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| {{Taxobox
| | #REDIRECT[[Mycoplasma genitalium infection]] |
| | color = lightgrey
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| | name = ''Mycoplasma genitalium''
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| | image = Mycoplasma genitalium.gif
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| | regnum = [[Bacterium|Bacteria]]
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| | divisio = [[Firmicutes]]
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| | classis = [[Mollicutes]]
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| | ordo = [[Mycoplasmatales]]
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| | familia = [[Mycoplasmataceae]]
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| | genus = ''[[Mycoplasma]]''
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| | species = '''''M. genitalium'''''
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| | binomial = ''Mycoplasma genitalium''
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| | binomial_authority = Tully et al., 1983
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| }}
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| __NOTOC__
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| {{CMG}}; {{AE}}{{DN}}
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| {{SI}}
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| ==Overview==
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| ==Classification==
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| ==Historical Perspective==
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| *'''''[[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>
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| *In 1980, 13 men were tested for non-gonoccal [[urethritis]] (NGU). '''''[[Mycoplasma genitalium]]''''' was isolated from 2 of those 13 men.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid26975162">{{cite journal |vauthors= |title=Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines |journal=J Miss State Med Assoc |volume=56 |issue=12 |pages=372–5 |year=2015 |pmid=26975162 |doi= |url=}}</ref><ref name="pmid12599082">{{cite journal |vauthors=Manhart LE, Critchlow CW, Holmes KK, Dutro SM, Eschenbach DA, Stevens CE, Totten PA |title=Mucopurulent cervicitis and Mycoplasma genitalium |journal=J. Infect. Dis. |volume=187 |issue=4 |pages=650–7 |year=2003 |pmid=12599082 |doi=10.1086/367992 |url=}}</ref>
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| *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>
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| *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>
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| ==Pathophysiology==
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| ===Pathogenesis===
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| ====Mode of Transmission====
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| *'''''[[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>
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| *'''''[[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>
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| *Whether or not '''''[[Mycoplasma genitalium]]''''' is vertically transmitted from mother to [[newborn]] is yet to be studied. However, the [[bacterium]] has been isolated from the respiratory tract of [[newborns]]. <ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
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| ====Incubation Period====
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| 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>
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| ====Infectious Dose====
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| 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>
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| ====Factors facilitating the pathogenesis of '''''[[Mycoplasma genitalium]]'''''====
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| 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>
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| *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]]'''''.
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| *[[Intracellular]] localization: '''''[[Mycoplasma genitalium]]''''' is a facultative intracellular organism and this allows for its survival both inside and outside of cells.
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| *[[Antigenic]] variation: '''''[[Mycoplasma genitalium]]''''' is able to generate surface lipoprotein with high frequency, which helps it evade the human [[immune system]].
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| *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]]'''''.
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| *Enzymes: Glyceraldehyde 3-phosphate dehydrogenase [[(GADPH)]] acts as a [[ligand]] to the [[receptors]] [[mucin]] and [[fibronectin]], found on [[vaginal]] and [[cervical]] [[epithelium]].
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| *Immunological response: '''''[[Mycoplasma genitalium]]''''' possesses an immunogenic protein, MG-309, which secretes pro-inflammatory [[cytokines]], such as IL-6 and IL-8. MG-309 exerts its effect via attaching to a [[toll-like receptor]], hence activating nuclear factor kappa B ([[NF-kB]])
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| ===Genetics===
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| ===Associated Conditions===
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| '''''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>
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| *Chlamydia Trachomatis
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| *Neisseria Gonorrhea
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| *Trichomonas vaginalis
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| *[[HIV]]
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| ===Gross Pathology===
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| ===Microscopic Pathology===
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| ==Causes==
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| The cause of '''''Mycoplasma genitalium''''' infection is '''''[[Mycoplasma]] genitalium'''''.
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| ==Differentiating Mycoplasma genitalium infection from other diseases==
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| '''''Mycoplasma genitalium''''' infection must be distinguished from other [[sexually transmitted diseases]], which may have a similar presentation. These include:
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| *'''''Chlamydia trachomatis'''''
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| *'''''Neisseria gonorrhea'''''
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| *'''''Trichomonas vaginalis'''''
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| *'''''Ureaplasma urealyticum'''''
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| *'''''Herpes simplex''''' virus
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| ==Epidemiology and Demographics==
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| *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>
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| *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>
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| **The prevalence in all females aged 14-70 years old is 16.3%.
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| **The prevalence in all males aged 18-78 years old is 17.2%.
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| **Infection in both males and females was more prevalent in those younger than 30 years of age.
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| **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>
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| *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>
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| ==Risk Factors==
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| 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>
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| *High risk sexual behavior, defined as having >3 new sexual partners in the past year
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| *Being engaged in sexual contact with persons with [[STDs]], particularly '''''[[Mycoplasma genitalium]]'''''
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| *Non-white race
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| *Having a black partner
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| *Young age (<20 years old)
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| *[[Smoking]]
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| *Having less than high school education
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| *Having an annual income of less than $10,000
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| *Risk factors specific to [[females]] includes:
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| **Frequent douching
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| **Proliferative phase of the [[menstrual cycle]]
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| **History of spontaneous [[miscarriage]]
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| **Undergoing procedures that breach the [[cervical]] barrier
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| **Use of [[Depo-Provera]] for [[contraception]]
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| ==Screening==
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| 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>
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| ==Natural history, Complications and Prognosis==
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| ===Natural History===
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| ===Complications===
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| 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="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="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>
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| *Complications in females include: [[cervicitis]], [[endometritis]], tubal factor [[infertility]], [[pelvic inflammatory disease]] [[(PID)]], as well as sexually active [[reactive arthritis]] (SARA).
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| *Complications in males include: [[epididymitis]], [[urethritis]], as well as sexually active [[reactive arthritis]] (SARA).
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| ===Prognosis===
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| ==History==
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| The presenting symptoms of '''''[[Mycoplasma genitalium]]''''' are related to the disease processes it may cause. Presenting symptoms can be divided based on gender:
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| *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>
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| **[[Cervicitis]]: presents with [[vaginal]] [[discharge]], [[vaginal]] itching, inter-menstrual, heavy or post-coital [[bleeding]]
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| **[[PID]]: presents with pelvic discomfort or lower abdominal pain, painful sexual intercourse (dyspareunia), vaginal [[discharge]] and/or [[bleeding]]
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| **[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
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| *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>
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| ==Physical Examination==
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| 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.
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| *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>
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| **[[Cervicitis]]: findings include a [[purulent]] or [[mucopurulent]] cervical [[discharge]], [[vaginal]] itching, inter-menstrual, heavy or post-coital [[bleeding]]<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="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="pmid18842689">{{cite journal |vauthors=Moi H, Reinton N, Moghaddam A |title=Mycoplasma genitalium in women with lower genital tract inflammation |journal=Sex Transm Infect |volume=85 |issue=1 |pages=10–4 |year=2009 |pmid=18842689 |doi=10.1136/sti.2008.032748 |url=}}</ref>
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| **[[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>
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| *Males:
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| **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>
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| ==Laboratory Findings==
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| *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>
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| *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>
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| ==X-Ray==
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| There is no role for x-ray in '''''Mycoplasma genitalium''''' infection.
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| ==CT==
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| [[CT]] scan may be used if '''''Mycoplasma genitalium''''' infection has been complicated by [[PID]]. These include thickened and fluid-filled tubes with or without free pelvic fluid.
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| ==Other Imaging Findings==
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| [[MRI]] may be used if '''''Mycoplasma genitalium''''' infection has been complicated by [[PID]].
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| ==Other Diagnostic Studies==
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| There are no other diagnostic studies for '''''Mycoplasma genitalium''''' infection.
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| ==Medical Therapy==
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| '''''[[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>
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| *[[Doxycycline]] has poor efficacy for '''''[[Mycoplasma]] genitalium'''''.
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| *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.
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| *For uncomplicated [[macrolide]] resistant '''''[[Mycoplasma]] genitalium''''' infection, [[moxifloxacin]] 400mg once daily is given for 7-10 days.
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| *[[Pristinamycin]] 1g 4 times daily is given for 7-10 days when both [[azithromycin]] and [[moxifloxacin]] fail.
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| *For complicated '''''[[Mycoplasma]] genitalium''''' infection, [[moxifloxacin]] 400mg once daily is used for 14 days.
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| ==Surgical Therapy==
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| Medical therapy is the mainstay of treatment for '''''Mycoplasma genitalium''''' infection. There is no role for surgery in the management of '''''Mycoplasma genitalium''''' infection.
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| ==Primary Prevention==
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| Since '''''Mycoplasma genitalium''''' infection is a [[sexually transmitted disease]], prevention must target safe sexual practices. These include:
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| *practicing safe sex with one partner and avoiding multiple sexual partners
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| *using condoms and/or other barrier methods
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| ==Secondary Prevention==
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| 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>
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| *Prompt treatment with antibiotics to prevent complications of the infection
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| *Partner notification and evaluation: if partner does not attend evaluation for infection, then he/she can be offered the same treatment as the patient
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| *Screening for other [[sexually transmitted diseases]]
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| ==References==
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| [[Category:Infectious Disease]]
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| [[Category:Primary Care]]
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| [[Category:Gynecology]]
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| [[Category:Urology]]
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| {{WH}}{{WS}}
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| {{Reflist|2}}
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