Mycoplasma genitalium: Difference between revisions

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===Gross Pathology===
===Gross Pathology===
Gross pathology of '''''Mycoplasma genitalium''''' infection is related to the disease processes it may result: [[cervicitis]], [[PID]], [[uretheritis]] or [[epididymitis]].
===Microscopic Pathology===
===Microscopic Pathology===



Revision as of 15:31, 12 October 2016

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


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

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Overview

Classification

Historical Perspective

Pathophysiology

Pathogenesis

Mode of Transmission

Incubation Period

The incubation period of Mycoplasma genitalium is unknown yet.[6]

Infectious Dose

The infectious dose of Mycoplasma genitalium is unknown yet.[6]

Factors facilitating the pathogenesis of Mycoplasma genitalium

The following virulence factors have been implicated in the pathogenesis of Mycoplasma genitalium: [1][2][7]

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:[8]

  • 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, uretheritis or epididymitis.

Microscopic Pathology

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.[2]
  • In the United States, the prevalence of Mycoplasma genitalium was estimated as follows:[8]
    • The prevalence in all females aged 14-70 years old is 16.3%.
    • The prevalence 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%).[9]
  • Between the years 2002-2011, the prevalence of Mycoplasma genitalium worldwide ranged between 4%-42%.[7]

Risk Factors

There several risk factors that have been identified with Mycoplasma genitalium infection. These risk factors include:[2][4][10]

  • 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
  • Having a black partner
  • Young age (<20 years old)
  • Smoking
  • Having less than high school education
  • Having an annual income of less than $10,000
  • Risk factors specific to females includes:

Screening

There are no recommendations for screening for Mycoplasma genitalium.[11]

Natural history, Complications and Prognosis

Natural History

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

Complications

The following complications may be the result of Mycoplasma genitalium infection:[2][5][12][13][14][15][16][14][17][18][19]

Prognosis

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

History

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

Physical Examination

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

Laboratory Findings

  • Culture of Mycoplasma genitalium is not commonly used, as culture takes about 6 months to grow and is not widely available.[2]
  • 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.[2][3][22][26][27][28]

X-Ray

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

CT

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

Other Imaging Findings

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

Other Diagnostic Studies

There are no other diagnostic studies for Mycoplasma genitalium infection.

Medical Therapy

Mycoplasma genitalium is intracellular and 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:[2][3][5]

Surgical Therapy

Medical therapy is the mainstay of treatment for Mycoplasma genitalium infection. There is no role for surgery in 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:[29][30]

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

Secondary Prevention

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

  • Prompt treatment with antibiotics to prevent complications of the infection
  • 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

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  1. 1.0 1.1 Taylor-Robinson D, Jensen JS (2011). "Mycoplasma genitalium: from Chrysalis to multicolored butterfly". Clin. Microbiol. Rev. 24 (3): 498–514. doi:10.1128/CMR.00006-11. PMC 3131060. PMID 21734246.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 Jensen JS, Cusini M, Gomberg M, Moi H (2016). "Background review for the 2016 European guideline on Mycoplasma genitalium infections". J Eur Acad Dermatol Venereol. doi:10.1111/jdv.13850. PMID 27605499.
  3. 3.0 3.1 3.2 3.3 3.4 "Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines". J Miss State Med Assoc. 56 (12): 372–5. 2015. PMID 26975162.
  4. 4.0 4.1 4.2 Manhart LE, Critchlow CW, Holmes KK, Dutro SM, Eschenbach DA, Stevens CE, Totten PA (2003). "Mucopurulent cervicitis and Mycoplasma genitalium". J. Infect. Dis. 187 (4): 650–7. doi:10.1086/367992. PMID 12599082.
  5. 5.0 5.1 5.2 5.3 Ross JD, Jensen JS (2006). "Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment". Sex Transm Infect. 82 (4): 269–71. doi:10.1136/sti.2005.017368. PMC 2564705. PMID 16877571.
  6. 6.0 6.1 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.
  7. 7.0 7.1 Sethi S, Singh G, Samanta P, Sharma M (2012). "Mycoplasma genitalium: an emerging sexually transmitted pathogen". Indian J. Med. Res. 136 (6): 942–55. PMC 3612323. PMID 23391789.
  8. 8.0 8.1 Getman D, Jiang A, O'Donnell M, Cohen S (2016). "Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States". J. Clin. Microbiol. 54 (9): 2278–83. doi:10.1128/JCM.01053-16. PMC 5005488. PMID 27307460.
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  11. United States Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=mycoplasma+genitalium Accessed on Oct. 6, 2016.
  12. 12.0 12.1 12.2 Falk L, Fredlund H, Jensen JS (2004). "Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis". Sex Transm Infect. 80 (4): 289–93. doi:10.1136/sti.2003.006817. PMC 1744873. PMID 15295128.
  13. 13.0 13.1 13.2 Jensen JS, Orsum R, Dohn B, Uldum S, Worm AM, Lind K (1993). "Mycoplasma genitalium: a cause of male urethritis?". Genitourin Med. 69 (4): 265–9. PMC 1195084. PMID 7721285.
  14. 14.0 14.1 14.2 14.3 Anagrius C, Loré B, Jensen JS (2005). "Mycoplasma genitalium: prevalence, clinical significance, and transmission". Sex Transm Infect. 81 (6): 458–62. doi:10.1136/sti.2004.012062. PMC 1745067. PMID 16326846.
  15. 15.0 15.1 Wetmore CM, Manhart LE, Lowens MS, Golden MR, Whittington WL, Xet-Mull AM, Astete SG, McFarland NL, McDougal SJ, Totten PA (2011). "Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study". Sex Transm Dis. 38 (3): 180–6. doi:10.1097/OLQ.0b013e3182040de9. PMC 4024216. PMID 21285914.
  16. Mena L, Wang X, Mroczkowski TF, Martin DH (2002). "Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans". Clin. Infect. Dis. 35 (10): 1167–73. doi:10.1086/343829. PMID 12410476.
  17. 17.0 17.1 Falk L, Fredlund H, Jensen JS (2005). "Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection". Sex Transm Infect. 81 (1): 73–8. doi:10.1136/sti.2004.010439. PMC 1763725. PMID 15681728.
  18. 18.0 18.1 Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC (2009). "Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics". Sex Transm Dis. 36 (10): 598–606. doi:10.1097/OLQ.0b013e3181b01948. PMC 2924808. PMID 19704398.
  19. Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL (2009). "Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease". Clin. Infect. Dis. 48 (1): 41–7. doi:10.1086/594123. PMC 2652068. PMID 19025498.
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  23. Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL (2005). "Comparison of acute and subclinical pelvic inflammatory disease". Sex Transm Dis. 32 (7): 400–5. PMID 15976596.
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  29. LeFevre ML. USPSTF: behavioral counseling interventions to prevent sexually transmitted infections. Ann Intern Med 2014;161:894–901.
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