= 2020 | volume= 71 | issue= 10 | pages= e624-e632 | pmid=32185385 | doi=10.1093/cid/ciaa293 | pmc=7744987 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32185385  }}</ref><ref name="pmid24280088">{{cite journal| author=Pond MJ, Nori AV, Witney AA, Lopeman RC, Butcher PD, Sadiq ST| title=High prevalence of antibiotic-resistant Mycoplasma genitalium in nongonococcal urethritis: the need for routine testing and the inadequacy of current treatment options. | journal=Clin Infect Dis | year= 2014 | volume= 58 | issue= 5 | pages= 631-7 | pmid=24280088 | doi=10.1093/cid/cit752 | pmc=3922211 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24280088  }}</ref><ref name="pmid30972419">{{cite journal| author=Li Y, Su X, Le W, Li S, Yang Z, Chaisson C | display-authors=etal| title=Mycoplasma genitalium in Symptomatic Male Urethritis: Macrolide Use Is Associated With Increased Resistance. | journal=Clin Infect Dis | year= 2020 | volume= 70 | issue= 5 | pages= 805-810 | pmid=30972419 | doi=10.1093/cid/ciz294 | pmc=7390511 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30972419  }}</ref>


==Risk Factors==
==Risk Factors==
There several risk factors that have been identified with ''Mycoplasma genitalium'' infection. These risk factors include:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid12599082">{{cite journal |vauthors=Manhart LE, Critchlow CW, Holmes KK, Dutro SM, Eschenbach DA, Stevens CE, Totten PA |title=Mucopurulent cervicitis and Mycoplasma genitalium |journal=J. Infect. Dis. |volume=187 |issue=4 |pages=650–7 |year=2003 |pmid=12599082 |doi=10.1086/367992 |url=}}</ref><ref name="pmid20679963">{{cite journal |vauthors=Hancock EB, Manhart LE, Nelson SJ, Kerani R, Wroblewski JK, Totten PA |title=Comprehensive assessment of sociodemographic and behavioral risk factors for Mycoplasma genitalium infection in women |journal=Sex Transm Dis |volume=37 |issue=12 |pages=777–83 |year=2010 |pmid=20679963 |pmc=4628821 |doi=10.1097/OLQ.0b013e3181e8087e |url=}}</ref>
There several [[Risk factor|risk factors]] that have been identified with ''[[Mycoplasma genitalium]]'' infection. These risk factors include:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid12599082">{{cite journal |vauthors=Manhart LE, Critchlow CW, Holmes KK, Dutro SM, Eschenbach DA, Stevens CE, Totten PA |title=Mucopurulent cervicitis and Mycoplasma genitalium |journal=J. Infect. Dis. |volume=187 |issue=4 |pages=650–7 |year=2003 |pmid=12599082 |doi=10.1086/367992 |url=}}</ref><ref name="pmid20679963">{{cite journal |vauthors=Hancock EB, Manhart LE, Nelson SJ, Kerani R, Wroblewski JK, Totten PA |title=Comprehensive assessment of sociodemographic and behavioral risk factors for Mycoplasma genitalium infection in women |journal=Sex Transm Dis |volume=37 |issue=12 |pages=777–83 |year=2010 |pmid=20679963 |pmc=4628821 |doi=10.1097/OLQ.0b013e3181e8087e |url=}}</ref>
 
*High risk sexual behavior, defined as having >3 new sexual partners in the past year
*High risk sexual behavior, defined as having >3 new sexual partners in the past year
*Being engaged in sexual contact with persons with [[STDs]], particularly ''Mycoplasma genitalium''
*Being engaged in [[sexual contact]] with persons with [[STDs]], particularly ''Mycoplasma genitalium''
*Non-white race
*Non-white race
*Young age (<20 years old)
*Young age (<20 years old)
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==Screening==
==Screening==
There are no recommendations for screening for ''Mycoplasma genitalium''.<ref name= "USPSTF"> United States Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=mycoplasma+genitalium Accessed on Oct. 6, 2016.</ref>
There are no recommendations for screening for ''Mycoplasma genitalium''.<ref name="USPSTF"> United States Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=mycoplasma+genitalium Accessed on Oct. 6, 2016.</ref>


==Natural history, Complications and Prognosis==
==Natural history, Complications and Prognosis==
Line 112: Line 123:


===Complications===
===Complications===
The following complications may be the result of ''[[Mycoplasma genitalium]]'' infection:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid16877571">{{cite journal |vauthors=Ross JD, Jensen JS |title=Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment |journal=Sex Transm Infect |volume=82 |issue=4 |pages=269–71 |year=2006 |pmid=16877571 |pmc=2564705 |doi=10.1136/sti.2005.017368 |url=}}</ref><ref name="pmid15295128">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis |journal=Sex Transm Infect |volume=80 |issue=4 |pages=289–93 |year=2004 |pmid=15295128 |pmc=1744873 |doi=10.1136/sti.2003.006817 |url=}}</ref><ref name="pmid7721285">{{cite journal |vauthors=Jensen JS, Orsum R, Dohn B, Uldum S, Worm AM, Lind K |title=Mycoplasma genitalium: a cause of male urethritis? |journal=Genitourin Med |volume=69 |issue=4 |pages=265–9 |year=1993 |pmid=7721285 |pmc=1195084 |doi= |url=}}</ref><ref name="pmid16326846">{{cite journal |vauthors=Anagrius C, Loré B, Jensen JS |title=Mycoplasma genitalium: prevalence, clinical significance, and transmission |journal=Sex Transm Infect |volume=81 |issue=6 |pages=458–62 |year=2005 |pmid=16326846 |pmc=1745067 |doi=10.1136/sti.2004.012062 |url=}}</ref><ref name="pmid21285914">{{cite journal |vauthors=Wetmore CM, Manhart LE, Lowens MS, Golden MR, Whittington WL, Xet-Mull AM, Astete SG, McFarland NL, McDougal SJ, Totten PA |title=Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study |journal=Sex Transm Dis |volume=38 |issue=3 |pages=180–6 |year=2011 |pmid=21285914 |pmc=4024216 |doi=10.1097/OLQ.0b013e3182040de9 |url=}}</ref><ref name="pmid12410476">{{cite journal |vauthors=Mena L, Wang X, Mroczkowski TF, Martin DH |title=Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans |journal=Clin. Infect. Dis. |volume=35 |issue=10 |pages=1167–73 |year=2002 |pmid=12410476 |doi=10.1086/343829 |url=}}</ref><ref name="pmid15681728">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection |journal=Sex Transm Infect |volume=81 |issue=1 |pages=73–8 |year=2005 |pmid=15681728 |pmc=1763725 |doi=10.1136/sti.2004.010439 |url=}}</ref><ref name="pmid19704398">{{cite journal |vauthors=Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC |title=Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics |journal=Sex Transm Dis |volume=36 |issue=10 |pages=598–606 |year=2009 |pmid=19704398 |pmc=2924808 |doi=10.1097/OLQ.0b013e3181b01948 |url=}}</ref><ref name="pmid19025498">{{cite journal |vauthors=Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL |title=Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease |journal=Clin. Infect. Dis. |volume=48 |issue=1 |pages=41–7 |year=2009 |pmid=19025498 |pmc=2652068 |doi=10.1086/594123 |url=}}</ref>
The following [[Complication (medicine)|complications]] may be the result of ''[[Mycoplasma genitalium]]'' infection:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid16877571">{{cite journal |vauthors=Ross JD, Jensen JS |title=Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment |journal=Sex Transm Infect |volume=82 |issue=4 |pages=269–71 |year=2006 |pmid=16877571 |pmc=2564705 |doi=10.1136/sti.2005.017368 |url=}}</ref><ref name="pmid15295128">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis |journal=Sex Transm Infect |volume=80 |issue=4 |pages=289–93 |year=2004 |pmid=15295128 |pmc=1744873 |doi=10.1136/sti.2003.006817 |url=}}</ref><ref name="pmid7721285">{{cite journal |vauthors=Jensen JS, Orsum R, Dohn B, Uldum S, Worm AM, Lind K |title=Mycoplasma genitalium: a cause of male urethritis? |journal=Genitourin Med |volume=69 |issue=4 |pages=265–9 |year=1993 |pmid=7721285 |pmc=1195084 |doi= |url=}}</ref><ref name="pmid16326846">{{cite journal |vauthors=Anagrius C, Loré B, Jensen JS |title=Mycoplasma genitalium: prevalence, clinical significance, and transmission |journal=Sex Transm Infect |volume=81 |issue=6 |pages=458–62 |year=2005 |pmid=16326846 |pmc=1745067 |doi=10.1136/sti.2004.012062 |url=}}</ref><ref name="pmid21285914">{{cite journal |vauthors=Wetmore CM, Manhart LE, Lowens MS, Golden MR, Whittington WL, Xet-Mull AM, Astete SG, McFarland NL, McDougal SJ, Totten PA |title=Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study |journal=Sex Transm Dis |volume=38 |issue=3 |pages=180–6 |year=2011 |pmid=21285914 |pmc=4024216 |doi=10.1097/OLQ.0b013e3182040de9 |url=}}</ref><ref name="pmid12410476">{{cite journal |vauthors=Mena L, Wang X, Mroczkowski TF, Martin DH |title=Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans |journal=Clin. Infect. Dis. |volume=35 |issue=10 |pages=1167–73 |year=2002 |pmid=12410476 |doi=10.1086/343829 |url=}}</ref><ref name="pmid15681728">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection |journal=Sex Transm Infect |volume=81 |issue=1 |pages=73–8 |year=2005 |pmid=15681728 |pmc=1763725 |doi=10.1136/sti.2004.010439 |url=}}</ref><ref name="pmid19704398">{{cite journal |vauthors=Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC |title=Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics |journal=Sex Transm Dis |volume=36 |issue=10 |pages=598–606 |year=2009 |pmid=19704398 |pmc=2924808 |doi=10.1097/OLQ.0b013e3181b01948 |url=}}</ref><ref name="pmid19025498">{{cite journal |vauthors=Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL |title=Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease |journal=Clin. Infect. Dis. |volume=48 |issue=1 |pages=41–7 |year=2009 |pmid=19025498 |pmc=2652068 |doi=10.1086/594123 |url=}}</ref><ref name="pmid22902666">{{cite journal| author=Mobley VL, Hobbs MM, Lau K, Weinbaum BS, Getman DK, Seña AC| title=Mycoplasma genitalium infection in women attending a sexually transmitted infection clinic: diagnostic specimen type, coinfections, and predictors. | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 9 | pages= 706-9 | pmid=22902666 | doi=10.1097/OLQ.0b013e318255de03 | pmc=3428747 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22902666  }}</ref><ref name="pmid259001">{{cite journal| author=Tkach JR, Shannon AM, Beastrom R| title=Pseudofolliculitis due to preoperative shaving. | journal=AORN J | year= 1979 | volume= 30 | issue= 5 | pages= 881-4 | pmid=259001 | doi=10.1016/s0001-2092(07)61393-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=259001  }}</ref>
*Complications in females include: [[cervicitis]], [[endometritis]], tubal factor [[infertility]], [[pelvic inflammatory disease]] [[(PID)]], as well as sexually active [[reactive arthritis]] (SARA).
 
*Complications in females include: [[cervicitis]], [[endometritis]], tubal factor [[infertility]], [[pelvic inflammatory disease]] [[(PID)]], [[Preterm labor and birth|preterm labor]] as well as sexually active [[reactive arthritis]] (SARA).
*Complications in males include: [[epididymitis]], [[urethritis]], as well as sexually active [[reactive arthritis]] (SARA).
*Complications in males include: [[epididymitis]], [[urethritis]], as well as sexually active [[reactive arthritis]] (SARA).


===Prognosis===
===Prognosis===
The prognosis of ''Mycoplasma genitalium'' infection is generally excellent. Cure rates are almost 100% with the correct and prompt antibiotic treatment.<ref name="pmid26975162">{{cite journal |vauthors= |title=Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines |journal=J Miss State Med Assoc |volume=56 |issue=12 |pages=372–5 |year=2015 |pmid=26975162 |doi= |url=}}</ref>
The [[prognosis]] of ''Mycoplasma genitalium'' infection is generally excellent. [[Cure]] rates are almost 100% with the correct and prompt [[antibiotic]] treatment.<ref name="pmid26975162">{{cite journal |vauthors= |title=Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines |journal=J Miss State Med Assoc |volume=56 |issue=12 |pages=372–5 |year=2015 |pmid=26975162 |doi= |url=}}</ref>


==History and Symptoms==
==History and Symptoms==
The presenting symptoms of ''Mycoplasma genitalium'' are related to the disease processes it may cause. Presenting symptoms can be divided based on gender:
The presenting symptoms of ''Mycoplasma genitalium'' are related to the disease processes it may cause. Presenting symptoms can be divided based on gender:
*Females: 40-75% of women infected with ''Mycoplasma genitalium'' are asymptomatic. However, when symptoms are present, they are usually related to the disease process ''Mycoplasma genitalium'' resulted. These include:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid17448398">{{cite journal |vauthors=Tosh AK, Van Der Pol B, Fortenberry JD, Williams JA, Katz BP, Batteiger BE, Orr DP |title=Mycoplasma genitalium among adolescent women and their partners |journal=J Adolesc Health |volume=40 |issue=5 |pages=412–7 |year=2007 |pmid=17448398 |pmc=1899169 |doi=10.1016/j.jadohealth.2006.12.005 |url=}}</ref><ref name="pmid16533338">{{cite journal |vauthors=Korte JE, Baseman JB, Cagle MP, Herrera C, Piper JM, Holden AE, Perdue ST, Champion JD, Shain RN |title=Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium |journal=Am. J. Reprod. Immunol. |volume=55 |issue=4 |pages=265–75 |year=2006 |pmid=16533338 |doi=10.1111/j.1600-0897.2005.00359.x |url=}}</ref>
*Females: 40-75% of women infected with ''Mycoplasma genitalium'' are asymptomatic. However, when symptoms are present, they are usually related to the disease process ''Mycoplasma genitalium'' resulted. These include:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid17448398">{{cite journal |vauthors=Tosh AK, Van Der Pol B, Fortenberry JD, Williams JA, Katz BP, Batteiger BE, Orr DP |title=Mycoplasma genitalium among adolescent women and their partners |journal=J Adolesc Health |volume=40 |issue=5 |pages=412–7 |year=2007 |pmid=17448398 |pmc=1899169 |doi=10.1016/j.jadohealth.2006.12.005 |url=}}</ref><ref name="pmid16533338">{{cite journal |vauthors=Korte JE, Baseman JB, Cagle MP, Herrera C, Piper JM, Holden AE, Perdue ST, Champion JD, Shain RN |title=Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium |journal=Am. J. Reprod. Immunol. |volume=55 |issue=4 |pages=265–75 |year=2006 |pmid=16533338 |doi=10.1111/j.1600-0897.2005.00359.x |url=}}</ref>
**[[Cervicitis]]: presents with [[vaginal]] [[discharge]], [[vaginal]] itching, inter-[[menstrual]], heavy or post-coital [[bleeding]]
**[[Cervicitis]]: presents with [[vaginal]] [[discharge]], [[vaginal]] itching, inter-[[menstrual]], heavy or post-coital [[bleeding]]
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==Physical Examination==
==Physical Examination==
Physical examination findings in ''Mycoplasma genitalium'' are related to the disease processes it may cause. These findings can be divided based on the several disease pathologies in males and females.
Physical examination findings in ''Mycoplasma genitalium'' are related to the disease processes it may cause. These findings can be divided based on the several disease pathologies in males and females.
*Females:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid17448398">{{cite journal |vauthors=Tosh AK, Van Der Pol B, Fortenberry JD, Williams JA, Katz BP, Batteiger BE, Orr DP |title=Mycoplasma genitalium among adolescent women and their partners |journal=J Adolesc Health |volume=40 |issue=5 |pages=412–7 |year=2007 |pmid=17448398 |pmc=1899169 |doi=10.1016/j.jadohealth.2006.12.005 |url=}}</ref><ref name="pmid16533338">{{cite journal |vauthors=Korte JE, Baseman JB, Cagle MP, Herrera C, Piper JM, Holden AE, Perdue ST, Champion JD, Shain RN |title=Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium |journal=Am. J. Reprod. Immunol. |volume=55 |issue=4 |pages=265–75 |year=2006 |pmid=16533338 |doi=10.1111/j.1600-0897.2005.00359.x |url=}}</ref>
*Females:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid17448398">{{cite journal |vauthors=Tosh AK, Van Der Pol B, Fortenberry JD, Williams JA, Katz BP, Batteiger BE, Orr DP |title=Mycoplasma genitalium among adolescent women and their partners |journal=J Adolesc Health |volume=40 |issue=5 |pages=412–7 |year=2007 |pmid=17448398 |pmc=1899169 |doi=10.1016/j.jadohealth.2006.12.005 |url=}}</ref><ref name="pmid16533338">{{cite journal |vauthors=Korte JE, Baseman JB, Cagle MP, Herrera C, Piper JM, Holden AE, Perdue ST, Champion JD, Shain RN |title=Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium |journal=Am. J. Reprod. Immunol. |volume=55 |issue=4 |pages=265–75 |year=2006 |pmid=16533338 |doi=10.1111/j.1600-0897.2005.00359.x |url=}}</ref>
**[[Cervicitis]]: findings include a [[purulent]] or [[mucopurulent]] cervical [[discharge]], [[vaginal]] itching, inter-menstrual, heavy or post-coital [[bleeding]]<ref name="pmid15681728">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection |journal=Sex Transm Infect |volume=81 |issue=1 |pages=73–8 |year=2005 |pmid=15681728 |pmc=1763725 |doi=10.1136/sti.2004.010439 |url=}}</ref><ref name="pmid19704398">{{cite journal |vauthors=Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC |title=Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics |journal=Sex Transm Dis |volume=36 |issue=10 |pages=598–606 |year=2009 |pmid=19704398 |pmc=2924808 |doi=10.1097/OLQ.0b013e3181b01948 |url=}}</ref><ref name="pmid18842689">{{cite journal |vauthors=Moi H, Reinton N, Moghaddam A |title=Mycoplasma genitalium in women with lower genital tract inflammation |journal=Sex Transm Infect |volume=85 |issue=1 |pages=10–4 |year=2009 |pmid=18842689 |doi=10.1136/sti.2008.032748 |url=}}</ref>
**[[Cervicitis]]: findings include a [[purulent]] or [[mucopurulent]] cervical [[discharge]], [[vaginal]] itching, inter-menstrual, heavy or post-coital [[bleeding]]<ref name="pmid15681728">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection |journal=Sex Transm Infect |volume=81 |issue=1 |pages=73–8 |year=2005 |pmid=15681728 |pmc=1763725 |doi=10.1136/sti.2004.010439 |url=}}</ref><ref name="pmid19704398">{{cite journal |vauthors=Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC |title=Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics |journal=Sex Transm Dis |volume=36 |issue=10 |pages=598–606 |year=2009 |pmid=19704398 |pmc=2924808 |doi=10.1097/OLQ.0b013e3181b01948 |url=}}</ref><ref name="pmid18842689">{{cite journal |vauthors=Moi H, Reinton N, Moghaddam A |title=Mycoplasma genitalium in women with lower genital tract inflammation |journal=Sex Transm Infect |volume=85 |issue=1 |pages=10–4 |year=2009 |pmid=18842689 |doi=10.1136/sti.2008.032748 |url=}}</ref>
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==Laboratory Findings==
==Laboratory Findings==
*Culture of ''Mycoplasma genitalium'' is not commonly used, as culture takes about 6 months to grow and is not widely available.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
*Culture of ''Mycoplasma genitalium'' is not commonly used, as culture takes about 6 months to grow and is not widely available.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
*Nucleic acid amplification test (NAAT) via [[polymerase chain reaction]] [[(PCR)]] or transcription-mediated amplification (TMA) is the preferred method for isolating ''Mycoplasma genitalium''. Samples can be obtained from [[urine]], [[urethral]], [[vaginal]] or [[cervical]] swabs. However, first void urine sample is considered the best method for isolating the organism in both females and males.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid26975162">{{cite journal |vauthors= |title=Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines |journal=J Miss State Med Assoc |volume=56 |issue=12 |pages=372–5 |year=2015 |pmid=26975162 |doi= |url=}}</ref><ref name="pmid18842689">{{cite journal |vauthors=Moi H, Reinton N, Moghaddam A |title=Mycoplasma genitalium in women with lower genital tract inflammation |journal=Sex Transm Infect |volume=85 |issue=1 |pages=10–4 |year=2009 |pmid=18842689 |doi=10.1136/sti.2008.032748 |url=}}</ref><ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref><ref name="pmid18490867">{{cite journal |vauthors=Huppert JS, Mortensen JE, Reed JL, Kahn JA, Rich KD, Hobbs MM |title=Mycoplasma genitalium detected by transcription-mediated amplification is associated with Chlamydia trachomatis in adolescent women |journal=Sex Transm Dis |volume=35 |issue=3 |pages=250–4 |year=2008 |pmid=18490867 |pmc=3807598 |doi=10.1097/OLQ.0b013e31815abac6 |url=}}</ref><ref name="pmid18073017">{{cite journal |vauthors=Högdahl M, Kihlström E |title=Leucocyte esterase testing of first-voided urine and urethral and cervical smears to identify Mycoplasma genitalium-infected men and women |journal=Int J STD AIDS |volume=18 |issue=12 |pages=835–8 |year=2007 |pmid=18073017 |doi=10.1258/095646207782716983 |url=}}</ref>
*Nucleic acid amplification test (NAAT) via [[polymerase chain reaction]] [[(PCR)]] or transcription-mediated amplification (TMA) is the preferred method for isolating ''Mycoplasma genitalium''. Samples can be obtained from [[urine]], [[urethral]], [[vaginal]] or [[cervical]] swabs. However, first void urine sample is considered the best method for isolating the organism in both females and males.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid26975162">{{cite journal |vauthors= |title=Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines |journal=J Miss State Med Assoc |volume=56 |issue=12 |pages=372–5 |year=2015 |pmid=26975162 |doi= |url=}}</ref><ref name="pmid18842689">{{cite journal |vauthors=Moi H, Reinton N, Moghaddam A |title=Mycoplasma genitalium in women with lower genital tract inflammation |journal=Sex Transm Infect |volume=85 |issue=1 |pages=10–4 |year=2009 |pmid=18842689 |doi=10.1136/sti.2008.032748 |url=}}</ref><ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref><ref name="pmid18490867">{{cite journal |vauthors=Huppert JS, Mortensen JE, Reed JL, Kahn JA, Rich KD, Hobbs MM |title=Mycoplasma genitalium detected by transcription-mediated amplification is associated with Chlamydia trachomatis in adolescent women |journal=Sex Transm Dis |volume=35 |issue=3 |pages=250–4 |year=2008 |pmid=18490867 |pmc=3807598 |doi=10.1097/OLQ.0b013e31815abac6 |url=}}</ref><ref name="pmid18073017">{{cite journal |vauthors=Högdahl M, Kihlström E |title=Leucocyte esterase testing of first-voided urine and urethral and cervical smears to identify Mycoplasma genitalium-infected men and women |journal=Int J STD AIDS |volume=18 |issue=12 |pages=835–8 |year=2007 |pmid=18073017 |doi=10.1258/095646207782716983 |url=}}</ref>
*[[Male|Males]] with recurrent [[nongonococcal urethritis]] as well as [[Female|females]] with recurrent [[cervicitis]] or [[PID]] should be tested for [[Mycoplasma genitalium|''Mycoplasma genitalium'']] using [[Nucleic acid test|NAAT]]. [[Drug resistance|Resistance]] testing should be performed if available.


==Imaging Findings==
==Imaging Findings==
===X Ray===
===X Ray===
There is no role for x ray in ''Mycoplasma genitalium'' infection.
There is no role for [[X rays|x ray]] in ''Mycoplasma genitalium'' infection.


===CT===
===CT===
[[CT]] scan may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]]. These include thickened and fluid-filled tubes with or without free pelvic fluid.
[[CT]] scan may be used if ''[[Mycoplasma genitalium]]'' infection has been complicated by [[pelvic inflammatory disease|PID]]. These include thickened and fluid-filled tubes with or without free pelvic fluid.


===MRI===
===MRI===
[[MRI]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]].
[[MRI]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|PID]].


==Other Diagnostic Studies==
==Other Diagnostic Studies==
Line 153: Line 169:


==Medical Therapy==
==Medical Therapy==
''Mycoplasma genitalium'' is intracellular and hence, eradication of the organism is sometimes challenging. The antibiotic drug of choice and dosing depends on susceptibility of the ''Mycoplasma genitalium'' strain, as well as the clinical presentation of the infection, as follows:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid26975162">{{cite journal |vauthors= |title=Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines |journal=J Miss State Med Assoc |volume=56 |issue=12 |pages=372–5 |year=2015 |pmid=26975162 |doi= |url=}}</ref><ref name="pmid16877571">{{cite journal |vauthors=Ross JD, Jensen JS |title=Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment |journal=Sex Transm Infect |volume=82 |issue=4 |pages=269–71 |year=2006 |pmid=16877571 |pmc=2564705 |doi=10.1136/sti.2005.017368 |url=}}</ref>
''[[Mycoplasma genitalium]]'' is [[intracellular]] and lacks the [[cell wall]]; hence, eradication of the organism is sometimes challenging. The [[antibiotic]] drug of choice and [[dosing]] depends on [[Susceptibility loci for intracranial aneurysm in European and Japanese populations|susceptibility]] of the ''Mycoplasma genitalium'' strain, and the availability of macrolides-resistance testing , as follows:<ref name="pmid31629365">{{cite journal| author=Durukan D, Read TRH, Murray G, Doyle M, Chow EPF, Vodstrcil LA | display-authors=etal| title=Resistance-Guided Antimicrobial Therapy Using Doxycycline-Moxifloxacin and Doxycycline-2.5 g Azithromycin for the Treatment of Mycoplasma genitalium Infection: Efficacy and Tolerability. | journal=Clin Infect Dis | year= 2020 | volume= 71 | issue= 6 | pages= 1461-1468 | pmid=31629365 | doi=10.1093/cid/ciz1031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31629365  }}</ref><ref name="pmid28118803">{{cite journal| author=Li Y, Le WJ, Li S, Cao YP, Su XH| title=Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection. | journal=Int J STD AIDS | year= 2017 | volume= 28 | issue= 11 | pages= 1106-1114 | pmid=28118803 | doi=10.1177/0956462416688562 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28118803  }}</ref><ref name="pmid30486786">{{cite journal| author=Mondeja BA, Couri J, Rodríguez NM, Blanco O, Fernández C, Jensen JS| title=Macrolide-resistant Mycoplasma genitalium infections in Cuban patients: an underestimated health problem. | journal=BMC Infect Dis | year= 2018 | volume= 18 | issue= 1 | pages= 601 | pmid=30486786 | doi=10.1186/s12879-018-3523-9 | pmc=6264040 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30486786  }}</ref>
*[[Doxycycline]] has poor efficacy for ''Mycoplasma genitalium''.
 
*For uncomplicated ''Mycoplasma genitalium'' infection susceptible to [[macrolides]], [[azithromycin]] given as a single 1g dose or 500mg on day 1 followed by 250mg on days 2-5 may be used. Another [[macrolide]] that may be used is [[josamycin]] 500mg, given 3 times daily for 10 days.
===Recommended Regimens if Mycoplasma genitalium Resistance Testing Is Available===
*For uncomplicated [[macrolide]] resistant ''Mycoplasma genitalium'' infection, [[moxifloxacin]] 400mg once daily is given for 7-10 days.
 
*[[Pristinamycin]] 1g 4 times daily is given for 7-10 days when both [[azithromycin]] and [[moxifloxacin]] fail.
*'''If macrolide sensitive''': [[Doxycycline]] 100 mg orally 2 times/day for 7 days, followed by [[azithromycin]] 1 g orally initial dose, followed by 500 mg orally daily for 3 additional days (2.5 g total)
*For complicated ''Mycoplasma genitalium'' infection, [[moxifloxacin]] 400mg once daily is used for 14 days.
*'''If macrolide resistant:''' [[Doxycycline]] 100 mg orally 2 times/day for 7 days followed by [[moxifloxacin]] 400 mg orally once daily for 7 days
 
===Recommended Regimen if Mycoplasma genitalium Resistance Testing Is Not Available===
[[Doxycycline]] 100 mg orally 2 times/day for 7 days, followed by [[moxifloxacin]] 400 mg orally once daily for 7 days


==Surgery==
==Surgery==
Line 164: Line 183:


==Primary Prevention==
==Primary Prevention==
Since ''Mycoplasma genitalium'' infection is a [[sexually transmitted disease]], prevention must target safe sexual practices. These include:<ref name=primary-prev>LeFevre ML. USPSTF: behavioral counseling interventions to prevent sexually transmitted infections. Ann Intern Med 2014;161:894–901.</ref><ref name=gono-condom>Warner L, Stone KM, Macaluso M, et al. Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006;33:36–51.</ref>
Since ''Mycoplasma genitalium'' infection is a [[sexually transmitted disease]], prevention must target safe sexual practices. These include:<ref name="primary-prev">LeFevre ML. USPSTF: behavioral counseling interventions to prevent sexually transmitted infections. Ann Intern Med 2014;161:894–901.</ref><ref name="gono-condom">Warner L, Stone KM, Macaluso M, et al. Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006;33:36–51.</ref>
 
*Practicing safe sex with one partner and avoiding multiple sexual partners
*Practicing safe sex with one partner and avoiding multiple sexual partners
*Using condoms and/or other barrier methods
*Using condoms and/or other barrier methods
Line 170: Line 190:
==Secondary Prevention==
==Secondary Prevention==
Secondary prevention in ''Mycoplasma genitalium'' infection consists of the following measures:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
Secondary prevention in ''Mycoplasma genitalium'' infection consists of the following measures:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
*Prompt treatment with antibiotics to prevent complications of the infection
*Prompt treatment with antibiotics to prevent complications of the infection
*Test of cure is not recommended for [[asymptomatic]] individuals
*Partner notification and evaluation: if partner does not attend evaluation for infection, then he/she can be offered the same treatment as the patient
*Partner notification and evaluation: if partner does not attend evaluation for infection, then he/she can be offered the same treatment as the patient
*Screening for other [[sexually transmitted diseases]]
*[[Screening]] and treatment for other [[sexually transmitted diseases]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Infectious disease]]
[[Category:Primary care]]
[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Urology]]
[[Category:Urology]]

Latest revision as of 06:22, 14 August 2021

Mycoplasma genitalium
File:Mycoplasma genitalium.gif
Scientific classification
Kingdom: Bacteria
Division: Firmicutes
Class: Mollicutes
Order: Mycoplasmatales
Family: Mycoplasmataceae
Genus: Mycoplasma
Species: M. genitalium
Binomial name
Mycoplasma genitalium
Tully et al., 1983

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2] Mohamed Riad, M.D.[3]

Overview

Mycoplasma genitalium infection is caused by the bacteria Mycoplasma genitalium. It was first isolated from 2 men with urethritis in the early 1980s, but was not recognized as a sexually transmitted disease until the early 1990s, following the development of polymerase chain reaction (PCR). Co-infection of Mycoplasma genitalium with other STDs is not uncommon. However, an isolated infection with Mycoplasma genitalium must be differentiated from other STDs, which may have a similar presentation. Mycoplasma genitalium infection is more common than Neisseria gonorrhea, but less common than Chlamydia trachomatis. However, it is not recognized as a common STD, largely because the infection is mostly asymptomatic. Symptoms are related to the complications it may cause, such as PID and cervicitis in women, and urethritis and epididymitis in men. Prompt antibiotic treatment is needed to prevent complications. Mycoplasma genitalium infection is prevented by promoting safe sexual practice, as well as the use of condoms.

Historical Perspective

Classification

Mycoplasma genitalium infection can be divided based on the clinical presentation into:[2][6][7][8][9][10]

  • Asymptomatic Mycoplasma genitalium infection
  • Symptomatic Mycoplasma genitalium infection: symptoms are related to PID or cervicitis in women and urethritis or epididymitis in men

Pathophysiology

Pathogenesis

Mode of Transmission

  • Mycoplasma genitalium is recognized as a sexually transmitted disease (STD) with the mode of transmission being through direct genital-to-genital contact and subsequent inoculation of infected secretions. Transmission of Mycoplasma genitalium has also been implicated in penile-anal intercourse.[2]
  • Mycoplasma genitalium is less likely to be transmitted via oro-genital contact, as carriage in the oropharynx is low.[2]
  • Whether or not Mycoplasma genitalium is vertically transmitted from mother to newborn is yet to be studied. However, the bacterium has been isolated from the respiratory tract of newborns.[2]

Incubation Period

The incubation period of Mycoplasma genitalium is unknown yet.[11]

Infectious Dose

The infectious dose of Mycoplasma genitalium is unknown yet.[11]

Factors facilitating the pathogenesis of Mycoplasma genitalium

The following virulence factors have been implicated in the pathogenesis of Mycoplasma genitalium:[1][2][12]

  • Adhesion molecules: Mycoplasma genitalium has the ability to attach to different types of cells, including red blood cells, respiratory cells, fallopian tube cells, as well as sperm cells. It is believed that the attachment to sperm cells facilitates the spread of Mycoplasma genitalium to the female genital tract. MgPa, a major adhesion in attachment protein complex, facilitates not only adhesion to epithelial cells, but also the motility of Mycoplasma genitalium.
  • Intracellular localization: Mycoplasma genitalium is a facultative intracellular organism and this allows for its survival both inside and outside of cells.
  • Antigenic variation: Mycoplasma genitalium is able to generate surface lipoprotein with high frequency, which helps it evade the human immune system.
  • Toxins: Mycoplasma genitalium has a calcium-dependent membrane associated nuclease known as MG-186. MG-186 is capable of degrading host cell nucleic acid, hence providing a source of nucleotides for the growth and pathogenesis of Mycoplasma genitalium.
  • Enzymes: Glyceraldehyde 3-phosphate dehydrogenase (GADPH) acts as a ligand to the receptors mucin and fibronectin, found on vaginal and cervical epithelium.
  • Immunological response: Mycoplasma genitalium possesses an immunogenic protein, MG-309, which secretes pro-inflammatory cytokines, such as IL-6 and IL-8. MG-309 exerts its effect via attaching to a toll-like receptor, hence activating nuclear factor kappa B (NF-kB)

Genetics

There are no identified genetic factors associated with Mycoplasma genitalium infection.

Associated Conditions

Mycoplasma genitalium infection is associated with co-infection with other sexually transmitted diseases, such as:[13]

Gross Pathology

Gross pathology of Mycoplasma genitalium infection is related to the disease processes it may result: cervicitis, PID, urethritis, or epididymitis.

Microscopic Pathology

Microscopic pathology of Mycoplasma genitalium infection is related to the disease processes it may result: cervicitis, PID, urethritis, or epididymitis.

Causes

The cause of Mycoplasma genitalium infection is Mycoplasma genitalium.

Differentiating Mycoplasma genitalium Infection from Other Diseases

Mycoplasma genitalium infection must be distinguished from other sexually transmitted diseases, which may have a similar presentation. These include:

Epidemiology and Demographics

  • The incidence and prevalence of Mycoplasma genitalium is not well established, because more than half of the women who tested positive were asymptomatic.[2]
  • In the United States, the prevalence of Mycoplasma genitalium was estimated as follows:[13]
    • The prevalence of Mycoplasma genitalium in all females aged 14-70 years old is 16.3%.
    • The prevalence of Mycoplasma genitalium in all males aged 18-78 years old is 17.2%.
    • Infection in both males and females was more prevalent in those younger than 30 years of age.
    • The overall prevalence of Mycoplasma genitalium infection is 1%, which makes it more prevalent than Neisseria gonorrhea (0.4%), but less common than Chlamydia trachomatis (4.2%).[15]
  • Between the years 2002-2011, the prevalence of Mycoplasma genitalium worldwide ranged between 4%-42%.[12]
  • Mycoplasma genitalium is the cause of about 15%–20% of nongonococcal urethritis and 40% of persistent or recurrent urethritis.[16]
  • Rectal infection with Mycoplasma genitalium was detected in 1%–26% of men who had sex with men and among approximately 3% of women; however, rectal infections are usually asymptomatic.[17][18]
  • Macrolides resistance and treatment failure have been reported between 44% and 90% in the United States, Canada, Australia, and Western Europe due to frequent use of azithromycin as a single treatment for Mycoplasma genitalium.[19][20][21]

Risk Factors

There several risk factors that have been identified with Mycoplasma genitalium infection. These risk factors include:[2][4][22]

  • High risk sexual behavior, defined as having >3 new sexual partners in the past year
  • Being engaged in sexual contact with persons with STDs, particularly Mycoplasma genitalium
  • Non-white race
  • Young age (<20 years old)
  • Smoking
  • Having less than high school education
  • Having an annual income of less than $10,000
  • Risk factors specific to females includes:

Screening

There are no recommendations for screening for Mycoplasma genitalium.[23]

Natural history, Complications and Prognosis

Natural History

If left untreated, Mycoplasma genitalium infection can lead to persistent cervicitis, PID, or urethritis.[3]

Complications

The following complications may be the result of Mycoplasma genitalium infection:[2][5][6][7][8][24][25][26][27][28][29][30]

Prognosis

The prognosis of Mycoplasma genitalium infection is generally excellent. Cure rates are almost 100% with the correct and prompt antibiotic treatment.[3]

History and Symptoms

The presenting symptoms of Mycoplasma genitalium are related to the disease processes it may cause. Presenting symptoms can be divided based on gender:

Physical Examination

Physical examination findings in Mycoplasma genitalium are related to the disease processes it may cause. These findings can be divided based on the several disease pathologies in males and females.

Laboratory Findings

Imaging Findings

X Ray

There is no role for x ray in Mycoplasma genitalium infection.

CT

CT scan may be used if Mycoplasma genitalium infection has been complicated by PID. These include thickened and fluid-filled tubes with or without free pelvic fluid.

MRI

MRI may be used if Mycoplasma genitalium infection has been complicated by PID.

Other Diagnostic Studies

There are no other diagnostic studies for Mycoplasma genitalium infection.

Medical Therapy

Mycoplasma genitalium is intracellular and lacks the cell wall; hence, eradication of the organism is sometimes challenging. The antibiotic drug of choice and dosing depends on susceptibility of the Mycoplasma genitalium strain, and the availability of macrolides-resistance testing , as follows:[38][39][40]

Recommended Regimens if Mycoplasma genitalium Resistance Testing Is Available

  • If macrolide sensitive: Doxycycline 100 mg orally 2 times/day for 7 days, followed by azithromycin 1 g orally initial dose, followed by 500 mg orally daily for 3 additional days (2.5 g total)
  • If macrolide resistant: Doxycycline 100 mg orally 2 times/day for 7 days followed by moxifloxacin 400 mg orally once daily for 7 days

Recommended Regimen if Mycoplasma genitalium Resistance Testing Is Not Available

Doxycycline 100 mg orally 2 times/day for 7 days, followed by moxifloxacin 400 mg orally once daily for 7 days

Surgery

Surgical intervention is not recommended for the management of Mycoplasma genitalium infection.

Primary Prevention

Since Mycoplasma genitalium infection is a sexually transmitted disease, prevention must target safe sexual practices. These include:[41][42]

  • Practicing safe sex with one partner and avoiding multiple sexual partners
  • Using condoms and/or other barrier methods

Secondary Prevention

Secondary prevention in Mycoplasma genitalium infection consists of the following measures:[2]

  • Prompt treatment with antibiotics to prevent complications of the infection
  • Test of cure is not recommended for asymptomatic individuals
  • Partner notification and evaluation: if partner does not attend evaluation for infection, then he/she can be offered the same treatment as the patient
  • Screening and treatment for other sexually transmitted diseases

References

  1. ↑ 1.0 1.1 Taylor-Robinson D, Jensen JS (2011). "Mycoplasma genitalium: from Chrysalis to multicolored butterfly". Clin. Microbiol. Rev. 24 (3): 498–514. doi:10.1128/CMR.00006-11. PMC 3131060. PMID 21734246.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 Jensen JS, Cusini M, Gomberg M, Moi H (2016). "Background review for the 2016 European guideline on Mycoplasma genitalium infections". J Eur Acad Dermatol Venereol. doi:10.1111/jdv.13850. PMID 27605499.
  3. ↑ 3.0 3.1 3.2 3.3 "Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines". J Miss State Med Assoc. 56 (12): 372–5. 2015. PMID 26975162.
  4. ↑ 4.0 4.1 4.2 Manhart LE, Critchlow CW, Holmes KK, Dutro SM, Eschenbach DA, Stevens CE, Totten PA (2003). "Mucopurulent cervicitis and Mycoplasma genitalium". J. Infect. Dis. 187 (4): 650–7. doi:10.1086/367992. PMID 12599082.
  5. ↑ 5.0 5.1 5.2 Ross JD, Jensen JS (2006). "Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment". Sex Transm Infect. 82 (4): 269–71. doi:10.1136/sti.2005.017368. PMC 2564705. PMID 16877571.
  6. ↑ 6.0 6.1 6.2 6.3 Falk L, Fredlund H, Jensen JS (2004). "Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis". Sex Transm Infect. 80 (4): 289–93. doi:10.1136/sti.2003.006817. PMC 1744873. PMID 15295128.
  7. ↑ 7.0 7.1 7.2 7.3 Jensen JS, Orsum R, Dohn B, Uldum S, Worm AM, Lind K (1993). "Mycoplasma genitalium: a cause of male urethritis?". Genitourin Med. 69 (4): 265–9. PMC 1195084. PMID 7721285.
  8. ↑ 8.0 8.1 8.2 8.3 Anagrius C, Loré B, Jensen JS (2005). "Mycoplasma genitalium: prevalence, clinical significance, and transmission". Sex Transm Infect. 81 (6): 458–62. doi:10.1136/sti.2004.012062. PMC 1745067. PMID 16326846.
  9. ↑ 9.0 9.1 9.2 Tosh AK, Van Der Pol B, Fortenberry JD, Williams JA, Katz BP, Batteiger BE, Orr DP (2007). "Mycoplasma genitalium among adolescent women and their partners". J Adolesc Health. 40 (5): 412–7. doi:10.1016/j.jadohealth.2006.12.005. PMC 1899169. PMID 17448398.
  10. ↑ 10.0 10.1 10.2 Korte JE, Baseman JB, Cagle MP, Herrera C, Piper JM, Holden AE, Perdue ST, Champion JD, Shain RN (2006). "Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium". Am. J. Reprod. Immunol. 55 (4): 265–75. doi:10.1111/j.1600-0897.2005.00359.x. PMID 16533338.
  11. ↑ 11.0 11.1 Public Health Agency of Canada http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/mycoplasma-genitalium-eng.php Accessed on Oct 6, 2016.
  12. ↑ 12.0 12.1 Sethi S, Singh G, Samanta P, Sharma M (2012). "Mycoplasma genitalium: an emerging sexually transmitted pathogen". Indian J. Med. Res. 136 (6): 942–55. PMC 3612323. PMID 23391789.
  13. ↑ 13.0 13.1 Getman D, Jiang A, O'Donnell M, Cohen S (2016). "Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States". J. Clin. Microbiol. 54 (9): 2278–83. doi:10.1128/JCM.01053-16. PMC 5005488. PMID 27307460.
  14. ↑ Vandepitte J, Weiss HA, Bukenya J, Kyakuwa N, Muller E, Buvé A; et al. (2014). "Association between Mycoplasma genitalium infection and HIV acquisition among female sex workers in Uganda: evidence from a nested case-control study". Sex Transm Infect. 90 (7): 545–9. doi:10.1136/sextrans-2013-051467. PMC 4215342. PMID :24687129 Check |pmid= value (help).
  15. ↑ Manhart LE, Holmes KK, Hughes JP, Houston LS, Totten PA (2007). "Mycoplasma genitalium among young adults in the United States: an emerging sexually transmitted infection". Am J Public Health. 97 (6): 1118–25. doi:10.2105/AJPH.2005.074062. PMC 1874220. PMID 17463380.
  16. ↑ Taylor-Robinson D, Jensen JS (2011). "Mycoplasma genitalium: from Chrysalis to multicolored butterfly". Clin Microbiol Rev. 24 (3): 498–514. doi:10.1128/CMR.00006-11. PMC 3131060. PMID 21734246.
  17. ↑ Cina M, Baumann L, Egli-Gany D, Halbeisen FS, Ali H, Scott P; et al. (2019). "Mycoplasma genitalium incidence, persistence, concordance between partners and progression: systematic review and meta-analysis". Sex Transm Infect. 95 (5): 328–335. doi:10.1136/sextrans-2018-053823. PMC 6678058 Check |pmc= value (help). PMID 31055469.
  18. ↑ Baumann L, Cina M, Egli-Gany D, Goutaki M, Halbeisen FS, Lohrer GR; et al. (2018). "Prevalence of Mycoplasma genitalium in different population groups: systematic review andmeta-analysis". Sex Transm Infect. 94 (4): 255–262. doi:10.1136/sextrans-2017-053384. PMC 5969327. PMID 29440466.
  19. ↑ Bachmann LH, Kirkcaldy RD, Geisler WM, Wiesenfeld HC, Manhart LE, Taylor SN; et al. (2020). "Prevalence of Mycoplasma genitalium Infection, Antimicrobial Resistance Mutations, and Symptom Resolution Following Treatment of Urethritis". Clin Infect Dis. 71 (10): e624–e632. doi:10.1093/cid/ciaa293. PMC 7744987 Check |pmc= value (help). PMID 32185385 Check |pmid= value (help).
  20. ↑ Pond MJ, Nori AV, Witney AA, Lopeman RC, Butcher PD, Sadiq ST (2014). "High prevalence of antibiotic-resistant Mycoplasma genitalium in nongonococcal urethritis: the need for routine testing and the inadequacy of current treatment options". Clin Infect Dis. 58 (5): 631–7. doi:10.1093/cid/cit752. PMC 3922211. PMID 24280088.
  21. ↑ Li Y, Su X, Le W, Li S, Yang Z, Chaisson C; et al. (2020). "Mycoplasma genitalium in Symptomatic Male Urethritis: Macrolide Use Is Associated With Increased Resistance". Clin Infect Dis. 70 (5): 805–810. doi:10.1093/cid/ciz294. PMC 7390511 Check |pmc= value (help). PMID 30972419.
  22. ↑ Hancock EB, Manhart LE, Nelson SJ, Kerani R, Wroblewski JK, Totten PA (2010). "Comprehensive assessment of sociodemographic and behavioral risk factors for Mycoplasma genitalium infection in women". Sex Transm Dis. 37 (12): 777–83. doi:10.1097/OLQ.0b013e3181e8087e. PMC 4628821. PMID 20679963.
  23. ↑ United States Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=mycoplasma+genitalium Accessed on Oct. 6, 2016.
  24. ↑ 24.0 24.1 Wetmore CM, Manhart LE, Lowens MS, Golden MR, Whittington WL, Xet-Mull AM, Astete SG, McFarland NL, McDougal SJ, Totten PA (2011). "Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study". Sex Transm Dis. 38 (3): 180–6. doi:10.1097/OLQ.0b013e3182040de9. PMC 4024216. PMID 21285914.
  25. ↑ Mena L, Wang X, Mroczkowski TF, Martin DH (2002). "Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans". Clin. Infect. Dis. 35 (10): 1167–73. doi:10.1086/343829. PMID 12410476.
  26. ↑ 26.0 26.1 Falk L, Fredlund H, Jensen JS (2005). "Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection". Sex Transm Infect. 81 (1): 73–8. doi:10.1136/sti.2004.010439. PMC 1763725. PMID 15681728.
  27. ↑ 27.0 27.1 Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC (2009). "Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics". Sex Transm Dis. 36 (10): 598–606. doi:10.1097/OLQ.0b013e3181b01948. PMC 2924808. PMID 19704398.
  28. ↑ Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL (2009). "Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease". Clin. Infect. Dis. 48 (1): 41–7. doi:10.1086/594123. PMC 2652068. PMID 19025498.
  29. ↑ Mobley VL, Hobbs MM, Lau K, Weinbaum BS, Getman DK, Seña AC (2012). "Mycoplasma genitalium infection in women attending a sexually transmitted infection clinic: diagnostic specimen type, coinfections, and predictors". Sex Transm Dis. 39 (9): 706–9. doi:10.1097/OLQ.0b013e318255de03. PMC 3428747. PMID 22902666.
  30. ↑ Tkach JR, Shannon AM, Beastrom R (1979). "Pseudofolliculitis due to preoperative shaving". AORN J. 30 (5): 881–4. doi:10.1016/s0001-2092(07)61393-3. PMID 259001.
  31. ↑ 31.0 31.1 Moi H, Reinton N, Moghaddam A (2009). "Mycoplasma genitalium in women with lower genital tract inflammation". Sex Transm Infect. 85 (1): 10–4. doi:10.1136/sti.2008.032748. PMID 18842689.
  32. ↑ Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL (2005). "Comparison of acute and subclinical pelvic inflammatory disease". Sex Transm Dis. 32 (7): 400–5. PMID 15976596.
  33. ↑ Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC (2001). "Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease". Am. J. Obstet. Gynecol. 184 (5): 856–63, discussion 863–4. doi:10.1067/mob.2001.113847. PMID 11303192.
  34. ↑ Horner PJ, Taylor-Robinson D (2011). "Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis". Sex Transm Infect. 87 (1): 38–40. doi:10.1136/sti.2010.044487. PMID 20852310.
  35. ↑ Workowski KA, Bolan GA (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.
  36. ↑ Huppert JS, Mortensen JE, Reed JL, Kahn JA, Rich KD, Hobbs MM (2008). "Mycoplasma genitalium detected by transcription-mediated amplification is associated with Chlamydia trachomatis in adolescent women". Sex Transm Dis. 35 (3): 250–4. doi:10.1097/OLQ.0b013e31815abac6. PMC 3807598. PMID 18490867.
  37. ↑ Högdahl M, Kihlström E (2007). "Leucocyte esterase testing of first-voided urine and urethral and cervical smears to identify Mycoplasma genitalium-infected men and women". Int J STD AIDS. 18 (12): 835–8. doi:10.1258/095646207782716983. PMID 18073017.
  38. ↑ Durukan D, Read TRH, Murray G, Doyle M, Chow EPF, Vodstrcil LA; et al. (2020). "Resistance-Guided Antimicrobial Therapy Using Doxycycline-Moxifloxacin and Doxycycline-2.5 g Azithromycin for the Treatment of Mycoplasma genitalium Infection: Efficacy and Tolerability". Clin Infect Dis. 71 (6): 1461–1468. doi:10.1093/cid/ciz1031. PMID 31629365.
  39. ↑ Li Y, Le WJ, Li S, Cao YP, Su XH (2017). "Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection". Int J STD AIDS. 28 (11): 1106–1114. doi:10.1177/0956462416688562. PMID 28118803.
  40. ↑ Mondeja BA, Couri J, Rodríguez NM, Blanco O, Fernández C, Jensen JS (2018). "Macrolide-resistant Mycoplasma genitalium infections in Cuban patients: an underestimated health problem". BMC Infect Dis. 18 (1): 601. doi:10.1186/s12879-018-3523-9. PMC 6264040. PMID 30486786.
  41. ↑ LeFevre ML. USPSTF: behavioral counseling interventions to prevent sexually transmitted infections. Ann Intern Med 2014;161:894–901.
  42. ↑ Warner L, Stone KM, Macaluso M, et al. Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006;33:36–51.
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