wikidoc - User contributions [en]

User:Mohamed riad

2021-11-22T01:38:02Z

Mohamed riad:

'''Mohamed Riad Abdelgawad Abouzid, M.D,''' Research Fellow, Institute of Molecular Cardiology, University of Louisville.

'''Contact:''' mohamed.riad22@yahoo.com and mohamedriadabdelgawad.abouzid@louisville.edu

COVID-19 Variants of Concern

2021-08-20T06:34:07Z

Mohamed riad:

__NOTOC__
{{COVID-19}}
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 

{{CMG}} ; {{AE}} {{Mohamed riad}}

==Overview==
As a result of mutations occurring in [[COVID-19]] virus, new variants of COVID-19 emerge and most of them are being tracked in the United States. The '''''"variants of concern"''''' refer to those [[COVID-19]] variants with clear evidence of an increased rate of transmission, severe illness and death, marked decrease in neutralization by antibodies produced as a result of previous infection or vaccination, decreased effectiveness of [[Vaccine|vaccines]] or treatments, or failure of diagnostic detection.

==Variants of Concern==
As in all [[viruses]], [[COVID-19]] virus continuously undergo spontaneous [[Mutation|mutations]] followed by emergence of new variants of [[COVID-19]]. Some of these variants appear then disappear; however, others persist causing global [[pandemic]]. The best way to fight against the appearance of new variants is commitment to the protective measures.

The '''''"variants of concern"''''' refer to those [[COVID-19]] variants with clear evidence of an increased rate of transmission, severe illness and death, marked decrease in neutralization by antibodies produced as a result of previous infection or vaccination, decreased effectiveness of [[Vaccine|vaccines]] or treatments, or failure of diagnostic detection. The [[genomic]] and [[Epidemiology|epidemiological]] as well as other properties of these variants are summarized in the table below.
{| class="wikitable"
|+
!WHO Label
!Name
!Countries of Earlier Detection
!Time of First Detection
!Spike Protein Substitutions
!BEI Reference Isolate
!Properties
!Rate of Spread
!Severe Illness and Mortality
!Vaccine
!Treatments
|-
|Alpha B.1.1.7
|20I/501Y.V1
|United Kingdom
|September 2020
|69del, 70del, 144del, (E484K*), (S494P*), N501Y, A570D, D614G, P681H, T716I, S982A, D1118H (K1191N*)
|NR-54000external icon
|
*Approximately 50% increased transmissibility
*Increased severity according to hospitalizations and case fatality rates
*Little effect on neutralization by convalescent and post-vaccination sera
|High
|Occur
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Effective
|-
|Beta B.1.357
|20H/501.V2
|South Africa
|September 2020
|D80A, D215G, 241del, 242del, 243del, K417N, E484K, N501Y, D614G, A701V
|NR-55282
|
*Approximately 50% increased transmissibility
*A marked decrease in the susceptibility to the combination of bamlanivimab and etesevimab monoclonal antibody treatment; however, other EUA monoclonal antibody treatments are available
*Decreased neutralization by convalescent and post-vaccination sera
|High
|Not common
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|-
|Gamma P.1
|20J/501Y.V3
|Brazil and Japan
|December 2020
|L18F, T20N, P26S, D138Y, R190S, K417T, E484K, N501Y, D614G, H655Y, T1027I
|NR-54982
|
*A marked decrease in the susceptibility to the combination of bamlanivimab and etesevimab monoclonal antibody treatment; however, other EUA monoclonal antibody treatments are available
*Decreased neutralization by convalescent and post-vaccination sera
|High
|Not common
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|-
|Delta B.1.617.2
|21A/S:478K
|India
|December 2020
|T19R, (V70F*), T95I, G142D, E156-, F157-, R158G, (A222V*), (W258L*), (K417N*), L452R, T478K, D614G, P681R, D950N
|
|
*Increased transmissibility
*Decreased neutralization by some EUA monoclonal antibody treatments 
*Significant decrease in neutralization by post-vaccination sera
|Characterized by the highest rate of spread among these variants
|Characterized by higher rates of hospitalizations, severe illness, and death than other variants
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|}
'''BEI Resources:''' refer to the "Biodefense and Emerging Infections Research Resources" that is a NIAID-funded repository to provide reagents, tools, and information to the research community.

==References==

COVID-19 Variants of Concern

2021-08-20T06:33:42Z

Mohamed riad: /* Variants of Concern */

__NOTOC__
{{COVID-19}}
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 

{{CMG}} ; {{AE}}

==Overview==
As a result of mutations occurring in [[COVID-19]] virus, new variants of COVID-19 emerge and most of them are being tracked in the United States. The '''''"variants of concern"''''' refer to those [[COVID-19]] variants with clear evidence of an increased rate of transmission, severe illness and death, marked decrease in neutralization by antibodies produced as a result of previous infection or vaccination, decreased effectiveness of [[Vaccine|vaccines]] or treatments, or failure of diagnostic detection.

==Variants of Concern==
As in all [[viruses]], [[COVID-19]] virus continuously undergo spontaneous [[Mutation|mutations]] followed by emergence of new variants of [[COVID-19]]. Some of these variants appear then disappear; however, others persist causing global [[pandemic]]. The best way to fight against the appearance of new variants is commitment to the protective measures.

The '''''"variants of concern"''''' refer to those [[COVID-19]] variants with clear evidence of an increased rate of transmission, severe illness and death, marked decrease in neutralization by antibodies produced as a result of previous infection or vaccination, decreased effectiveness of [[Vaccine|vaccines]] or treatments, or failure of diagnostic detection. The [[genomic]] and [[Epidemiology|epidemiological]] as well as other properties of these variants are summarized in the table below.
{| class="wikitable"
|+
!WHO Label
!Name
!Countries of Earlier Detection
!Time of First Detection
!Spike Protein Substitutions
!BEI Reference Isolate
!Properties
!Rate of Spread
!Severe Illness and Mortality
!Vaccine
!Treatments
|-
|Alpha B.1.1.7
|20I/501Y.V1
|United Kingdom
|September 2020
|69del, 70del, 144del, (E484K*), (S494P*), N501Y, A570D, D614G, P681H, T716I, S982A, D1118H (K1191N*)
|NR-54000external icon
|
*Approximately 50% increased transmissibility
*Increased severity according to hospitalizations and case fatality rates
*Little effect on neutralization by convalescent and post-vaccination sera
|High
|Occur
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Effective
|-
|Beta B.1.357
|20H/501.V2
|South Africa
|September 2020
|D80A, D215G, 241del, 242del, 243del, K417N, E484K, N501Y, D614G, A701V
|NR-55282
|
*Approximately 50% increased transmissibility
*A marked decrease in the susceptibility to the combination of bamlanivimab and etesevimab monoclonal antibody treatment; however, other EUA monoclonal antibody treatments are available
*Decreased neutralization by convalescent and post-vaccination sera
|High
|Not common
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|-
|Gamma P.1
|20J/501Y.V3
|Brazil and Japan
|December 2020
|L18F, T20N, P26S, D138Y, R190S, K417T, E484K, N501Y, D614G, H655Y, T1027I
|NR-54982
|
*A marked decrease in the susceptibility to the combination of bamlanivimab and etesevimab monoclonal antibody treatment; however, other EUA monoclonal antibody treatments are available
*Decreased neutralization by convalescent and post-vaccination sera
|High
|Not common
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|-
|Delta B.1.617.2
|21A/S:478K
|India
|December 2020
|T19R, (V70F*), T95I, G142D, E156-, F157-, R158G, (A222V*), (W258L*), (K417N*), L452R, T478K, D614G, P681R, D950N
|
|
*Increased transmissibility
*Decreased neutralization by some EUA monoclonal antibody treatments 
*Significant decrease in neutralization by post-vaccination sera
|Characterized by the highest rate of spread among these variants
|Characterized by higher rates of hospitalizations, severe illness, and death than other variants
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|}
'''BEI Resources:''' refer to the "Biodefense and Emerging Infections Research Resources" that is a NIAID-funded repository to provide reagents, tools, and information to the research community.

==References==

COVID-19 Variants of Concern

2021-08-20T06:27:27Z

Mohamed riad: /* Variants of Concern */

__NOTOC__
{{COVID-19}}
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 

{{CMG}} ; {{AE}}

==Overview==
As a result of mutations occurring in [[COVID-19]] virus, new variants of COVID-19 emerge and most of them are being tracked in the United States. The '''''"variants of concern"''''' refer to those [[COVID-19]] variants with clear evidence of an increased rate of transmission, severe illness and death, marked decrease in neutralization by antibodies produced as a result of previous infection or vaccination, decreased effectiveness of [[Vaccine|vaccines]] or treatments, or failure of diagnostic detection.

==Variants of Concern==
As in all [[viruses]], [[COVID-19]] virus continuously undergo spontaneous [[Mutation|mutations]] followed by emergence of new variants of [[COVID-19]]. Some of these variants appear then disappear; however, others persist causing global [[pandemic]]. The best way to fight against the appearance of new variants is commitment to the protective measures.

The '''''"variants of concern"''''' refer to those [[COVID-19]] variants with clear evidence of an increased rate of transmission, severe illness and death, marked decrease in neutralization by antibodies produced as a result of previous infection or vaccination, decreased effectiveness of [[Vaccine|vaccines]] or treatments, or failure of diagnostic detection. The [[genomic]] and [[Epidemiology|epidemiological]] as well as other properties of these variants are summarized in the table below.
{| class="wikitable"
|+
!WHO Label
!Name
!Countries of Earlier Detection
!Time of First Detection
!Spike Protein Substitutions
!BEI Reference Isolate
!Properties
!Rate of Spread
!Severe Illness and Mortality
!Vaccine
!Treatments
|-
|Alpha B.1.1.7
|20I/501Y.V1
|United Kingdom
|September 2020
|69del, 70del, 144del, (E484K*), (S494P*), N501Y, A570D, D614G, P681H, T716I, S982A, D1118H (K1191N*)
|NR-54000external icon
|
*Approximately 50% increased transmissibility
*Increased severity according to hospitalizations and case fatality rates
*Little effect on neutralization by convalescent and post-vaccination sera
|High
|Occur
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Effective
|-
|Beta B.1.357
|20H/501.V2
|South Africa
|September 2020
|D80A, D215G, 241del, 242del, 243del, K417N, E484K, N501Y, D614G, A701V
|NR-55282
|
*Approximately 50% increased transmissibility
*A marked decrease in the susceptibility to the combination of bamlanivimab and etesevimab monoclonal antibody treatment; however, other EUA monoclonal antibody treatments are available
*Decreased neutralization by convalescent and post-vaccination sera
|High
|Not common
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|-
|Gamma P.1
|20J/501Y.V3
|Brazil and Japan
|December 2020
|L18F, T20N, P26S, D138Y, R190S, K417T, E484K, N501Y, D614G, H655Y, T1027I
|NR-54982
|
*A marked decrease in the susceptibility to the combination of bamlanivimab and etesevimab monoclonal antibody treatment; however, other EUA monoclonal antibody treatments are available
*Decreased neutralization by convalescent and post-vaccination sera
|High
|Not common
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|-
|Delta B.1.617.2
|21A/S:478K
|India
|December 2020
|T19R, (V70F*), T95I, G142D, E156-, F157-, R158G, (A222V*), (W258L*), (K417N*), L452R, T478K, D614G, P681R, D950N
|
|
*Increased transmissibility
*Decreased neutralization by some EUA monoclonal antibody treatments 
*Significant decrease in neutralization by post-vaccination sera
|Characterized by the highest rate of spread among these variants
|Characterized by higher rates of hospitalizations, severe illness, and death than other variants
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|}

==References==

COVID-19 Variants of Concern

2021-08-20T05:44:04Z

Mohamed riad: /* Variants of Concern */

__NOTOC__
{{COVID-19}}
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 

{{CMG}} ; {{AE}}

==Overview==

==Variants of Concern==
As in all viruses, COVID-19 virus continuously undergo spontaneous mutations followed by emergence of new variants of COVID-19. Some of these variants appear then disappear; however, others persist causing global pandemic. The best way to fight against the appearance of new variants is commitment to the protective measures.

The '''''"variants of concern"''''' refer to those COVID-19 variants with evidence of an increased rate of transmission, severe illness and death, marked decrease in neutralization by antibodies produced as a result of previous infection or vaccination, decreased effectiveness of vaccines or treatments, or failure of diagnostic detection.
{| class="wikitable"
|+
!WHO Label
!Name
!Countries of Earlier Detection
!Time of First Detection
!Spike Protein Substitutions
!BEI Reference Isolate
!Properties
!Rate of Spread
!Severe Illness and Mortality
!Vaccine
!Treatments
|-
|Alpha B.1.1.7
|20I/501Y.V1
|United Kingdom
|September 2020
|69del, 70del, 144del, (E484K*), (S494P*), N501Y, A570D, D614G, P681H, T716I, S982A, D1118H (K1191N*)
|NR-54000external icon
|
*Approximately 50% increased transmissibility
*Increased severity according to hospitalizations and case fatality rates
*Little effect on neutralization by convalescent and post-vaccination sera
|High
|Occur
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Effective
|-
|Beta B.1.357
|20H/501.V2
|South Africa
|September 2020
|D80A, D215G, 241del, 242del, 243del, K417N, E484K, N501Y, D614G, A701V
|NR-55282
|
*Approximately 50% increased transmissibility
*A marked decrease in the susceptibility to the combination of bamlanivimab and etesevimab monoclonal antibody treatment; however, other EUA monoclonal antibody treatments are available
*Decreased neutralization by convalescent and post-vaccination sera
|High
|Not common
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|-
|Gamma P.1
|20J/501Y.V3
|Brazil and Japan
|December 2020
|L18F, T20N, P26S, D138Y, R190S, K417T, E484K, N501Y, D614G, H655Y, T1027I
|NR-54982
|
*A marked decrease in the susceptibility to the combination of bamlanivimab and etesevimab monoclonal antibody treatment; however, other EUA monoclonal antibody treatments are available
*Decreased neutralization by convalescent and post-vaccination sera
|High
|Not common
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|-
|Delta B.1.617.2
|21A/S:478K
|India
|December 2020
|T19R, (V70F*), T95I, G142D, E156-, F157-, R158G, (A222V*), (W258L*), (K417N*), L452R, T478K, D614G, P681R, D950N
|
|
*Increased transmissibility
*Decreased neutralization by some EUA monoclonal antibody treatments 
*Significant decrease in neutralization by post-vaccination sera
|Characterized by the highest rate of spread among these variants
|Characterized by higher rates of hospitalizations, severe illness, and death than other variants
|
*Effective
*Rarely, breakthrough infections in vaccinated individuals may occur
|Less effective
|}

==References==

COVID-19 Variants of Concern

2021-08-20T05:18:58Z

Mohamed riad: /* Variants of Concern */

COVID-19 Variants of Concern

2021-08-20T04:46:22Z

Mohamed riad: /* Variants of Concern */

COVID-19 Variants of Concern

2021-08-20T02:28:51Z

Mohamed riad: /* Variants of Concern */

Colitis

2021-08-14T22:21:07Z

Mohamed riad:

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}}; {{Mohamed riad}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Infectious colitis]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
*Protozoan (''[[Entamoeba histolytica]]'')
*[[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Lymphocytic colitis]]
*[[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Iatrogenic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Diversion colitis]]
*[[Chemical colitis]]
*[[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Vascular'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unclassifiable'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
*Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:

*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===

*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===

*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===

*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===

*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

==Screening==
There is insufficient evidence to recommend routine screening of sexual partners of patients with sexually transmitted enteric pathogens.

==Diagnosis==

===History and Symptoms===

*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
*Symptoms of [[proctocolitis]] include fatigue, weight loss, [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].

===Laboratory Findings===
Laboratory findings consistent with the diagnosis of proctitis include:

*[[Stool examination]]: Detection of [[blood]] or fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
*[[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. [[CMV]] and other [[Opportunistic infection|opportunistic infections]] may be evaluated in [[Immunosuppression|immunosuppressed]] individuals as [[HIV AIDS|HIV/AIDS]].
*An elevated [[erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]]) is one typical finding in the acute exacerbation of [[proctocolitis]].

===Other Imaging Findings===

====Colonoscopy====
[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]]. 

==Treatment==

===Medical Therapy===
Acute [[proctocolitis]] among individuals with receptive anal exposure is often [[sexually-transmitted]]. [[Empiric therapy|Empiric]] [[antibiotic]] treatment should be started while awaiting for the results of laboratory tests for

patients presenting with anorectal [[exudate]] on anoscopy or positive [[Gram staining|Gram]]-stained [[Smear test|smear]] of [[anorectal]] exudate or secretions [[polymorphonuclear leukocytes]] or if anoscopy or Gram stain is not available.<ref name="pmid24275725">{{cite journal| author=Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M| title=The etiology of infectious proctitis in men who have sex with men differs according to HIV status. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 10 | pages= 768-70 | pmid=24275725 | doi=10.1097/OLQ.0000000000000022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24275725 }}</ref>

====Recommended Regimen for Acute Proctitis====
'''[[Ceftriaxone]]''' 500 mg IM in a single dose

plus

'''[[Doxycycline]]''' 100 mg orally 2 times/day for 7 days

*[[Doxycycline]] course is continued to 100 mg orally 2 times/day for 21 days in case of [[Perianal abscess|perianal]] or [[mucosal]] [[Ulcer|ulcers]], [[Dysentery|bloody]] [[discharge]], or [[tenesmus]] and a positive [[rectal]] [[chlamydia]] test.
*For individuals weighing ≥150 kg, 1 g of [[ceftriaxone]] is given.
*Patients presenting with [[mucosal]] or [[Perianal abscess|perianal]] ulcers or [[bloody diarrhea]] with positive [[Nucleic acid test|NAAT]] for [[chlamydia]] should receive [[Empiric therapy|empiric]] therapy for [[Lymphogranuloma venereum|Lymphogranuloma Venereum]] (LGV) with a prolonged course of [[doxycycline]] 100 mg orally 2 times/day for 3 weeks.<ref name="pmid25394161">{{cite journal| author=Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ| title=Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment. | journal=J Int AIDS Soc | year= 2014 | volume= 17 | issue= 4 Suppl 3 | pages= 19657 | pmid=25394161 | doi=10.7448/IAS.17.4.19657 | pmc=4225278 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25394161 }}</ref>
*Patients presenting with [[painful]] [[Perianal abscess|perianal]] [[Ulcer|ulcers]] or [[mucosal]] [[Ulcer|ulcers]] on anoscopy should also receive [[Empiric therapy|empiric]] treatment for [[genital herpes]].
*[[Herpes Genitalis|Herpes]] [[proctocolitis]] and [[Lymphogranuloma venereum|LGV]] occur predominantly among [[HIV AIDS|HIV/AIDS]] patients; hence [[Empiric therapy|empiric]] treatment in those patients should cover [[Herpes simplex|genital herpes]] and [[Lymphogranuloma venereum|LGV]].

===Surgery===
Surgical intervention is not recommended for the management of [[proctocolitis]].

==Primary Prevention==
As [[proctocolitis]] can be a sexually transmitted disease, effective measures for the primary prevention of [[proctocolitis]] include:

*[[Counseling]] on safe sex practices
*Avoiding contact with feces during [[sexual intercourse]]
*Hand washing after handing objects or materials that have been in contact with the [[Anal-oral contact|anal]] area (i.e., sex toys or barriers) and after touching the anal area.

==Secondary Prevention==
Effective measures for the secondary prevention of [[proctocolitis]] include:

*Abstinence from sexual activity until the patient and their partners are successfully treated (i.e., completion of a 7-day regimen and resolution of symptoms)
*Sexual partners with individuals treated for [[Chlamydia infection|chlamydia]] or [[gonorrhea]] <60 days before the onset of symptoms should receive evaluation and empiric treatment of the causative infection
*Testing for other sexually-transmitted diseases
*In case of [[proctocolitis]] caused by [[Chlamydia infection|chlamydia]] or [[Neisseria gonorrhoeae|Neisseria gonorrhea]], retesting for the causative organism is recommended 3 months after completion of treatment.

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

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T22:19:34Z

Mohamed riad: /* Secondary Prevention */

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Infectious colitis]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
*Protozoan (''[[Entamoeba histolytica]]'')
*[[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Lymphocytic colitis]]
*[[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Iatrogenic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Diversion colitis]]
*[[Chemical colitis]]
*[[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Vascular'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unclassifiable'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
*Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:

*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===

*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===

*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===

*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===

*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

==Screening==
There is insufficient evidence to recommend routine screening of sexual partners of patients with sexually transmitted enteric pathogens.

==Diagnosis==

===History and Symptoms===

*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
*Symptoms of [[proctocolitis]] include fatigue, weight loss, [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].

===Laboratory Findings===
Laboratory findings consistent with the diagnosis of proctitis include:

*[[Stool examination]]: Detection of [[blood]] or fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
*[[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. [[CMV]] and other [[Opportunistic infection|opportunistic infections]] may be evaluated in [[Immunosuppression|immunosuppressed]] individuals as [[HIV AIDS|HIV/AIDS]].
*An elevated [[erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]]) is one typical finding in the acute exacerbation of [[proctocolitis]].

===Other Imaging Findings===

====Colonoscopy====
[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]]. 

==Treatment==

===Medical Therapy===
Acute [[proctocolitis]] among individuals with receptive anal exposure is often [[sexually-transmitted]]. [[Empiric therapy|Empiric]] [[antibiotic]] treatment should be started while awaiting for the results of laboratory tests for

patients presenting with anorectal [[exudate]] on anoscopy or positive [[Gram staining|Gram]]-stained [[Smear test|smear]] of [[anorectal]] exudate or secretions [[polymorphonuclear leukocytes]] or if anoscopy or Gram stain is not available.<ref name="pmid24275725">{{cite journal| author=Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M| title=The etiology of infectious proctitis in men who have sex with men differs according to HIV status. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 10 | pages= 768-70 | pmid=24275725 | doi=10.1097/OLQ.0000000000000022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24275725 }}</ref>

====Recommended Regimen for Acute Proctitis====
'''[[Ceftriaxone]]''' 500 mg IM in a single dose

plus

'''[[Doxycycline]]''' 100 mg orally 2 times/day for 7 days

*[[Doxycycline]] course is continued to 100 mg orally 2 times/day for 21 days in case of [[Perianal abscess|perianal]] or [[mucosal]] [[Ulcer|ulcers]], [[Dysentery|bloody]] [[discharge]], or [[tenesmus]] and a positive [[rectal]] [[chlamydia]] test.
*For individuals weighing ≥150 kg, 1 g of [[ceftriaxone]] is given.
*Patients presenting with [[mucosal]] or [[Perianal abscess|perianal]] ulcers or [[bloody diarrhea]] with positive [[Nucleic acid test|NAAT]] for [[chlamydia]] should receive [[Empiric therapy|empiric]] therapy for [[Lymphogranuloma venereum|Lymphogranuloma Venereum]] (LGV) with a prolonged course of [[doxycycline]] 100 mg orally 2 times/day for 3 weeks.<ref name="pmid25394161">{{cite journal| author=Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ| title=Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment. | journal=J Int AIDS Soc | year= 2014 | volume= 17 | issue= 4 Suppl 3 | pages= 19657 | pmid=25394161 | doi=10.7448/IAS.17.4.19657 | pmc=4225278 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25394161 }}</ref>
*Patients presenting with [[painful]] [[Perianal abscess|perianal]] [[Ulcer|ulcers]] or [[mucosal]] [[Ulcer|ulcers]] on anoscopy should also receive [[Empiric therapy|empiric]] treatment for [[genital herpes]].
*[[Herpes Genitalis|Herpes]] [[proctocolitis]] and [[Lymphogranuloma venereum|LGV]] occur predominantly among [[HIV AIDS|HIV/AIDS]] patients; hence [[Empiric therapy|empiric]] treatment in those patients should cover [[Herpes simplex|genital herpes]] and [[Lymphogranuloma venereum|LGV]].

===Surgery===
Surgical intervention is not recommended for the management of [[proctocolitis]].

==Primary Prevention==
As [[proctocolitis]] can be a sexually transmitted disease, effective measures for the primary prevention of [[proctocolitis]] include:

*[[Counseling]] on safe sex practices
*Avoiding contact with feces during [[sexual intercourse]]
*Hand washing after handing objects or materials that have been in contact with the [[Anal-oral contact|anal]] area (i.e., sex toys or barriers) and after touching the anal area.

==Secondary Prevention==
Effective measures for the secondary prevention of [[proctocolitis]] include:

*Abstinence from sexual activity until the patient and their partners are successfully treated (i.e., completion of a 7-day regimen and resolution of symptoms)
*Sexual partners with individuals treated for [[Chlamydia infection|chlamydia]] or [[gonorrhea]] <60 days before the onset of symptoms should receive evaluation and empiric treatment of the causative infection
*Testing for other sexually-transmitted diseases
*In case of [[proctocolitis]] caused by [[Chlamydia infection|chlamydia]] or [[Neisseria gonorrhoeae|Neisseria gonorrhea]], retesting for the causative organism is recommended 3 months after completion of treatment.

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

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T22:18:08Z

Mohamed riad: /* Laboratory Findings */

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Infectious colitis]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
*Protozoan (''[[Entamoeba histolytica]]'')
*[[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Lymphocytic colitis]]
*[[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Iatrogenic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Diversion colitis]]
*[[Chemical colitis]]
*[[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Vascular'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unclassifiable'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
*Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:

*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===

*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===

*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===

*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===

*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

==Screening==
There is insufficient evidence to recommend routine screening of sexual partners of patients with sexually transmitted enteric pathogens.

==Diagnosis==

===History and Symptoms===

*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
*Symptoms of [[proctocolitis]] include fatigue, weight loss, [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].

===Laboratory Findings===
Laboratory findings consistent with the diagnosis of proctitis include:

*[[Stool examination]]: Detection of [[blood]] or fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
*[[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. [[CMV]] and other [[Opportunistic infection|opportunistic infections]] may be evaluated in [[Immunosuppression|immunosuppressed]] individuals as [[HIV AIDS|HIV/AIDS]].
*An elevated [[erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]]) is one typical finding in the acute exacerbation of [[proctocolitis]].

===Other Imaging Findings===

====Colonoscopy====
[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]]. 

==Treatment==

===Medical Therapy===
Acute [[proctocolitis]] among individuals with receptive anal exposure is often [[sexually-transmitted]]. [[Empiric therapy|Empiric]] [[antibiotic]] treatment should be started while awaiting for the results of laboratory tests for

patients presenting with anorectal [[exudate]] on anoscopy or positive [[Gram staining|Gram]]-stained [[Smear test|smear]] of [[anorectal]] exudate or secretions [[polymorphonuclear leukocytes]] or if anoscopy or Gram stain is not available.<ref name="pmid24275725">{{cite journal| author=Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M| title=The etiology of infectious proctitis in men who have sex with men differs according to HIV status. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 10 | pages= 768-70 | pmid=24275725 | doi=10.1097/OLQ.0000000000000022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24275725 }}</ref>

====Recommended Regimen for Acute Proctitis====
'''[[Ceftriaxone]]''' 500 mg IM in a single dose

plus

'''[[Doxycycline]]''' 100 mg orally 2 times/day for 7 days

*[[Doxycycline]] course is continued to 100 mg orally 2 times/day for 21 days in case of [[Perianal abscess|perianal]] or [[mucosal]] [[Ulcer|ulcers]], [[Dysentery|bloody]] [[discharge]], or [[tenesmus]] and a positive [[rectal]] [[chlamydia]] test.
*For individuals weighing ≥150 kg, 1 g of [[ceftriaxone]] is given.
*Patients presenting with [[mucosal]] or [[Perianal abscess|perianal]] ulcers or [[bloody diarrhea]] with positive [[Nucleic acid test|NAAT]] for [[chlamydia]] should receive [[Empiric therapy|empiric]] therapy for [[Lymphogranuloma venereum|Lymphogranuloma Venereum]] (LGV) with a prolonged course of [[doxycycline]] 100 mg orally 2 times/day for 3 weeks.<ref name="pmid25394161">{{cite journal| author=Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ| title=Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment. | journal=J Int AIDS Soc | year= 2014 | volume= 17 | issue= 4 Suppl 3 | pages= 19657 | pmid=25394161 | doi=10.7448/IAS.17.4.19657 | pmc=4225278 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25394161 }}</ref>
*Patients presenting with [[painful]] [[Perianal abscess|perianal]] [[Ulcer|ulcers]] or [[mucosal]] [[Ulcer|ulcers]] on anoscopy should also receive [[Empiric therapy|empiric]] treatment for [[genital herpes]].
*[[Herpes Genitalis|Herpes]] [[proctocolitis]] and [[Lymphogranuloma venereum|LGV]] occur predominantly among [[HIV AIDS|HIV/AIDS]] patients; hence [[Empiric therapy|empiric]] treatment in those patients should cover [[Herpes simplex|genital herpes]] and [[Lymphogranuloma venereum|LGV]].

===Surgery===
Surgical intervention is not recommended for the management of [[proctocolitis]].

==Primary Prevention==
As [[proctocolitis]] can be a sexually transmitted disease, effective measures for the primary prevention of [[proctocolitis]] include:

*[[Counseling]] on safe sex practices
*Avoiding contact with feces during [[sexual intercourse]]
*Hand washing after handing objects or materials that have been in contact with the [[Anal-oral contact|anal]] area (i.e., sex toys or barriers) and after touching the anal area.

==Secondary Prevention==

*Abstinence from sexual activity until the patient and their partners are successfully treated (i.e., completion of a 7-day regimen and resolution of symptoms)
*Sexual partners with individuals treated for [[Chlamydia infection|chlamydia]] or [[gonorrhea]] <60 days before the onset of symptoms should receive evaluation and empiric treatment of the causative infection
*Testing for other sexually-transmitted diseases
*In case of [[proctocolitis]] caused by [[Chlamydia infection|chlamydia]] or [[Neisseria gonorrhoeae|Neisseria gonorrhea]], retesting for the causative organism is recommended 3 months after completion of treatment.

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

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T22:13:35Z

Mohamed riad:

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Infectious colitis]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
*Protozoan (''[[Entamoeba histolytica]]'')
*[[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Lymphocytic colitis]]
*[[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Iatrogenic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Diversion colitis]]
*[[Chemical colitis]]
*[[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Vascular'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unclassifiable'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
*Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:

*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===

*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===

*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===

*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===

*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

===Diagnostic Tests===
Common tests which may reveal diagnosis of colitis include:

*Abdominal [[X-ray]]s
*Testing the stool for blood and pus
*[[Sigmoidoscopy]]
*[[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbation of colitis.

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

== Screening ==
There is insufficient evidence to recommend routine screening of sexual partners of patients with sexually transmitted enteric pathogens.

==Diagnosis==

===History and Symptoms===

*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
*Symptoms of [[proctocolitis]] include fatigue, weight loss, [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].

===Laboratory Findings===
Laboratory findings consistent with the diagnosis of proctitis include:

*[[Stool examination]]: Detection of fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
*[[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. [[CMV]] and other [[Opportunistic infection|opportunistic infections]] may be evaluated in [[Immunosuppression|immunosuppressed]] individuals as [[HIV AIDS|HIV/AIDS]].

===Other Imaging Findings===

====Colonoscopy====
[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]]. 

==Treatment==

===Medical Therapy===
Acute [[proctocolitis]] among individuals with receptive anal exposure is often [[sexually-transmitted]]. [[Empiric therapy|Empiric]] [[antibiotic]] treatment should be started while awaiting for the results of laboratory tests for

patients presenting with anorectal [[exudate]] on anoscopy or positive [[Gram staining|Gram]]-stained [[Smear test|smear]] of [[anorectal]] exudate or secretions [[polymorphonuclear leukocytes]] or if anoscopy or Gram stain is not available.<ref name="pmid24275725">{{cite journal| author=Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M| title=The etiology of infectious proctitis in men who have sex with men differs according to HIV status. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 10 | pages= 768-70 | pmid=24275725 | doi=10.1097/OLQ.0000000000000022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24275725 }}</ref>

====Recommended Regimen for Acute Proctitis====
'''[[Ceftriaxone]]''' 500 mg IM in a single dose

plus

'''[[Doxycycline]]''' 100 mg orally 2 times/day for 7 days

*[[Doxycycline]] course is continued to 100 mg orally 2 times/day for 21 days in case of [[Perianal abscess|perianal]] or [[mucosal]] [[Ulcer|ulcers]], [[Dysentery|bloody]] [[discharge]], or [[tenesmus]] and a positive [[rectal]] [[chlamydia]] test.
*For individuals weighing ≥150 kg, 1 g of [[ceftriaxone]] is given.
*Patients presenting with [[mucosal]] or [[Perianal abscess|perianal]] ulcers or [[bloody diarrhea]] with positive [[Nucleic acid test|NAAT]] for [[chlamydia]] should receive [[Empiric therapy|empiric]] therapy for [[Lymphogranuloma venereum|Lymphogranuloma Venereum]] (LGV) with a prolonged course of [[doxycycline]] 100 mg orally 2 times/day for 3 weeks.<ref name="pmid25394161">{{cite journal| author=Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ| title=Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment. | journal=J Int AIDS Soc | year= 2014 | volume= 17 | issue= 4 Suppl 3 | pages= 19657 | pmid=25394161 | doi=10.7448/IAS.17.4.19657 | pmc=4225278 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25394161 }}</ref>
*Patients presenting with [[painful]] [[Perianal abscess|perianal]] [[Ulcer|ulcers]] or [[mucosal]] [[Ulcer|ulcers]] on anoscopy should also receive [[Empiric therapy|empiric]] treatment for [[genital herpes]].
*[[Herpes Genitalis|Herpes]] [[proctocolitis]] and [[Lymphogranuloma venereum|LGV]] occur predominantly among [[HIV AIDS|HIV/AIDS]] patients; hence [[Empiric therapy|empiric]] treatment in those patients should cover [[Herpes simplex|genital herpes]] and [[Lymphogranuloma venereum|LGV]].

===Surgery===
Surgical intervention is not recommended for the management of [[proctocolitis]].

==Primary Prevention==
As [[proctocolitis]] can be a sexually transmitted disease, effective measures for the primary prevention of [[proctocolitis]] include:

*[[Counseling]] on safe sex practices
*Avoiding contact with feces during [[sexual intercourse]]
*Hand washing after handing objects or materials that have been in contact with the [[Anal-oral contact|anal]] area (i.e., sex toys or barriers) and after touching the anal area.

==Secondary Prevention==

*Abstinence from sexual activity until the patient and their partners are successfully treated (i.e., completion of a 7-day regimen and resolution of symptoms)
*Sexual partners with individuals treated for [[Chlamydia infection|chlamydia]] or [[gonorrhea]] <60 days before the onset of symptoms should receive evaluation and empiric treatment of the causative infection
*Testing for other sexually-transmitted diseases
*In case of [[proctocolitis]] caused by [[Chlamydia infection|chlamydia]] or [[Neisseria gonorrhoeae|Neisseria gonorrhea]], retesting for the causative organism is recommended 3 months after completion of treatment.

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

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T22:05:25Z

Mohamed riad:

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Infectious colitis]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
*Protozoan (''[[Entamoeba histolytica]]'')
*[[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Lymphocytic colitis]]
*[[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Iatrogenic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Diversion colitis]]
*[[Chemical colitis]]
*[[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Vascular'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unclassifiable'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
*Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:

*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===

*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===

*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===

*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===

*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

===Diagnostic Tests===
Common tests which may reveal diagnosis of colitis include:

*Abdominal [[X-ray]]s
*Testing the stool for blood and pus
*[[Sigmoidoscopy]]
*[[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbation of colitis.

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

==Diagnosis==

===History and Symptoms===

*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
*Symptoms of [[proctocolitis]] include fatigue, weight loss, [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].

===Laboratory Findings===
Laboratory findings consistent with the diagnosis of proctitis include:

*[[Stool examination]]: Detection of fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
*[[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. [[CMV]] and other [[Opportunistic infection|opportunistic infections]] may be evaluated in [[Immunosuppression|immunosuppressed]] individuals as [[HIV AIDS|HIV/AIDS]].

===Other Imaging Findings===

====Colonoscopy====
[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]]. 

== Treatment ==

===Medical Therapy===
Acute [[proctocolitis]] among individuals with receptive anal exposure is often [[sexually-transmitted]]. [[Empiric therapy|Empiric]] [[antibiotic]] treatment should be started while awaiting for the results of laboratory tests for

patients presenting with anorectal [[exudate]] on anoscopy or positive [[Gram staining|Gram]]-stained [[Smear test|smear]] of [[anorectal]] exudate or secretions [[polymorphonuclear leukocytes]] or if anoscopy or Gram stain is not available.<ref name="pmid24275725">{{cite journal| author=Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M| title=The etiology of infectious proctitis in men who have sex with men differs according to HIV status. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 10 | pages= 768-70 | pmid=24275725 | doi=10.1097/OLQ.0000000000000022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24275725 }}</ref>

====Recommended Regimen for Acute Proctitis====
'''[[Ceftriaxone]]''' 500 mg IM in a single dose

plus

'''[[Doxycycline]]''' 100 mg orally 2 times/day for 7 days

*[[Doxycycline]] course is continued to 100 mg orally 2 times/day for 21 days in case of [[Perianal abscess|perianal]] or [[mucosal]] [[Ulcer|ulcers]], [[Dysentery|bloody]] [[discharge]], or [[tenesmus]] and a positive [[rectal]] [[chlamydia]] test.
*For individuals weighing ≥150 kg, 1 g of [[ceftriaxone]] is given.
*Patients presenting with [[mucosal]] or [[Perianal abscess|perianal]] ulcers or [[bloody diarrhea]] with positive [[Nucleic acid test|NAAT]] for [[chlamydia]] should receive [[Empiric therapy|empiric]] therapy for [[Lymphogranuloma venereum|Lymphogranuloma Venereum]] with a prolonged course of [[doxycycline]] 100 mg orally 2 times/day for 3 weeks.<ref name="pmid25394161">{{cite journal| author=Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ| title=Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment. | journal=J Int AIDS Soc | year= 2014 | volume= 17 | issue= 4 Suppl 3 | pages= 19657 | pmid=25394161 | doi=10.7448/IAS.17.4.19657 | pmc=4225278 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25394161 }}</ref>
*Patients presenting with [[painful]] [[Perianal abscess|perianal]] [[Ulcer|ulcers]] or [[mucosal]] [[Ulcer|ulcers]] on anoscopy should also receive [[Empiric therapy|empiric]] treatment for [[genital herpes]].

=== Surgery ===
Surgical intervention is not recommended for the management of proctocolitis.

== Primary Prevention ==
As [[proctocolitis]] can be a sexually transmitted disease, effective measures for the primary prevention of proctocolitis include:

* [[Counseling]] on safe sex practices
* Avoiding contact with feces during [[sexual intercourse]]
* Hand washing after handing objects or materials that have been in contact with the anal area (i.e., sex toys or barriers) and after touching the anal area.

== Secondary Prevention ==

* Abstinence from sexual activity until the patient and their partners are successfully treated (i.e., completion of a 7-day regimen and resolution of symptoms)
* Sexual partners with individuals treated for [[Chlamydia infection|chlamydia]] or [[gonorrhea]] <60 days before the onset of symptoms should receive evaluation and empiric treatment of the causative infection
* Testing for other sexually-transmitted diseases
* In case of [[proctocolitis]] caused by [[Chlamydia infection|chlamydia]] or [[Neisseria gonorrhoeae|Neisseria gonorrhea]], retesting for the causative organism is recommended 3 months after completion of treatment.

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

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T21:29:44Z

Mohamed riad:

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Infectious colitis]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
*Protozoan (''[[Entamoeba histolytica]]'')
*[[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Lymphocytic colitis]]
*[[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Iatrogenic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Diversion colitis]]
*[[Chemical colitis]]
*[[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Vascular'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unclassifiable'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
*Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:

*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===

*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===

*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===

*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===

*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

===Diagnostic Tests===
Common tests which may reveal diagnosis of colitis include:

*Abdominal [[X-ray]]s
*Testing the stool for blood and pus
*[[Sigmoidoscopy]]
*[[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbation of colitis.

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

==Diagnosis==

===History and Symptoms===

*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
*Symptoms of [[proctocolitis]] include [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].

===Laboratory Findings===
Laboratory findings consistent with the diagnosis of proctitis include:

*[[Stool examination]]: Detection of fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
*[[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. [[CMV]] and other [[Opportunistic infection|opportunistic infections]] may be evaluated in [[Immunosuppression|immunosuppressed]] individuals as [[HIV AIDS|HIV/AIDS]].

===Other Imaging Findings===

====Anoscopy or Sigmoidoscopy====
[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]]. 

== Treatment ==

=== Medical Therapy ===
Acute [[proctocolitis]] among individuals with receptive anal exposure is often [[sexually-transmitted]]. [[Empiric therapy|Empiric]] [[antibiotic]] treatment should be started while awaiting for the results of laboratory tests for

patients presenting with anorectal [[exudate]] on anoscopy or positive [[Gram staining|Gram]]-stained [[Smear test|smear]] of [[anorectal]] exudate or secretions [[polymorphonuclear leukocytes]] or if anoscopy or Gram stain is not available.<ref name="pmid24275725">{{cite journal| author=Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M| title=The etiology of infectious proctitis in men who have sex with men differs according to HIV status. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 10 | pages= 768-70 | pmid=24275725 | doi=10.1097/OLQ.0000000000000022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24275725 }}</ref>

==== Recommended Regimen for Acute Proctitis ====
'''[[Ceftriaxone]]''' 500 mg IM in a single dose

plus

'''[[Doxycycline]]''' 100 mg orally 2 times/day for 7 days

* [[Doxycycline]] course is continued to 100 mg orally 2 times/day for 21 days in case of [[Perianal abscess|perianal]] or [[mucosal]] [[Ulcer|ulcers]], [[Dysentery|bloody]] [[discharge]], or [[tenesmus]] and a positive [[rectal]] [[chlamydia]] test.
* For individuals weighing ≥150 kg, 1 g of [[ceftriaxone]] is given.
* Patients presenting with [[mucosal]] or [[Perianal abscess|perianal]] ulcers or [[bloody diarrhea]] with positive [[Nucleic acid test|NAAT]] for [[chlamydia]] should receive [[Empiric therapy|empiric]] therapy for [[Lymphogranuloma venereum|Lymphogranuloma Venereum]] with a prolonged course of [[doxycycline]] 100 mg orally 2 times/day for 3 weeks.<ref name="pmid25394161">{{cite journal| author=Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ| title=Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment. | journal=J Int AIDS Soc | year= 2014 | volume= 17 | issue= 4 Suppl 3 | pages= 19657 | pmid=25394161 | doi=10.7448/IAS.17.4.19657 | pmc=4225278 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25394161 }}</ref>
* Patients presenting with [[painful]] [[Perianal abscess|perianal]] [[Ulcer|ulcers]] or [[mucosal]] [[Ulcer|ulcers]] on anoscopy should also receive [[Empiric therapy|empiric]] treatment for [[genital herpes]].

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

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T20:53:54Z

Mohamed riad: /* Other Imaging Findings */

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Infectious colitis]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
*Protozoan (''[[Entamoeba histolytica]]'')
*[[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Lymphocytic colitis]]
*[[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Iatrogenic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Diversion colitis]]
*[[Chemical colitis]]
*[[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Vascular'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unclassifiable'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
*Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:

*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===

*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===

*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===

*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===

*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

===Diagnostic Tests===
Common tests which may reveal diagnosis of colitis include:

*Abdominal [[X-ray]]s
*Testing the stool for blood and pus
*[[Sigmoidoscopy]]
*[[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbation of colitis.

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

==Diagnosis==

===History and Symptoms===

*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
*Symptoms of [[proctocolitis]] include [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].

===Laboratory Findings===
Laboratory findings consistent with the diagnosis of proctitis include:

*[[Stool examination]]: Detection of fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
*[[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. [[CMV]] and other [[Opportunistic infection|opportunistic infections]] may be evaluated in [[Immunosuppression|immunosuppressed]] individuals as [[HIV AIDS|HIV/AIDS]].

===Other Imaging Findings===

==== Anoscopy or Sigmoidoscopy ====
[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]]. 
==References==
{{Reflist|2}}

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T20:41:27Z

Mohamed riad: /* Laboratory Findings */

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Infectious colitis]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
*Protozoan (''[[Entamoeba histolytica]]'')
*[[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Lymphocytic colitis]]
*[[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Iatrogenic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Diversion colitis]]
*[[Chemical colitis]]
*[[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Vascular'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unclassifiable'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
*Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:

*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===

*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===

*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===

*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===

*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

===Diagnostic Tests===
Common tests which may reveal diagnosis of colitis include:

*Abdominal [[X-ray]]s
*Testing the stool for blood and pus
*[[Sigmoidoscopy]]
*[[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbation of colitis.

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

==Diagnosis==

===History and Symptoms===

*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
*Symptoms of [[proctocolitis]] include [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].

===Laboratory Findings===
Laboratory findings consistent with the diagnosis of proctitis include:

*[[Stool examination]]: Detection of fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
*[[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. [[CMV]] and other [[Opportunistic infection|opportunistic infections]] may be evaluated in [[Immunosuppression|immunosuppressed]] individuals as [[HIV AIDS|HIV/AIDS]].

===Other Imaging Findings===
[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]].
 
==References==
{{Reflist|2}}

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T20:39:39Z

Mohamed riad:

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Infectious colitis]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
*Protozoan (''[[Entamoeba histolytica]]'')
*[[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Lymphocytic colitis]]
*[[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Iatrogenic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Diversion colitis]]
*[[Chemical colitis]]
*[[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Vascular'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unclassifiable'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
*Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:

*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===

*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===

*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===

*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===

*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

===Diagnostic Tests===
Common tests which may reveal diagnosis of colitis include:

*Abdominal [[X-ray]]s
*Testing the stool for blood and pus
*[[Sigmoidoscopy]]
*[[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbation of colitis.

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

== Diagnosis ==

=== History and Symptoms ===

* Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
* Symptoms of [[proctocolitis]] include [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].

=== Laboratory Findings ===
Laboratory findings consistent with the diagnosis of proctitis include:

* [[Stool examination]]: Detection of fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
* [[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. CMV and other opportunistic infections may be evaluated in immunosuppressed individuals as [[HIV AIDS|HIV/AIDS]].

=== Other Imaging Findings ===
[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]].
 
==References==
{{Reflist|2}}

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T19:48:13Z

Mohamed riad: /* Causes */

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''[[Infectious colitis]]''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
* Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
* Protozoan (''[[Entamoeba histolytica]]'')
* [[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Lymphocytic colitis]]
* [[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Iatrogenic''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Diversion colitis]]
* [[Chemical colitis]]
* [[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Vascular''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Unclassifiable''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
* Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:
*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===
*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===
*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===
*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===
*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

===Diagnostic Tests===
Common tests which may reveal diagnosis of colitis include:
* Abdominal [[X-ray]]s
* Testing the stool for blood and pus
* [[Sigmoidoscopy]]
* [[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbation of colitis.

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| bgcolor="Beige" | [[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
| '''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" | [[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" | [[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" | [[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | [[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" | [[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| bgcolor="Beige" | [[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| bgcolor="Beige" | [[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" | [[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| bgcolor="Beige" | [[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<ref name="pmid24687130">{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" | Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

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

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T19:46:40Z

Mohamed riad: /* Causes */

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''[[Infectious colitis]]''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
* Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
* Protozoan (''[[Entamoeba histolytica]]'')
* [[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Lymphocytic colitis]]
* [[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Iatrogenic''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Diversion colitis]]
* [[Chemical colitis]]
* [[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Vascular''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Unclassifiable''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
* Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:
*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===
*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===
*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===
*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===
*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

===Diagnostic Tests===
Common tests which may reveal diagnosis of colitis include:
* Abdominal [[X-ray]]s
* Testing the stool for blood and pus
* [[Sigmoidoscopy]]
* [[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbation of colitis.

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| bgcolor="Beige" | [[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
| '''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" | [[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" | [[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" | [[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | [[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" | [[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| bgcolor="Beige" | [[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| bgcolor="Beige" | [[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" | [[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| bgcolor="Beige" | [[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<ref name="pmid24687130">{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130 }} </ref>
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" | Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

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

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Colitis

2021-08-14T19:43:16Z

Mohamed riad: /* Causes */

__NOTOC__
{{Colitis}}

{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}} 

{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]]. It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''[[Infectious colitis]]''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
* Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
* Protozoan (''[[Entamoeba histolytica]]'')
* [[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Lymphocytic colitis]]
* [[Collagenous colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Iatrogenic''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Diversion colitis]]
* [[Chemical colitis]]
* [[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Vascular''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Ischemic colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Unclassifiable''' || style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
* Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:
*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===
*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*'''Adult'''

===Classification by duration of symptoms===
*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===
*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*[[Intussusception]]
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Adults===
*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis

===Differentiating Between Different Types of Colitis===
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}

===Diagnostic Tests===
Common tests which may reveal diagnosis of colitis include:
* Abdominal [[X-ray]]s
* Testing the stool for blood and pus
* [[Sigmoidoscopy]]
* [[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbation of colitis.

==Causes==
===Common Causes===
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).

===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| bgcolor="Beige" | [[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|- bgcolor="LightSteelBlue"
| '''Dental'''
| bgcolor="Beige" |[[Dental braces]]
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" | [[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" | [[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" | [[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | [[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" | [[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| bgcolor="Beige" | [[Ankylosing Spondylitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| bgcolor="Beige" | [[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" | [[Autistic enterocolitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| bgcolor="Beige" | [[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124 }} </ref>
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" | Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as [[escherichia coli O157:H7]] and [[shigella]].

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

{{WH}}
{{WS}}

[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Mycoplasma genitalium infection

2021-08-14T06:22:30Z

Mohamed riad:

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}} {{Mohamed riad}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[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 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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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==
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
*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===Complications===
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)]], [[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).

===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

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

===CT===
[[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]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|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 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>

===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:<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
*Using condoms and/or other barrier methods

==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>

*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==
{{Reflist|2}}

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T06:20:46Z

Mohamed riad: /* Epidemiology and Demographics */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[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 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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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==
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
*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===Complications===
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)]], [[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).

===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

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

===CT===
[[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]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|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 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>

===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:<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
*Using condoms and/or other barrier methods

==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>

*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==
{{Reflist|2}}

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T06:09:26Z

Mohamed riad: /* Natural history, Complications and Prognosis */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[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 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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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 have sex with men and among 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>

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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><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)]], [[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).

=== 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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

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

===CT===
[[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]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|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 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>

===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:<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
*Using condoms and/or other barrier methods

==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>

*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==
{{Reflist|2}}

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T06:08:10Z

Mohamed riad: /* Associated Conditions */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[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 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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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 have sex with men and among 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>

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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><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)]], [[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).

 

===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

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

===CT===
[[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]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|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 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>

===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:<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
*Using condoms and/or other barrier methods

==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>

*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==
{{Reflist|2}}

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T06:07:38Z

Mohamed riad: /* Complications */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[HIV]]

===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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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 have sex with men and among 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>

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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><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)]], [[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).

 

===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

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

===CT===
[[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]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|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 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>

===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:<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
*Using condoms and/or other barrier methods

==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>

*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==
{{Reflist|2}}

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T06:06:55Z

Mohamed riad: /* Medical Therapy */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[HIV]]

===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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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 have sex with men and among 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>

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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><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)]], [[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).
*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>

 
===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

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

===CT===
[[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]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|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 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>

===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:<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
*Using condoms and/or other barrier methods

==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>

*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==
{{Reflist|2}}

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T06:04:34Z

Mohamed riad: /* Secondary Prevention */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[HIV]]

===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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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 have sex with men and among 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>

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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><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)]], [[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).
*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>

 
===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

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

===CT===
[[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]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|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:<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>

===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:<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
*Using condoms and/or other barrier methods

==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>

*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==
{{Reflist|2}}

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T05:59:30Z

Mohamed riad: /* Medical Therapy */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[HIV]]

===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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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 have sex with men and among 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>

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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><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)]], [[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).
*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>

 
===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

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

===CT===
[[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]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[pelvic inflammatory disease|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:<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>

=== 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:<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
*Using condoms and/or other barrier methods

==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>

*Prompt treatment with antibiotics to prevent complications of the infection
*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]]

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

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T05:36:31Z

Mohamed riad: /* Laboratory Findings */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[HIV]]

===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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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 have sex with men and among 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>

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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><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)]], [[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).
*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>

 
===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

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

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

==Other Diagnostic Studies==
There are no other diagnostic studies for ''Mycoplasma genitalium'' infection.

==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>

*[[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.
*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.
*For complicated ''Mycoplasma genitalium'' infection, [[moxifloxacin]] 400mg once daily is used for 14 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:<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
*Using condoms and/or other barrier methods

==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>

*Prompt treatment with antibiotics to prevent complications of the infection
*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]]

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

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T05:26:03Z

Mohamed riad: /* Complications */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[HIV]]

===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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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 have sex with men and among 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>

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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><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)]], [[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).
*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>

 
===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

==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>
*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>

==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 [[pelvic inflammatory disease|pelvic inflammatory disease (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 [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]].

==Other Diagnostic Studies==
There are no other diagnostic studies for ''Mycoplasma genitalium'' infection.

==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>

*[[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.
*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.
*For complicated ''Mycoplasma genitalium'' infection, [[moxifloxacin]] 400mg once daily is used for 14 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:<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
*Using condoms and/or other barrier methods

==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>

*Prompt treatment with antibiotics to prevent complications of the infection
*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]]

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

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T05:15:29Z

Mohamed riad: /* Complications */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[HIV]]

===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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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 have sex with men and among 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>

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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><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)]], [[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).

===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

==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>
*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>

==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 [[pelvic inflammatory disease|pelvic inflammatory disease (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 [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]].

==Other Diagnostic Studies==
There are no other diagnostic studies for ''Mycoplasma genitalium'' infection.

==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>

*[[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.
*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.
*For complicated ''Mycoplasma genitalium'' infection, [[moxifloxacin]] 400mg once daily is used for 14 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:<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
*Using condoms and/or other barrier methods

==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>

*Prompt treatment with antibiotics to prevent complications of the infection
*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]]

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

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T05:00:31Z

Mohamed riad: /* Epidemiology and Demographics */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[HIV]]

===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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''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>

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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>

*Complications in females include: [[cervicitis]], [[endometritis]], tubal factor [[infertility]], [[pelvic inflammatory disease]] [[(PID)]], as well as sexually active [[reactive arthritis]] (SARA).
*Complications in males include: [[epididymitis]], [[urethritis]], as well as sexually active [[reactive arthritis]] (SARA).

===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

==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>
*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>

==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 [[pelvic inflammatory disease|pelvic inflammatory disease (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 [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]].

==Other Diagnostic Studies==
There are no other diagnostic studies for ''Mycoplasma genitalium'' infection.

==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>

*[[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.
*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.
*For complicated ''Mycoplasma genitalium'' infection, [[moxifloxacin]] 400mg once daily is used for 14 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:<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
*Using condoms and/or other barrier methods

==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>

*Prompt treatment with antibiotics to prevent complications of the infection
*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]]

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

[[Category:Gynecology]]
[[Category:Urology]]

Mycoplasma genitalium infection

2021-08-14T04:49:41Z

Mohamed riad: /* Epidemiology and Demographics */

__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Mycoplasma genitalium''
| image = Mycoplasma genitalium.gif
| regnum = [[Bacterium|Bacteria]]
| divisio = [[Firmicutes]]
| classis = [[Mollicutes]]
| ordo = [[Mycoplasmatales]]
| familia = [[Mycoplasmataceae]]
| genus = ''[[Mycoplasma]]''
| species = '''''M. genitalium'''''
| binomial = ''Mycoplasma genitalium''
| binomial_authority = Tully et al., 1983
}}
{{SI}}
'''For information on all sexually transmitted disease, click [[Sexually transmitted disease|here]].''' 
{{CMG}}; {{AE}} {{DN}}

==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==

*''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 the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of ''Mycoplasma genitalium''.<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="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>
*Since 1993, the role of ''Mycoplasma genitalium'' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<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>

==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>

*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 [[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>

====Incubation Period====
The [[incubation period]] of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====Infectious Dose====
The infectious dose of ''Mycoplasma genitalium'' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
====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>

*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:<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]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*[[HIV]]

===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:

*''[[Chlamydia trachomatis]]''
*''[[Neisseria gonorrhea]]''
*''[[Trichomonas vaginalis]]''
*''[[Ureaplasma urealyticum]]''
*[[Herpes simplex virus]]

==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>
*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 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%).<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>
*''Mycoplasma genitalium'' is the cause of about 15%–20% of [[nongonococcal urethritis]], and 40% of persistent or recurrent [[urethritis]]

==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>

*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:
**Frequent douching
**Proliferative phase of the [[menstrual cycle]]
**History of spontaneous [[miscarriage]]
**Undergoing procedures that breach the [[cervical]] barrier
**Use of [[Depo-Provera]] for [[contraception]]

==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>

==Natural history, Complications and Prognosis==
===Natural History===
If left untreated, ''[[Mycoplasma genitalium]]'' infection can lead to persistent [[cervicitis]], [[PID]], or [[urethritis]].<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>

===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>

*Complications in females include: [[cervicitis]], [[endometritis]], tubal factor [[infertility]], [[pelvic inflammatory disease]] [[(PID)]], as well as sexually active [[reactive arthritis]] (SARA).
*Complications in males include: [[epididymitis]], [[urethritis]], as well as sexually active [[reactive arthritis]] (SARA).

===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>

==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:

*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]]
**[[PID]]: presents with [[pelvic pain|pelvic discomfort]] or [[lower abdominal pain]], painful sexual intercourse ([[dyspareunia]]), vaginal [[discharge]], and/or [[bleeding]]
**[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
*Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<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>

==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.

*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>
**[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
*Males:
**Present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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="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> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>

==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>
*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>

==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 [[pelvic inflammatory disease|pelvic inflammatory disease (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 [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]].

==Other Diagnostic Studies==
There are no other diagnostic studies for ''Mycoplasma genitalium'' infection.

==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>

*[[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.
*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.
*For complicated ''Mycoplasma genitalium'' infection, [[moxifloxacin]] 400mg once daily is used for 14 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:<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
*Using condoms and/or other barrier methods

==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>

*Prompt treatment with antibiotics to prevent complications of the infection
*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]]

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

[[Category:Gynecology]]
[[Category:Urology]]

Dupuytrens contracture

2021-08-07T07:16:52Z

Mohamed riad: /* Physical Examination */

Dupuytrens contracture

2021-08-07T07:04:48Z

Mohamed riad:

__NOTOC__
{{Infobox_Disease |
Name = Dupuytren's contracture |
Image = Morbus dupuytren fcm.jpg |
Caption = Dupuytren's contracture of the fourth digit (ring finger). |
DiseasesDB = 4011 |
ICD10 = {{ICD10|M|72|0|m|70}} |
ICD9 = {{ICD9|728.6}} |
ICDO = |
OMIM = 126900 |
MedlinePlus = 001233 |
MeshID = |
}}
{{SI}}

'''Editors-In-Chief:'''{{Mohamed riad}}, Matthew I. Leibman, M.D.[mailto:MLeibman@partners.org]; Mark R. Belsky, M.D.[mailto:MBelsky@partners.org]; David E. Ruchelsman, M.D.[mailto:DRuchelsman@partners.org]{{KS}}

{{SK}} Dupuytren contracture I, included; DUPC1; palmar fascial fibromatosis; palmar fibromatosis
==Overview==
'''Dupuytren's contracture''' (also known as '''Morbus Dupuytren''') is an abnormal [[Thickening of the heart muscle|thickening]] of the hand causing curling of [[fingers]] and impaired function of the fingers, especially the little and ring fingers.. It is named after the famous [[surgery|surgeon]] [[Guillaume Dupuytren|Baron Guillaume Dupuytren]], who described an [[Surgery|operation]] to correct the affliction. It is thought that Dupuytren's contracture is the result of [[Microvascular disease|microvascular]] [[angiopathy]]. Common risk factors in the development of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] include family history, diabetes, antiepileptic medications, liver disease, smoking, alcoholism and manual work. The incidence of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] increases with age; the [[median]] age at diagnosis is 50-70 years. [[men]] are affected more often than [[women]].

==Historical Perspective==

*Dupuytren's contracture was named after [[Guillaume Dupuytren|Baron Guillaume Dupuytren]], a famous surgeon, following describing an [[Surgery|operation]] to correct the affliction.

==Pathophysiology==

===Pathogenesis===

*The exact pathogenesis of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] is not fully understood.
*It is thought that Dupuytren's contracture is the result of [[Microvascular disease|microvascular]] [[angiopathy]].<ref name="pmidhttps://doi.org/10.1136/bmj.n13085">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }}</ref>

===Associated Conditions===

*[[Diabetes mellitus]]
*[[Thyroid disease|Thyroid diseases]]
*[[Liver diseases|Liver disease]]
*[[Alcoholism]] and [[smoking]]

==Causes==
The cause of Dupuytren's contracture has not been identified.

== Epidemiology and Demographics ==

===Prevalence===

*The [[prevalence]] of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] among the UK population is 3-5%.<ref name="pmid21486483">{{cite journal| author=Gerber RA, Perry R, Thompson R, Bainbridge C| title=Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England. | journal=BMC Musculoskelet Disord | year= 2011 | volume= 12 | issue= | pages= 73 | pmid=21486483 | doi=10.1186/1471-2474-12-73 | pmc=3103491 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21486483 }}</ref>

===Age===

*The incidence of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] increases with age; the [[median]] age at diagnosis is 50-70 years.

===Race===

*Dupuytren's contracture usually affects individuals of the northern Europeans race (Icelandic and Scandinavian populations).<ref name="pmid10760640">{{cite journal| author=Gudmundsson KG, Arngrímsson R, Sigfússon N, Björnsson A, Jónsson T| title=Epidemiology of Dupuytren's disease: clinical, serological, and social assessment. The Reykjavik Study. | journal=J Clin Epidemiol | year= 2000 | volume= 53 | issue= 3 | pages= 291-6 | pmid=10760640 | doi=10.1016/s0895-4356(99)00145-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10760640 }}</ref>

===Gender===

*[[Male|Males]] are more commonly affected by Dupuytren's contracture than [[Female|females]]. The male to female [[ratio]] is approximately 3 to 1.<ref name="pmidhttps://doi.org/10.1136/bmj.n13084">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }}</ref>

==Risk Factors==
Common risk factors in the development of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] include:

*[[Family history]]: [[genetic predisposition]] may account for 80% of cases.<ref name="pmid24835475">{{cite journal| author=Larsen S, Krogsgaard DG, Aagaard Larsen L, Iachina M, Skytthe A, Frederiksen H| title=Genetic and environmental influences in Dupuytren's disease: a study of 30,330 Danish twin pairs. | journal=J Hand Surg Eur Vol | year= 2015 | volume= 40 | issue= 2 | pages= 171-6 | pmid=24835475 | doi=10.1177/1753193414535720 | pmc=4810018 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24835475 }}</ref>
*[[Diabetes]] and its medications<ref name="pmid15336742">{{cite journal| author=Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R| title=Dupuytren's disease risk factors. | journal=J Hand Surg Br | year= 2004 | volume= 29 | issue= 5 | pages= 423-6 | pmid=15336742 | doi=10.1016/j.jhsb.2004.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15336742 }}</ref>
*[[Smoking]]<ref name="pmid15485739">{{cite journal| author=Godtfredsen NS, Lucht H, Prescott E, Sørensen TI, Grønbaek M| title=A prospective study linked both alcohol and tobacco to Dupuytren's disease. | journal=J Clin Epidemiol | year= 2004 | volume= 57 | issue= 8 | pages= 858-63 | pmid=15485739 | doi=10.1016/j.jclinepi.2003.11.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15485739 }}</ref>
*[[Alcohol]] intake
*[[Antiepileptics|Antiepileptic]] medications<ref name="pmid25288296">{{cite journal| author=Nunn AC, Schreuder FB| title=Dupuytren's contracture: emerging insight into a Viking disease. | journal=Hand Surg | year= 2014 | volume= 19 | issue= 3 | pages= 481-90 | pmid=25288296 | doi=10.1142/S0218810414300058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25288296 }}</ref>
*There is also some speculation that [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] may be caused by [[physical trauma]], such as manual [[Labor (childbirth)|labor]] or other over-exertion of the hands. However, the fact that Dupuytren's is not connected with handedness casts some doubt on this claim.
*[[Surgery]] of the [[hand]] may trigger growth of Dupuytren nodules and cords if an inclination existed before.
*Certain occupations with repetitive [[hand trauma]]

==Natural History, Complications and Prognosis==

===Natural History===

*Dupuytren’s disease is [[Progressive angina|progressive]] in nature with no available [[cure]].
*Improvement of the [[painful]] [[Nodule (medicine)|nodules]] may occur with time, and many patients never experience a [[contracture]].

===Complications===

*[[Ectopic]] disease involving the [[penis]] (Pyronie's disease) or the feet ([[Ledderhose's disease|Ledderhose disease]])
*Limitation of daily activities and work capabilities

===Prognosis===

*[[Prognosis]] is generally poor.
*Development of [[Dupuytren's disease]] at an earlier age is associated with more severe [[Deformity|deformities]].

==Diagnosis==

===Diagnostic Study of Choice===
Dupuytren’s disease is primarily diagnosed based on the clinical presentation.

===History and Symptoms===

*Symptoms of '''Dupuytren's disease''' include abnormal [[Thickening of the heart muscle|thickening]] of the hand causing curling of [[fingers]] and impaired function of the fingers, especially the little and ring fingers.
*It usually has a gradual onset, often beginning as a [[Tenderness (medicine)|tender]] [[lump]] in the [[Palmar|palm]].
*It often starts as a [[Nodule (medicine)|nodule]], usually in line with the [[ring finger]].
*Over time, [[pain]] associated with the condition tends to go away, but tough bands of tissue may develop.
*These bands, which are the source of the reduced [[mobility]] commonly associated with the condition, are visible on the surface of the [[Palmar|palm]], and may appear similar to a small [[callus]].
*It commonly develops in both hands, and has no connection to dominant- or non-dominant hands, nor any correlation with right- or left-handedness.
*The [[contracture]] sets on very slowly, especially in women. However, when present in both hands, and when there is associated [[foot]] involvement, it tends to accelerate more rapidly.

===Physical Examination===
====Skin====
=====Hand=====
<gallery>
File:Dupuytren contracture01.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture02.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture03.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture04.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture05.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture06.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
</gallery>
==Treatment==

===Medical Therapy===

*Pharmacologic medical therapies for Dupuytren's disease include pain management and corticosteroid injection into the nodules,
*In some cases, repeated corticosteroid injections may cause softening of the nodules and slow down the disease progression.
*Most cases with simple nodules and without significant functional impairment benefit from conservative medical therapy.

=== Interventions ===

==== Collagenase clostridium histolyticum (CCH) injections ====

* The [[mechanism of action]] is to weaken the [[contracted]] [[cord]] by breaking down [[collagen]].<ref name="pmid19726771">{{cite journal| author=Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA | display-authors=etal| title=Injectable collagenase clostridium histolyticum for Dupuytren's contracture. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 10 | pages= 968-79 | pmid=19726771 | doi=10.1056/NEJMoa0810866 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19726771 }}</ref>
* It is done in an outpatient practice but requires another clinic visit to snap the cord.
* I t is generally safe; however several [[Complication (medicine)|complications]] were reported, such as [[tendon]] [[rupture]] and pulley injury.<ref name="pmid23200951">{{cite journal| author=Peimer CA, Blazar P, Coleman S, Kaplan FT, Smith T, Tursi JP | display-authors=etal| title=Dupuytren contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS study): 3-year data. | journal=J Hand Surg Am | year= 2013 | volume= 38 | issue= 1 | pages= 12-22 | pmid=23200951 | doi=10.1016/j.jhsa.2012.09.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23200951 }}</ref>
* CCH injectiont is available in only North America after its withdrawal from European, Australian, and Asian markets.<ref name="pmid31810821">{{cite journal| author=Cocci A, Russo GI, Salamanca JIM, Ralph D, Palmieri A, Mondaini N| title=The End of an Era: Withdrawal of Xiapex (Clostridium histolyticum Collagenase) from the European Market. | journal=Eur Urol | year= 2020 | volume= 77 | issue= 5 | pages= 660-661 | pmid=31810821 | doi=10.1016/j.eururo.2019.11.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31810821 }}</ref>

===Surgery===
[[Surgery]] is not the first-line treatment option for patients with [[Dupuytren's contracture (patient information)|Dupuytren's]] disease. Surgery is usually reserved for patients with either:<ref name="pmidhttps://doi.org/10.1136/bmj.n13083">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }}</ref>

*Rapid progression over a few months
*Severe thumb [[Contracture|contractures]] with functional impairment
*More than 30° [[metacarpophalangeal joint]] contracture or 10-20° [[Proximal interphalangeal joints|proximal interphalangeal joint]] [[contracture]]

The choice of the type of surgery depends the following variables:

*Severity of the disease
*Individual characteristics (such as [[age]], [[Occupational Medicine|occupation]], degree of functional disability)
*Patient and/or physician preference

Surgical options include:

* '''[[Percutaneous]] [[needle]] [[fasciotomy]] (PNF):''' involves division of the cord using a needle. It is generally effective and safe with no [[Complication (medicine)|complications]]; however [[tendon]] and [[Digital clubbing|digital]] [[nerve]] and [[Blood vessel|vessel]] damage were reported in some cases. Its efficacy is low in the management of extensive [[Contracture|contractures]] or contractures involving the [[Interphalangeal articulations of hand|proximal interphalangeal joints]]. The recurrence rate is high.<ref name="pmid16713831">{{cite journal| author=van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM| title=A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study. | journal=J Hand Surg Am | year= 2006 | volume= 31 | issue= 5 | pages= 717-25 | pmid=16713831 | doi=10.1016/j.jhsa.2006.02.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16713831 }}</ref><ref name="pmid26648251">{{cite journal| author=Rodrigues JN, Becker GW, Ball C, Zhang W, Giele H, Hobby J | display-authors=etal| title=Surgery for Dupuytren's contracture of the fingers. | journal=Cochrane Database Syst Rev | year= 2015 | volume= | issue= 12 | pages= CD010143 | pmid=26648251 | doi=10.1002/14651858.CD010143.pub2 | pmc=6464957 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26648251 }}</ref><ref name="pmid30012049">{{cite journal| author=Scherman P, Jenmalm P, Dahlin LB| title=Three-year recurrence of Dupuytren's contracture after needle fasciotomy and collagenase injection: a two-centre randomized controlled trial. | journal=J Hand Surg Eur Vol | year= 2018 | volume= 43 | issue= 8 | pages= 836-840 | pmid=30012049 | doi=10.1177/1753193418786947 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30012049 }}</ref>
* '''[[Fasciectomy]]''' '''either partial (segmental aponeurectomy) or complete (limited fasciectomy):''' involves excision of the cord with higher rate of [[complications]] PNF.<ref name="pmid10697321">{{cite journal| author=Armstrong JR, Hurren JS, Logan AM| title=Dermofasciectomy in the management of Dupuytren's disease. | journal=J Bone Joint Surg Br | year= 2000 | volume= 82 | issue= 1 | pages= 90-4 | pmid=10697321 | doi=10.1302/0301-620x.82b1.9808 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10697321 }}</ref>
* '''Dermofasciectomy:''' a more [[Invasive (medical)|invasive]] procedure that involves excising the whole diseased tissue, along with the overlying [[subcutaneous fat]] and [[skin]]. It is reserved for more severe cases with extensive skin involvement when the other surgical options have failed. The complication rate is the highest among the three surgical options. The [[Recurrence plot|recurrence]] rate is low.<ref name="pmid6379077">{{cite journal| author=Tonkin MA, Burke FD, Varian JP| title=Dupuytren's contracture: a comparative study of fasciectomy and dermofasciectomy in one hundred patients. | journal=J Hand Surg Br | year= 1984 | volume= 9 | issue= 2 | pages= 156-62 | pmid=6379077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6379077 }}</ref>

 

==External links==
http://www.nlm.nih.gov/medlineplus/ency/article/001233.htm

{{Diseases of the musculoskeletal system and connective tissue}}

[[Category:Diseases involving the fasciae]]

[[Category:Rare diseases]]
[[Category:Orthopedics]]
[[Category:Rheumatology]]

[[de:Morbus Dupuytren]]
[[es:Enfermedad de Dupuytren]]
[[fr:Maladie de Dupuytren]]
[[it:Malattia di Dupuytren]]
[[nl:Ziekte van Dupuytren]]
[[tr:Dupuytren kontraktürü]]

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Dupuytrens contracture

2021-08-07T07:04:14Z

Mohamed riad:

__NOTOC__
{{Infobox_Disease |
Name = Dupuytren's contracture |
Image = Morbus dupuytren fcm.jpg |
Caption = Dupuytren's contracture of the fourth digit (ring finger). |
DiseasesDB = 4011 |
ICD10 = {{ICD10|M|72|0|m|70}} |
ICD9 = {{ICD9|728.6}} |
ICDO = |
OMIM = 126900 |
MedlinePlus = 001233 |
MeshID = |
}}
{{SI}}

'''Editors-In-Chief:'''[[Mohamed riad]], Matthew I. Leibman, M.D.[mailto:MLeibman@partners.org]; Mark R. Belsky, M.D.[mailto:MBelsky@partners.org]; David E. Ruchelsman, M.D.[mailto:DRuchelsman@partners.org]{{KS}}

{{SK}} Dupuytren contracture I, included; DUPC1; palmar fascial fibromatosis; palmar fibromatosis
==Overview==
'''Dupuytren's contracture''' (also known as '''Morbus Dupuytren''') is an abnormal [[Thickening of the heart muscle|thickening]] of the hand causing curling of [[fingers]] and impaired function of the fingers, especially the little and ring fingers.. It is named after the famous [[surgery|surgeon]] [[Guillaume Dupuytren|Baron Guillaume Dupuytren]], who described an [[Surgery|operation]] to correct the affliction. It is thought that Dupuytren's contracture is the result of [[Microvascular disease|microvascular]] [[angiopathy]]. Common risk factors in the development of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] include family history, diabetes, antiepileptic medications, liver disease, smoking, alcoholism and manual work. The incidence of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] increases with age; the [[median]] age at diagnosis is 50-70 years. [[men]] are affected more often than [[women]].

==Historical Perspective==

*Dupuytren's contracture was named after [[Guillaume Dupuytren|Baron Guillaume Dupuytren]], a famous surgeon, following describing an [[Surgery|operation]] to correct the affliction.

==Pathophysiology==

===Pathogenesis===

*The exact pathogenesis of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] is not fully understood.
*It is thought that Dupuytren's contracture is the result of [[Microvascular disease|microvascular]] [[angiopathy]].<ref name="pmidhttps://doi.org/10.1136/bmj.n13085">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }}</ref>

===Associated Conditions===

*[[Diabetes mellitus]]
*[[Thyroid disease|Thyroid diseases]]
*[[Liver diseases|Liver disease]]
*[[Alcoholism]] and [[smoking]]

==Causes==
The cause of Dupuytren's contracture has not been identified.

== Epidemiology and Demographics ==

===Prevalence===

*The [[prevalence]] of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] among the UK population is 3-5%.<ref name="pmid21486483">{{cite journal| author=Gerber RA, Perry R, Thompson R, Bainbridge C| title=Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England. | journal=BMC Musculoskelet Disord | year= 2011 | volume= 12 | issue= | pages= 73 | pmid=21486483 | doi=10.1186/1471-2474-12-73 | pmc=3103491 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21486483 }}</ref>

===Age===

*The incidence of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] increases with age; the [[median]] age at diagnosis is 50-70 years.

===Race===

*Dupuytren's contracture usually affects individuals of the northern Europeans race (Icelandic and Scandinavian populations).<ref name="pmid10760640">{{cite journal| author=Gudmundsson KG, Arngrímsson R, Sigfússon N, Björnsson A, Jónsson T| title=Epidemiology of Dupuytren's disease: clinical, serological, and social assessment. The Reykjavik Study. | journal=J Clin Epidemiol | year= 2000 | volume= 53 | issue= 3 | pages= 291-6 | pmid=10760640 | doi=10.1016/s0895-4356(99)00145-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10760640 }}</ref>

===Gender===

*[[Male|Males]] are more commonly affected by Dupuytren's contracture than [[Female|females]]. The male to female [[ratio]] is approximately 3 to 1.<ref name="pmidhttps://doi.org/10.1136/bmj.n13084">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }}</ref>

==Risk Factors==
Common risk factors in the development of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] include:

*[[Family history]]: [[genetic predisposition]] may account for 80% of cases.<ref name="pmid24835475">{{cite journal| author=Larsen S, Krogsgaard DG, Aagaard Larsen L, Iachina M, Skytthe A, Frederiksen H| title=Genetic and environmental influences in Dupuytren's disease: a study of 30,330 Danish twin pairs. | journal=J Hand Surg Eur Vol | year= 2015 | volume= 40 | issue= 2 | pages= 171-6 | pmid=24835475 | doi=10.1177/1753193414535720 | pmc=4810018 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24835475 }}</ref>
*[[Diabetes]] and its medications<ref name="pmid15336742">{{cite journal| author=Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R| title=Dupuytren's disease risk factors. | journal=J Hand Surg Br | year= 2004 | volume= 29 | issue= 5 | pages= 423-6 | pmid=15336742 | doi=10.1016/j.jhsb.2004.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15336742 }}</ref>
*[[Smoking]]<ref name="pmid15485739">{{cite journal| author=Godtfredsen NS, Lucht H, Prescott E, Sørensen TI, Grønbaek M| title=A prospective study linked both alcohol and tobacco to Dupuytren's disease. | journal=J Clin Epidemiol | year= 2004 | volume= 57 | issue= 8 | pages= 858-63 | pmid=15485739 | doi=10.1016/j.jclinepi.2003.11.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15485739 }}</ref>
*[[Alcohol]] intake
*[[Antiepileptics|Antiepileptic]] medications<ref name="pmid25288296">{{cite journal| author=Nunn AC, Schreuder FB| title=Dupuytren's contracture: emerging insight into a Viking disease. | journal=Hand Surg | year= 2014 | volume= 19 | issue= 3 | pages= 481-90 | pmid=25288296 | doi=10.1142/S0218810414300058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25288296 }}</ref>
*There is also some speculation that [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] may be caused by [[physical trauma]], such as manual [[Labor (childbirth)|labor]] or other over-exertion of the hands. However, the fact that Dupuytren's is not connected with handedness casts some doubt on this claim.
*[[Surgery]] of the [[hand]] may trigger growth of Dupuytren nodules and cords if an inclination existed before.
*Certain occupations with repetitive [[hand trauma]]

==Natural History, Complications and Prognosis==

===Natural History===

*Dupuytren’s disease is [[Progressive angina|progressive]] in nature with no available [[cure]].
*Improvement of the [[painful]] [[Nodule (medicine)|nodules]] may occur with time, and many patients never experience a [[contracture]].

===Complications===

*[[Ectopic]] disease involving the [[penis]] (Pyronie's disease) or the feet ([[Ledderhose's disease|Ledderhose disease]])
*Limitation of daily activities and work capabilities

===Prognosis===

*[[Prognosis]] is generally poor.
*Development of [[Dupuytren's disease]] at an earlier age is associated with more severe [[Deformity|deformities]].

==Diagnosis==

===Diagnostic Study of Choice===
Dupuytren’s disease is primarily diagnosed based on the clinical presentation.

===History and Symptoms===

*Symptoms of '''Dupuytren's disease''' include abnormal [[Thickening of the heart muscle|thickening]] of the hand causing curling of [[fingers]] and impaired function of the fingers, especially the little and ring fingers.
*It usually has a gradual onset, often beginning as a [[Tenderness (medicine)|tender]] [[lump]] in the [[Palmar|palm]].
*It often starts as a [[Nodule (medicine)|nodule]], usually in line with the [[ring finger]].
*Over time, [[pain]] associated with the condition tends to go away, but tough bands of tissue may develop.
*These bands, which are the source of the reduced [[mobility]] commonly associated with the condition, are visible on the surface of the [[Palmar|palm]], and may appear similar to a small [[callus]].
*It commonly develops in both hands, and has no connection to dominant- or non-dominant hands, nor any correlation with right- or left-handedness.
*The [[contracture]] sets on very slowly, especially in women. However, when present in both hands, and when there is associated [[foot]] involvement, it tends to accelerate more rapidly.

===Physical Examination===
====Skin====
=====Hand=====
<gallery>
File:Dupuytren contracture01.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture02.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture03.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture04.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture05.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture06.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
</gallery>
==Treatment==

===Medical Therapy===

*Pharmacologic medical therapies for Dupuytren's disease include pain management and corticosteroid injection into the nodules,
*In some cases, repeated corticosteroid injections may cause softening of the nodules and slow down the disease progression.
*Most cases with simple nodules and without significant functional impairment benefit from conservative medical therapy.

=== Interventions ===

==== Collagenase clostridium histolyticum (CCH) injections ====

* The [[mechanism of action]] is to weaken the [[contracted]] [[cord]] by breaking down [[collagen]].<ref name="pmid19726771">{{cite journal| author=Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA | display-authors=etal| title=Injectable collagenase clostridium histolyticum for Dupuytren's contracture. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 10 | pages= 968-79 | pmid=19726771 | doi=10.1056/NEJMoa0810866 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19726771 }}</ref>
* It is done in an outpatient practice but requires another clinic visit to snap the cord.
* I t is generally safe; however several [[Complication (medicine)|complications]] were reported, such as [[tendon]] [[rupture]] and pulley injury.<ref name="pmid23200951">{{cite journal| author=Peimer CA, Blazar P, Coleman S, Kaplan FT, Smith T, Tursi JP | display-authors=etal| title=Dupuytren contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS study): 3-year data. | journal=J Hand Surg Am | year= 2013 | volume= 38 | issue= 1 | pages= 12-22 | pmid=23200951 | doi=10.1016/j.jhsa.2012.09.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23200951 }}</ref>
* CCH injectiont is available in only North America after its withdrawal from European, Australian, and Asian markets.<ref name="pmid31810821">{{cite journal| author=Cocci A, Russo GI, Salamanca JIM, Ralph D, Palmieri A, Mondaini N| title=The End of an Era: Withdrawal of Xiapex (Clostridium histolyticum Collagenase) from the European Market. | journal=Eur Urol | year= 2020 | volume= 77 | issue= 5 | pages= 660-661 | pmid=31810821 | doi=10.1016/j.eururo.2019.11.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31810821 }}</ref>

===Surgery===
[[Surgery]] is not the first-line treatment option for patients with [[Dupuytren's contracture (patient information)|Dupuytren's]] disease. Surgery is usually reserved for patients with either:<ref name="pmidhttps://doi.org/10.1136/bmj.n13083">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }}</ref>

*Rapid progression over a few months
*Severe thumb [[Contracture|contractures]] with functional impairment
*More than 30° [[metacarpophalangeal joint]] contracture or 10-20° [[Proximal interphalangeal joints|proximal interphalangeal joint]] [[contracture]]

The choice of the type of surgery depends the following variables:

*Severity of the disease
*Individual characteristics (such as [[age]], [[Occupational Medicine|occupation]], degree of functional disability)
*Patient and/or physician preference

Surgical options include:

* '''[[Percutaneous]] [[needle]] [[fasciotomy]] (PNF):''' involves division of the cord using a needle. It is generally effective and safe with no [[Complication (medicine)|complications]]; however [[tendon]] and [[Digital clubbing|digital]] [[nerve]] and [[Blood vessel|vessel]] damage were reported in some cases. Its efficacy is low in the management of extensive [[Contracture|contractures]] or contractures involving the [[Interphalangeal articulations of hand|proximal interphalangeal joints]]. The recurrence rate is high.<ref name="pmid16713831">{{cite journal| author=van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM| title=A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study. | journal=J Hand Surg Am | year= 2006 | volume= 31 | issue= 5 | pages= 717-25 | pmid=16713831 | doi=10.1016/j.jhsa.2006.02.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16713831 }}</ref><ref name="pmid26648251">{{cite journal| author=Rodrigues JN, Becker GW, Ball C, Zhang W, Giele H, Hobby J | display-authors=etal| title=Surgery for Dupuytren's contracture of the fingers. | journal=Cochrane Database Syst Rev | year= 2015 | volume= | issue= 12 | pages= CD010143 | pmid=26648251 | doi=10.1002/14651858.CD010143.pub2 | pmc=6464957 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26648251 }}</ref><ref name="pmid30012049">{{cite journal| author=Scherman P, Jenmalm P, Dahlin LB| title=Three-year recurrence of Dupuytren's contracture after needle fasciotomy and collagenase injection: a two-centre randomized controlled trial. | journal=J Hand Surg Eur Vol | year= 2018 | volume= 43 | issue= 8 | pages= 836-840 | pmid=30012049 | doi=10.1177/1753193418786947 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30012049 }}</ref>
* '''[[Fasciectomy]]''' '''either partial (segmental aponeurectomy) or complete (limited fasciectomy):''' involves excision of the cord with higher rate of [[complications]] PNF.<ref name="pmid10697321">{{cite journal| author=Armstrong JR, Hurren JS, Logan AM| title=Dermofasciectomy in the management of Dupuytren's disease. | journal=J Bone Joint Surg Br | year= 2000 | volume= 82 | issue= 1 | pages= 90-4 | pmid=10697321 | doi=10.1302/0301-620x.82b1.9808 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10697321 }}</ref>
* '''Dermofasciectomy:''' a more [[Invasive (medical)|invasive]] procedure that involves excising the whole diseased tissue, along with the overlying [[subcutaneous fat]] and [[skin]]. It is reserved for more severe cases with extensive skin involvement when the other surgical options have failed. The complication rate is the highest among the three surgical options. The [[Recurrence plot|recurrence]] rate is low.<ref name="pmid6379077">{{cite journal| author=Tonkin MA, Burke FD, Varian JP| title=Dupuytren's contracture: a comparative study of fasciectomy and dermofasciectomy in one hundred patients. | journal=J Hand Surg Br | year= 1984 | volume= 9 | issue= 2 | pages= 156-62 | pmid=6379077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6379077 }}</ref>

 

==External links==
http://www.nlm.nih.gov/medlineplus/ency/article/001233.htm

{{Diseases of the musculoskeletal system and connective tissue}}

[[Category:Diseases involving the fasciae]]

[[Category:Rare diseases]]
[[Category:Orthopedics]]
[[Category:Rheumatology]]

[[de:Morbus Dupuytren]]
[[es:Enfermedad de Dupuytren]]
[[fr:Maladie de Dupuytren]]
[[it:Malattia di Dupuytren]]
[[nl:Ziekte van Dupuytren]]
[[tr:Dupuytren kontraktürü]]

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Dupuytrens contracture

2021-08-07T07:02:44Z

Mohamed riad: /* Surgery */

__NOTOC__
{{Infobox_Disease |
Name = Dupuytren's contracture |
Image = Morbus dupuytren fcm.jpg |
Caption = Dupuytren's contracture of the fourth digit (ring finger). |
DiseasesDB = 4011 |
ICD10 = {{ICD10|M|72|0|m|70}} |
ICD9 = {{ICD9|728.6}} |
ICDO = |
OMIM = 126900 |
MedlinePlus = 001233 |
MeshID = |
}}
{{SI}}

'''Editors-In-Chief:''' Matthew I. Leibman, M.D.[mailto:MLeibman@partners.org]; Mark R. Belsky, M.D.[mailto:MBelsky@partners.org]; David E. Ruchelsman, M.D.[mailto:DRuchelsman@partners.org]{{KS}}

{{SK}} Dupuytren contracture I, included; DUPC1; palmar fascial fibromatosis; palmar fibromatosis
==Overview==
'''Dupuytren's contracture''' (also known as '''Morbus Dupuytren''') is an abnormal [[Thickening of the heart muscle|thickening]] of the hand causing curling of [[fingers]] and impaired function of the fingers, especially the little and ring fingers.. It is named after the famous [[surgery|surgeon]] [[Guillaume Dupuytren|Baron Guillaume Dupuytren]], who described an [[Surgery|operation]] to correct the affliction. It is thought that Dupuytren's contracture is the result of [[Microvascular disease|microvascular]] [[angiopathy]]. Common risk factors in the development of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] include family history, diabetes, antiepileptic medications, liver disease, smoking, alcoholism and manual work. The incidence of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] increases with age; the [[median]] age at diagnosis is 50-70 years. [[men]] are affected more often than [[women]].

==Historical Perspective==

*Dupuytren's contracture was named after [[Guillaume Dupuytren|Baron Guillaume Dupuytren]], a famous surgeon, following describing an [[Surgery|operation]] to correct the affliction.

==Pathophysiology==

===Pathogenesis===

*The exact pathogenesis of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] is not fully understood.
*It is thought that Dupuytren's contracture is the result of [[Microvascular disease|microvascular]] [[angiopathy]].<ref name="pmidhttps://doi.org/10.1136/bmj.n13085">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }}</ref>

===Associated Conditions===

*[[Diabetes mellitus]]
*[[Thyroid disease|Thyroid diseases]]
*[[Liver diseases|Liver disease]]
*[[Alcoholism]] and [[smoking]]

==Causes==
The cause of Dupuytren's contracture has not been identified.

== Epidemiology and Demographics ==

===Prevalence===

*The [[prevalence]] of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] among the UK population is 3-5%.<ref name="pmid21486483">{{cite journal| author=Gerber RA, Perry R, Thompson R, Bainbridge C| title=Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England. | journal=BMC Musculoskelet Disord | year= 2011 | volume= 12 | issue= | pages= 73 | pmid=21486483 | doi=10.1186/1471-2474-12-73 | pmc=3103491 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21486483 }}</ref>

===Age===

*The incidence of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] increases with age; the [[median]] age at diagnosis is 50-70 years.

===Race===

*Dupuytren's contracture usually affects individuals of the northern Europeans race (Icelandic and Scandinavian populations).<ref name="pmid10760640">{{cite journal| author=Gudmundsson KG, Arngrímsson R, Sigfússon N, Björnsson A, Jónsson T| title=Epidemiology of Dupuytren's disease: clinical, serological, and social assessment. The Reykjavik Study. | journal=J Clin Epidemiol | year= 2000 | volume= 53 | issue= 3 | pages= 291-6 | pmid=10760640 | doi=10.1016/s0895-4356(99)00145-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10760640 }}</ref>

===Gender===

*[[Male|Males]] are more commonly affected by Dupuytren's contracture than [[Female|females]]. The male to female [[ratio]] is approximately 3 to 1.<ref name="pmidhttps://doi.org/10.1136/bmj.n13084">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }}</ref>

==Risk Factors==
Common risk factors in the development of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] include:

*[[Family history]]: [[genetic predisposition]] may account for 80% of cases.<ref name="pmid24835475">{{cite journal| author=Larsen S, Krogsgaard DG, Aagaard Larsen L, Iachina M, Skytthe A, Frederiksen H| title=Genetic and environmental influences in Dupuytren's disease: a study of 30,330 Danish twin pairs. | journal=J Hand Surg Eur Vol | year= 2015 | volume= 40 | issue= 2 | pages= 171-6 | pmid=24835475 | doi=10.1177/1753193414535720 | pmc=4810018 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24835475 }}</ref>
*[[Diabetes]] and its medications<ref name="pmid15336742">{{cite journal| author=Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R| title=Dupuytren's disease risk factors. | journal=J Hand Surg Br | year= 2004 | volume= 29 | issue= 5 | pages= 423-6 | pmid=15336742 | doi=10.1016/j.jhsb.2004.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15336742 }}</ref>
*[[Smoking]]<ref name="pmid15485739">{{cite journal| author=Godtfredsen NS, Lucht H, Prescott E, Sørensen TI, Grønbaek M| title=A prospective study linked both alcohol and tobacco to Dupuytren's disease. | journal=J Clin Epidemiol | year= 2004 | volume= 57 | issue= 8 | pages= 858-63 | pmid=15485739 | doi=10.1016/j.jclinepi.2003.11.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15485739 }}</ref>
*[[Alcohol]] intake
*[[Antiepileptics|Antiepileptic]] medications<ref name="pmid25288296">{{cite journal| author=Nunn AC, Schreuder FB| title=Dupuytren's contracture: emerging insight into a Viking disease. | journal=Hand Surg | year= 2014 | volume= 19 | issue= 3 | pages= 481-90 | pmid=25288296 | doi=10.1142/S0218810414300058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25288296 }}</ref>
*There is also some speculation that [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] may be caused by [[physical trauma]], such as manual [[Labor (childbirth)|labor]] or other over-exertion of the hands. However, the fact that Dupuytren's is not connected with handedness casts some doubt on this claim.
*[[Surgery]] of the [[hand]] may trigger growth of Dupuytren nodules and cords if an inclination existed before.
*Certain occupations with repetitive [[hand trauma]]

==Natural History, Complications and Prognosis==

===Natural History===

*Dupuytren’s disease is [[Progressive angina|progressive]] in nature with no available [[cure]].
*Improvement of the [[painful]] [[Nodule (medicine)|nodules]] may occur with time, and many patients never experience a [[contracture]].

===Complications===

*[[Ectopic]] disease involving the [[penis]] (Pyronie's disease) or the feet ([[Ledderhose's disease|Ledderhose disease]])
*Limitation of daily activities and work capabilities

===Prognosis===

*[[Prognosis]] is generally poor.
*Development of [[Dupuytren's disease]] at an earlier age is associated with more severe [[Deformity|deformities]].

==Diagnosis==

===Diagnostic Study of Choice===
Dupuytren’s disease is primarily diagnosed based on the clinical presentation.

===History and Symptoms===

*Symptoms of '''Dupuytren's disease''' include abnormal [[Thickening of the heart muscle|thickening]] of the hand causing curling of [[fingers]] and impaired function of the fingers, especially the little and ring fingers.
*It usually has a gradual onset, often beginning as a [[Tenderness (medicine)|tender]] [[lump]] in the [[Palmar|palm]].
*It often starts as a [[Nodule (medicine)|nodule]], usually in line with the [[ring finger]].
*Over time, [[pain]] associated with the condition tends to go away, but tough bands of tissue may develop.
*These bands, which are the source of the reduced [[mobility]] commonly associated with the condition, are visible on the surface of the [[Palmar|palm]], and may appear similar to a small [[callus]].
*It commonly develops in both hands, and has no connection to dominant- or non-dominant hands, nor any correlation with right- or left-handedness.
*The [[contracture]] sets on very slowly, especially in women. However, when present in both hands, and when there is associated [[foot]] involvement, it tends to accelerate more rapidly.

===Physical Examination===
====Skin====
=====Hand=====
<gallery>
File:Dupuytren contracture01.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture02.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture03.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture04.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture05.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
File:Dupuytren contracture06.jpg|Dupuytren contracture. ''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''
</gallery>
==Treatment==

===Medical Therapy===

*Pharmacologic medical therapies for Dupuytren's disease include pain management and corticosteroid injection into the nodules,
*In some cases, repeated corticosteroid injections may cause softening of the nodules and slow down the disease progression.
*Most cases with simple nodules and without significant functional impairment benefit from conservative medical therapy.

=== Interventions ===

==== Collagenase clostridium histolyticum (CCH) injections ====

* The [[mechanism of action]] is to weaken the [[contracted]] [[cord]] by breaking down [[collagen]].<ref name="pmid19726771">{{cite journal| author=Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA | display-authors=etal| title=Injectable collagenase clostridium histolyticum for Dupuytren's contracture. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 10 | pages= 968-79 | pmid=19726771 | doi=10.1056/NEJMoa0810866 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19726771 }}</ref>
* It is done in an outpatient practice but requires another clinic visit to snap the cord.
* I t is generally safe; however several [[Complication (medicine)|complications]] were reported, such as [[tendon]] [[rupture]] and pulley injury.<ref name="pmid23200951">{{cite journal| author=Peimer CA, Blazar P, Coleman S, Kaplan FT, Smith T, Tursi JP | display-authors=etal| title=Dupuytren contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS study): 3-year data. | journal=J Hand Surg Am | year= 2013 | volume= 38 | issue= 1 | pages= 12-22 | pmid=23200951 | doi=10.1016/j.jhsa.2012.09.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23200951 }}</ref>
* CCH injectiont is available in only North America after its withdrawal from European, Australian, and Asian markets.<ref name="pmid31810821">{{cite journal| author=Cocci A, Russo GI, Salamanca JIM, Ralph D, Palmieri A, Mondaini N| title=The End of an Era: Withdrawal of Xiapex (Clostridium histolyticum Collagenase) from the European Market. | journal=Eur Urol | year= 2020 | volume= 77 | issue= 5 | pages= 660-661 | pmid=31810821 | doi=10.1016/j.eururo.2019.11.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31810821 }}</ref>

===Surgery===
[[Surgery]] is not the first-line treatment option for patients with [[Dupuytren's contracture (patient information)|Dupuytren's]] disease. Surgery is usually reserved for patients with either:<ref name="pmidhttps://doi.org/10.1136/bmj.n13083">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }}</ref>

*Rapid progression over a few months
*Severe thumb [[Contracture|contractures]] with functional impairment
*More than 30° [[metacarpophalangeal joint]] contracture or 10-20° [[Proximal interphalangeal joints|proximal interphalangeal joint]] [[contracture]]

The choice of the type of surgery depends the following variables:

*Severity of the disease
*Individual characteristics (such as [[age]], [[Occupational Medicine|occupation]], degree of functional disability)
*Patient and/or physician preference

Surgical options include:

* '''[[Percutaneous]] [[needle]] [[fasciotomy]] (PNF):''' involves division of the cord using a needle. It is generally effective and safe with no [[Complication (medicine)|complications]]; however [[tendon]] and [[Digital clubbing|digital]] [[nerve]] and [[Blood vessel|vessel]] damage were reported in some cases. Its efficacy is low in the management of extensive [[Contracture|contractures]] or contractures involving the [[Interphalangeal articulations of hand|proximal interphalangeal joints]]. The recurrence rate is high.<ref name="pmid16713831">{{cite journal| author=van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM| title=A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study. | journal=J Hand Surg Am | year= 2006 | volume= 31 | issue= 5 | pages= 717-25 | pmid=16713831 | doi=10.1016/j.jhsa.2006.02.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16713831 }}</ref><ref name="pmid26648251">{{cite journal| author=Rodrigues JN, Becker GW, Ball C, Zhang W, Giele H, Hobby J | display-authors=etal| title=Surgery for Dupuytren's contracture of the fingers. | journal=Cochrane Database Syst Rev | year= 2015 | volume= | issue= 12 | pages= CD010143 | pmid=26648251 | doi=10.1002/14651858.CD010143.pub2 | pmc=6464957 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26648251 }}</ref><ref name="pmid30012049">{{cite journal| author=Scherman P, Jenmalm P, Dahlin LB| title=Three-year recurrence of Dupuytren's contracture after needle fasciotomy and collagenase injection: a two-centre randomized controlled trial. | journal=J Hand Surg Eur Vol | year= 2018 | volume= 43 | issue= 8 | pages= 836-840 | pmid=30012049 | doi=10.1177/1753193418786947 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30012049 }}</ref>
* '''[[Fasciectomy]]''' '''either partial (segmental aponeurectomy) or complete (limited fasciectomy):''' involves excision of the cord with higher rate of [[complications]] PNF.<ref name="pmid10697321">{{cite journal| author=Armstrong JR, Hurren JS, Logan AM| title=Dermofasciectomy in the management of Dupuytren's disease. | journal=J Bone Joint Surg Br | year= 2000 | volume= 82 | issue= 1 | pages= 90-4 | pmid=10697321 | doi=10.1302/0301-620x.82b1.9808 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10697321 }}</ref>
* '''Dermofasciectomy:''' a more [[Invasive (medical)|invasive]] procedure that involves excising the whole diseased tissue, along with the overlying [[subcutaneous fat]] and [[skin]]. It is reserved for more severe cases with extensive skin involvement when the other surgical options have failed. The complication rate is the highest among the three surgical options. The [[Recurrence plot|recurrence]] rate is low.<ref name="pmid6379077">{{cite journal| author=Tonkin MA, Burke FD, Varian JP| title=Dupuytren's contracture: a comparative study of fasciectomy and dermofasciectomy in one hundred patients. | journal=J Hand Surg Br | year= 1984 | volume= 9 | issue= 2 | pages= 156-62 | pmid=6379077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6379077 }}</ref>

 

==External links==
http://www.nlm.nih.gov/medlineplus/ency/article/001233.htm

{{Diseases of the musculoskeletal system and connective tissue}}

[[Category:Diseases involving the fasciae]]

[[Category:Rare diseases]]
[[Category:Orthopedics]]
[[Category:Rheumatology]]

[[de:Morbus Dupuytren]]
[[es:Enfermedad de Dupuytren]]
[[fr:Maladie de Dupuytren]]
[[it:Malattia di Dupuytren]]
[[nl:Ziekte van Dupuytren]]
[[tr:Dupuytren kontraktürü]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
<references />

Dupuytrens contracture

2021-08-07T03:45:22Z

Mohamed riad: /* Treatment */

Dupuytrens contracture

2021-08-07T03:29:07Z

Mohamed riad: /* Natural History, Complications and Prognosis */

Dupuytrens contracture

2021-08-07T03:22:14Z

Mohamed riad: /* History and Symptoms */

Dupuytrens contracture

2021-08-06T02:17:01Z

Mohamed riad: /* Pathophysiology */

Dupuytrens contracture

2021-08-06T02:14:41Z

Mohamed riad: /* Risk Factors */

Dupuytrens contracture

2021-08-06T02:13:08Z

Mohamed riad: /* Prevalence */

Dupuytrens contracture

2021-08-06T02:12:50Z

Mohamed riad: /* Gender */

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2021-08-06T02:12:26Z

Mohamed riad: /* Race */

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2021-08-06T02:11:45Z

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2021-08-06T02:10:59Z

Mohamed riad: /* Prevalence */

Dupuytrens contracture

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Mohamed riad: /* History and Symptoms */

Dupuytrens contracture

2021-08-05T02:26:12Z

Mohamed riad: /* Natural History, Complications and Prognosis */

Dupuytrens contracture

2021-08-05T01:26:56Z

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