Mycoplasma Genitalium

Mycoplasma has only recently been identified as a sexually transmitted infection and is difficult to test for and to treat. There is still much to learn about this organism. It is one of the smallest living things on the planet and its has the shortest length of DNA known to science.

How do you get Mycoplasma?

As far as is known Mycoplasma genitalium can only infect the genitals and the anus and so it is contracted through vaginal and anal sexual intercourse. It isn’t really known how common this infection is because it usually doesn’t cause symptoms and it has only recently become possible to test for it.

How is Mycoplasma diagnosed?

In men it is diagnosed by an anal swab or a urine test. In women the best way to diagnose it is via a swab from the cervix collected by a doctor, alternative options are a self-collected swab or a urine test but these are less accurate.

Who should be tested for Mycoplasma?

It is currently not recommend that people be tested for mycoplasma unless they have symptoms of a sexually transmitted infection (STI). In men this is pain with passing urine, testicular pain or a discharge from the penis (similar to Chlamydia). In women it almost always asymptomatic but there may be pain with passing urine or bleeding after having sex.

What happens when you get Mycoplasma?

Apart from pain with passing urine in men it’s not clear if men are likely to suffer any more serious complication or whether the infection goes away naturally on its own. In women Mycoplasma Genitalium can cause a pelvic infection which can be serious and may affect their ability to fall pregnant. It can also cause pain with passing urine in women, bleeding after intercourse or a vaginal discharge.

How is Mycoplasma treated?

It’s not yet clear how best to treat Mycoplasma. It may be resistant to the usual treatment of azithromycin in 50% of cases meaning that this treatment may fail to cure the infection. The second line treatment is moxifloxacin but there is even resistance to this in about 15% of cases. Some people recommend treating with doxycycline (the alternative treatment for Chlamydia when azithromycin is used) first and then treating with azithromycin to be sure that the infection is cured.
All sexual partners from the last 6 months should be identified and notified so they can be tested and treated if necessary.

What follow up is needed?

A repeat test is needed between 2-4 weeks after treatment to see if the infection has been cured. If it hasn’t been cleared there are different treatment options but the best treatment isn’t clear and it would require discussion between specialists. Further testing is also recommended 3 months after treating the infection to check for any new STIs.