M. genitalium: The STD you've never heard of

Once again, there is a sexually transmitted disease/illness that you need to be mindful of. At this point, you should be very familiar with HIV, hepatitis, chlamydia/LGV, syphilis, gonorrhea, herpes, and HPV, as well as Monkeypox and covid19. Please click on the links provided if you are not or have any questions.

Being sexually active homosexual males places us at high risk for various infections related to our sexual activities. This includes sexual CONTACT as well as INTERCOURSE. Staying up-to-date on the latest news, treatments, and prevention methods keeps our community safe.

With this in mind, regular testing, at least every three (3) months, for ALL STDs should be a habit you adopt. The issue is that some medical providers are not as educated about the risks or treatments for our community and, thus cannot effectively treat us. Knowing your risk level, the symptoms of particular STDs, and the possible treatments will give you the knowledge you need to get the outcomes you deserve.

What you need to know

Mycoplasma genitalium (MG) is a type of bacteria that can cause an STD.

Scientists have known about this bacteria since the 1980s, but a recent study showed that more than 1 in 100 adults have it. It is responsible for 10–25% of cases of non-gonococcal urethritis (NGU) in Europe.

The bacteria can cause inflammation of the urethra, but, like with other STDs, you might not exhibit any symptoms. So it’s possible to have it and not know.

In men, the symptoms are:

pain when urinating
discharge from the penis
pain in the lower abdomen
pain or bleeding during or after anal sex

Mycoplasma genitalium can also infect the anus (there are usually no symptoms).

MG is also known to cause urethritis, so any changes in your everyday urinary habits should be a warning of possible infection.

M. genitalium causes symptomatic and asymptomatic urethritis among men and is the etiology of approximately 15%–20% of NGU, 20%–25% of nonchlamydial NGU, and 40% of persistent or recurrent urethritis.

Infection with C. trachomatis is common in selected geographic areas, although M. genitalium is often the sole pathogen.

Data are insufficient to implicate M. genitalium infection with chronic complications among men (e.g., epididymitis, prostatitis, or infertility).

The consequences of asymptomatic infection with M. genitalium among men are unknown.

Rectal infection with M. genitalium has been reported among 15%–26% of MSM. Rectal infections often are asymptomatic, although a higher prevalence of M. genitalium has been reported among men with rectal symptoms.

Similarly, although asymptomatic M. genitalium has been detected in the pharynx, no evidence exists of it causing oropharyngeal symptoms or systemic disease.

How can you get it?

Because MG is classified as a sexually transmitted disease, you get it by having sex with someone who has it. This includes sexual touching or rubbing.

At this time, there is no research on oral sex and contraction. But, the bacteria has been located within the pharynx. This is the part of the throat behind the mouth and nasal cavity and above the esophagus and trachea (the tubes going down to the stomach and the lungs). So, it is best to assume that oral sex may be a method of infection.

Like with other STDs, the best-known prevention method is to use a condom. But, just like with the others, this is no guarantee.

Testing for MG

And here is why you most likely have never heard of this disease. Among the standard tests for sexually transmitted diseases, this is not one of them, and mostmostmost providers have no idea it even exists!

Testing for mycoplasma is not currently recommended for people who don’t have symptoms.

You should have a mycoplasma test if:

you have signs or symptoms of mycoplasma genitalium
you have had sexual contact with someone who has been diagnosed as having mycoplasma genitalium

Unlike other STDs, there is no test for MG that the FDA has approved. But if you or your doctor thinks you might have it, you can get a nucleic acid amplification test (NAAT).

For this test, you might have to give a sample of your pee. Your doctor might also use a swab to take a sample from your urethra, the tube that carries your pee out of your body.

If you or your doctor believe you might have MG, it is essential you insist on a rectal screening.

The role of rectal MG as a reservoir and the need to treat asymptomatic rectal MG carriers have been controversial. A recent study in MSM with MG urethritis showed that up to 40% of sexual contacts undergoing a rectal exam were positive for MG. The presence of rectal MG is often asymptomatic, and rectal MG load is higher among patients with symptomatic proctitis than among asymptomatic rectal MG carriers.

Treatment

Mycoplasma genitalium infection is treated with 2 courses of antibiotics. Both courses need to be taken to cure the infection.

Your sexual partner/s needs to be tested and may need treatment. Your doctor or nurse can help you notify your sexual partner/s and there are websites where partner notification can be done anonymously.

You should have a follow-up test 2 weeks after finishing treatment (4 weeks after starting treatment).

It’s important to avoid sexual intercourse until you and your partner/s have had a negative test for mycoplasma. This is so that you don’t pass on the infection or become reinfected.

If you have a positive test for mycoplasma, it’s also a good idea to get tested for blood-borne viruses such as HIV and syphilis.

M. genitalium lacks a cell wall; thus, antibiotics targeting cell-wall biosynthesis (e.g., ß-lactams including penicillins and cephalosporins) are ineffective against this organism.

Because of the high rates of macrolide resistance with treatment failures and efficient selection of additional resistance, a 1-g dose of azithromycin should not be used.

Two-stage therapy approaches, ideally using resistance-guided therapy, are recommended or treatment. Resistance-guided therapy has demonstrated cure rates of >90% and should be used whenever possible; however, it requires access to macrolide-resistance testing.

As part of this approach, doxycycline is provided as initial empiric therapy, which reduces the organism load and facilitates organism clearance, followed by macrolide-sensitive M. genitalium infections treated with high-dose azithromycin; macrolide-resistant conditions are treated with moxifloxacin.

Before you go…

We know this information can seem challenging, but it is provided to give you more knowledge when speaking with your doctor if you have the mentioned symptoms. MG is just like every other STD you already know about, and the prevention methods are the same. The issue is that the treatments are varied, and those who are asymptomatic are still carriers of the bacteria.

If you are having urination issues or anal bleeding, it is best to make sure your medical provider also tests for MG and the other known causes of these conditions.