Mycoplasma genitalium: An Emergent Sexually Transmitted Disease?

https://doi.org/10.1016/j.idc.2013.08.003Get rights and content

Section snippets

Key points

  • Mycoplasma genitalium is found in 1% to 3% of the general population, less commonly than Chlamydia trachomatis but more commonly than Neisseria gonorrhoeae.

  • Strong and consistent evidence indicates that M genitalium causes nongonococcal urethritis in men.

  • Building evidence links M genitalium with cervicitis, pelvic inflammatory disease, and infertility in women.

  • Individuals infected with M genitalium have twice the risk of human immunodeficiency virus (HIV) infection and may be more likely to

M genitalium: the bacterium

M genitalium is a bacterium of the Mollicutes class, characterized by the absence of a cell wall. As a result it is not detectable by Gram staining, and is not susceptible to cell wall synthesis–inhibiting antimicrobials such as penicillins, cephalosporins, or polypeptide/antimycobacterial antibiotics. M genitalium is among the smallest known bacteria,5 making it the target of efforts to determine the minimal requirements for life6 and to create the first chemically synthesized bacterium.7 It

M genitalium: epidemiology

The prevalence of M genitalium in general population samples ranges from 1% to 3%12, 13, 14; lower than the prevalence of C trachomatis, but higher than the prevalence of N gonorrhoeae. In higher risk populations, such as STD clinic attendees and individuals with compatible clinical syndromes, the prevalence is higher, ranging from 2% to 33%.

M genitalium was first identified in 2 of 13 urethral specimens from men with NGU2; so early studies were focused on determining whether the bacterium

Human immunodeficiency virus infection and M genitalium

According to a recent meta-analysis, individuals infected with M genitalium are twice as likely to be infected with human immunodeficiency virus (HIV) (summary OR, 2.0; 1.4–2.8),108 and nearly all of the additional reports published since43, 78, 109, 110, 111, 112, 113, 114, 115, 116, 117 have confirmed a strong association between M genitalium and HIV infection. All were either cross-sectional or retrospective reports; thus, the possibility of common risk behavior explaining this observation,

Treatment

Despite the availability of assays to detect M genitalium in research settings, there is currently no diagnostic test approved by the US Food and Drug Administration (FDA) on the market in the United States. Therefore, most individuals infected with M genitalium receive one of the recommended syndromic therapies for NGU or cervicitis (doxycycline 100 mg twice a day × 7days or azithromycin 1 g single dose). Of these two regimens, azithromycin is the more effective. The median microbiologic cure

Future challenges

In the 30 years since its first identification, M genitalium has emerged as a sexually transmitted pathogen. Consistent evidence from well-designed epidemiologic studies has shown a strong association between M genitalium infection and male urethritis, and it is now widely recognized as a cause of NGU. Treatment failure is common and, in many settings, M genitalium is the most frequently detected pathogen among men with persistent NGU. Although the evidence for female STD syndromes is less

First page preview

First page preview
Click to open first page preview

References (130)

  • W.E. Stamm

    Chlamydia trachomatis infections of the adult

  • J.S. Jensen et al.

    Polymerase chain reaction for detection of Mycoplasma genitalium in clinical samples

    J Clin Microbiol

    (1991)
  • C.M. Fraser et al.

    The minimal gene complement of Mycoplasma genitalium

    Science

    (1995)
  • J.I. Glass et al.

    Essential genes of a minimal bacterium

    Proc Natl Acad Sci U S A

    (2006)
  • D.G. Gibson et al.

    Complete chemical synthesis, assembly, and cloning of a Mycoplasma genitalium genome

    Science

    (2008)
  • J.S. Jensen et al.

    Isolation of Mycoplasma genitalium strains from the male urethra

    J Clin Microbiol

    (1996)
  • S.D. Mehta et al.

    The effect of medical male circumcision on urogenital Mycoplasma genitalium among men in Kisumu, Kenya

    Sex Transm Dis

    (2012)
  • S.D. Mehta et al.

    Adult male circumcision does not reduce the risk of incident Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis infection: results from a randomized, controlled trial in Kenya

    J Infect Dis

    (2009)
  • D. Taylor-Robinson et al.

    Mycoplasma genitalium: from chrysalis to multicolored butterfly

    Clin Microbiol Rev

    (2011)
  • B. Andersen et al.

    Mycoplasma genitalium: prevalence and behavioural risk factors in the general population

    Sex Transm Infect

    (2007)
  • L.E. Manhart et al.

    Mycoplasma genitalium among young adults in the United States: an emerging sexually transmitted infection

    Am J Public Health

    (2007)
  • P. Oakeshott et al.

    Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial

    BMJ

    (2010)
  • C. Anagrius et al.

    Mycoplasma genitalium: prevalence, clinical significance, and transmission

    Sex Transm Infect

    (2005)
  • E. Bjornelius et al.

    Mycoplasma genitalium in non-gonococcal urethritis–a study in Swedish male STD patients

    Int J STD AIDS

    (2000)
  • C.S. Bradshaw et al.

    Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure

    J Infect Dis

    (2006)
  • F. Busolo et al.

    Detection of Mycoplasma genitalium and Chlamydia trachomatis DNAs in male patients with urethritis using the polymerase chain reaction

    New Microbiol

    (1997)
  • T. Deguchi et al.

    Mycoplasma genitalium in non-gonococcal urethritis

    Int J STD AIDS

    (1995)
  • N. Dupin et al.

    Detection and quantification of Mycoplasma genitalium in male patients with urethritis

    Clin Infect Dis

    (2003)
  • L. Falk et al.

    Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis

    Sex Transm Infect

    (2004)
  • D. Gambini et al.

    Mycoplasma genitalium in males with nongonococcal urethritis: prevalence and clinical efficacy of eradication

    Sex Transm Dis

    (2000)
  • P. Horner et al.

    Role of Mycoplasma genitalium and Ureaplasma urealyticum in acute and chronic nongonococcal urethritis

    Clin Infect Dis

    (2001)
  • P. Iser et al.

    Symptoms of non-gonococcal urethritis in heterosexual men: a case control study

    Sex Transm Infect

    (2005)
  • M. Janier et al.

    Male urethritis with and without discharge: a clinical and microbiological study

    Sex Transm Dis

    (1995)
  • J.S. Jensen et al.

    Mycoplasma genitalium: a cause of male urethritis?

    Genitourin Med

    (1993)
  • G. Johannisson et al.

    Occurrence and treatment of Mycoplasma genitalium in patients visiting STD clinics in Sweden

    Int J STD AIDS

    (2000)
  • F.E. Keane et al.

    The association of Mycoplasma hominis, Ureaplasma urealyticum and Mycoplasma genitalium with bacterial vaginosis: observations on heterosexual women and their male partners

    Int J STD AIDS

    (2000)
  • A. Leung et al.

    Mycoplasma genitalium is associated with symptomatic urethritis

    Int J STD AIDS

    (2006)
  • S. Maeda et al.

    Detection of Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in patients with non-gonococcal urethritis using polymerase chain reaction-microtiter plate hybridization

    Int J Urol

    (2004)
  • L. Mena et al.

    Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans

    Clin Infect Dis

    (2002)
  • W.E. Stamm et al.

    A randomized, double-blind study comparing single-dose rifalazil with single-dose azithromycin for the empirical treatment of nongonococcal urethritis in men

    Sex Transm Dis

    (2007)
  • P.A. Totten et al.

    Association of Mycoplasma genitalium with nongonococcal urethritis in heterosexual men

    J Infect Dis

    (2001)
  • T. Yoshida et al.

    Quantitative detection of Mycoplasma genitalium from first-pass urine of men with urethritis and asymptomatic men by real-time PCR

    J Clin Microbiol

    (2002)
  • J.T. Yu et al.

    Asymptomatic urethral infection in male sexually transmitted disease clinic attendees

    Int J STD AIDS

    (2008)
  • M. Berntsson et al.

    Viral and bacterial aetiologies of male urethritis: findings of a high prevalence of Epstein-Barr virus

    Int J STD AIDS

    (2010)
  • D.L. Couldwell et al.

    Ureaplasma urealyticum is significantly associated with non-gonococcal urethritis in heterosexual Sydney men

    Int J STD AIDS

    (2010)
  • C. Gaydos et al.

    Mycoplasma genitalium compared to chlamydia, gonorrhoea and trichomonas as an aetiological agent of urethritis in men attending STD clinics

    Sex Transm Infect

    (2009)
  • J. Hilton et al.

    A case-control study of men with non-gonococcal urethritis at Auckland Sexual Health Service: rates of detection of Mycoplasma genitalium

    Sex Health

    (2010)
  • H. Moi et al.

    Mycoplasma genitalium is associated with symptomatic and asymptomatic non-gonococcal urethritis in men

    Sex Transm Infect

    (2009)
  • S. Soni et al.

    The prevalence of urethral and rectal Mycoplasma genitalium and its associations in men who have sex with men attending a genitourinary medicine clinic

    Sex Transm Infect

    (2010)
  • D. Taylor-Robinson et al.

    Association of Mycoplasma genitalium with acute non-gonococcal urethritis in Russian men: a comparison with gonococcal and chlamydial urethritis

    Int J STD AIDS

    (2009)
  • Cited by (27)

    • The JAID/JSC guidelines to Clinical Management of Infectious Disease 2017 concerning male urethritis and related disorders

      2021, Journal of Infection and Chemotherapy
      Citation Excerpt :

      Many microbial species may be involved in non-chlamydial non-gonococcal urethritis as causative microorganisms [7–11]. Among them, studies have established the urethral pathogenicity of M. genitalium [1,12–18] (I, A). However, while tests for detection of this microorganism are available, its clinical use is not approved by the health insurance system of Japan, and it is presently used for research purposes alone.

    • Cervicitis: Etiology, diagnosis and treatment

      2019, Enfermedades Infecciosas y Microbiologia Clinica
    • Mycoplasma and Ureaplasma

      2017, Infectious Diseases, 2-Volume Set
    • A combined systems and structural modeling approach repositions antibiotics for Mycoplasma genitalium

      2015, Computational Biology and Chemistry
      Citation Excerpt :

      It infects 1–3% of all individuals, is the second most common cause of non-gonococcal urethritis in men, and is an increasingly common cause of cervicitis, endometritis, and pelvic inflammatory disease in women (Manhart, 2013). M. genitalium infection has also been associated with adverse sequelae including infertility, ectopic pregnancy, preterm birth, and cancer (Manhart, 2013; Zarei et al., 2013). M. genitalium infection is typically treated with macrolides such as azithromycin, fluoroquinolones such as moxifloxacin, and tetracyclines such as doxycycline (Taylor-Robinson, 2014).

    View all citing articles on Scopus

    Conflict of Interest: L.E. Manhart previously received study drugs from Pfizer, Inc and diagnostic test reagents from Gen-Probe, Inc.

    View full text