Mycoplasma genitalium

M. genitalium | M. gen |

Overview

  • Recently identified
  • Testing has not been widely available and limited to laboratories using in house assays.  However, several commercial assays are likely to become available in 2016/2017. 
  • Strong association with urethritis
  • Associated with cervicitispelvic inflammatory disease (PID) and preterm delivery.

Cause

Mycoplasma genitalium

Clinical presentation

Male Female
Symptoms
Causes similar symptoms to chlamydia Most are asymptomatic
Dysuria Dysuria
Urethral discharge Vaginal discharge
Testicular pain Pelvic pain
Proctitis Intermenstrual bleeding
  Post-coital bleeding
Complications
Epididymo-orchitis

pelvic inflammatory disease (PID), infertility and ectopic pregnancy

Possible role in tubal factor infertility

Further studies continuing to elucidate role in disease causation.

Diagnosis

Diagnosis in males
TestSite/SpecimenConsideration
NAAT FPU  n/a
NAAT – Nucleic Acid Amplification Test 
FPU – First pass urine

 

Diagnosis in females
TestSite/SpecimenConsideration
NAAT Endocervical swab If patient is examined, this is the best test
NAAT  
Self-collected vaginal swab
If not examined
NAAT FPU Not as sensitive as vaginal swab
NAAT – Nucleic Acid Amplification Test
FPU – First pass urine

Specimen collection

Clinician collected |
Self-collection

Investigations

  • Utility of testing other anatomical sites not determined.
  • NAAT is the only available test.
  • Testing for Mycoplasma genitalium is currently available through some private pathology companies and the following public laboratories:

Special considerations

There are currently no recommendations to include routine testing for M. genitalium in asymptomatic patients. Testing should be limited to those with symptoms or contacts of those with known infection.

Management

Optimal treatment for M. genitalium is still unclear. Most people diagnosed will have been pre-treated with azithromycin 1g as presumptive therapy for urethritis. This is effective in up to 60% of infected individuals and only those with persisting symptoms should have further treatment. While extended azithromycin regimens have been used in a number of settings there is no evidence that they currently achieve higher cure rates in Australia where circulating macrolide resistance is occurring in at least 30% of cases. 

Principal Treatment Options
SituationRecommendedAlternative
Uncomplicated genital infection Azithromycin 1g PO, stat Seek specialist advice.

Treatment advice:

Mycoplasma genitalium is developing macrolide resistance complicating the choice of first line treatment of urethritis for some men. If there are ongoing symptoms in the absence of re-infection, seek specialist advice.

Other immediate management

  • Advise no sexual contact for 7 days after treatment is administered.
  • Advise no sex with partners from the last 6 months until the partners have been tested and treated if necessary.
  • Provide patient with factsheet
  • M. genitalium is not a notifiable condition.

Special treatment situations

Special considerations

Seek specialist advice for persistent infection or before treating any complicated presentation.

 

SituationRecommended
Pregnant women
 pregnancy
Same as recommended treatment, however seek specialist advice.
Pelvic inflammatory disease (PID) Seek specialist advice.
Prior to a gynaecological procedure Seek specialist advice.
Allergy to principal treatment choice Seek specialist advice.

Contact tracing

  • Contact tracing is important to prevent reinfection and reduce transmission
  • There is currently insufficient data to provide a definitive period for contact tracing, though partner notification is likely to be beneficial and it is recommended to trace back for 6 months, or as guided by sexual history.

See Australasian Contract Tracing Manual - Mycoplasma genitalium for more information.

Follow up

Review in 1 week provides an opportunity to:

  • Confirm patient adherence with treatment and assess for symptom resolution.
  • Confirm contact tracing procedures have been undertaken or offer more contact tracing support.
  • Provide further sexual health education and prevention counselling.

Test of Cure (TOC)

TOC by NAAT should be done at least 2 weeks after treatment is completed. For special treatment situations (as above) seek specialist advice.

Retesting

Retest patients 3 months after exposure. This also provides an opportunity to consider tests for other STIs.

Auditable outcomes

  • 100% of patients diagnosed with M. genitalium are treated with an appropriate antibiotic regimen.
  • 100% of patients are advised to avoid sexual contact for 7 days after treatment is administered.

References

Bissessor M, Tabrizi SN, Twin J, et al. Macrolide resistance and azithromycin failure in a Mycoplasma genitalium-infected cohort and response of azithromycin failures to alternative antibiotic regimens. Clinical Infectious Diseases. 2015;60(8):1228-1236.

David Taylor-Robinson and Jørgen Skov Jensen. Mycoplasma Genitalium: form chrysalis to multicoloured butterfly. Clin. Microbiol. Rev. 2011; 24(3):498.

Manhart, Lisa E. Mycoplasma Genitalium An Emergent Sexually Transmitted Disease? Infect Dis Clin N Am. 2013;27:779–792.

Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: A meta-analysis. Clinical Infectious Diseases. 2015;61(3):418-426.

 

Last Updated: Monday, 23 May 2016