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| {{Taxobox
| | #REDIRECT[[Mycoplasma genitalium infection]] |
| | color = lightgrey
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| | name = ''Mycoplasma genitalium''
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| | image = Mycoplasma genitalium.gif
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| | regnum = [[Bacterium|Bacteria]]
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| | divisio = [[Firmicutes]]
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| | classis = [[Mollicutes]]
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| | ordo = [[Mycoplasmatales]]
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| | familia = [[Mycoplasmataceae]]
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| | genus = ''[[Mycoplasma]]''
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| | species = '''''M. genitalium'''''
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| | binomial = ''Mycoplasma genitalium''
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| | binomial_authority = Tully et al., 1983
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| }}
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| __NOTOC__
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| {{CMG}}; {{AE}}{{DN}}
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| {{SI}}
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| ==Overview==
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| ==Classification==
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| ==Historical Perspective==
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| *'''''[[Mycoplasma genitalium]]''''' is the 11th '''''[[Mycoplasma]]''''' species of human origin.<ref name="pmid21734246">{{cite journal |vauthors=Taylor-Robinson D, Jensen JS |title=Mycoplasma genitalium: from Chrysalis to multicolored butterfly |journal=Clin. Microbiol. Rev. |volume=24 |issue=3 |pages=498–514 |year=2011 |pmid=21734246 |pmc=3131060 |doi=10.1128/CMR.00006-11 |url=}}</ref>
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| *In 1980, 13 men were tested for non-gonoccal [[urethritis]] (NGU). '''''[[Mycoplasma genitalium]]''''' was isolated from 2 of those 13 men.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid26975162">{{cite journal |vauthors= |title=Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines |journal=J Miss State Med Assoc |volume=56 |issue=12 |pages=372–5 |year=2015 |pmid=26975162 |doi= |url=}}</ref><ref name="pmid12599082">{{cite journal |vauthors=Manhart LE, Critchlow CW, Holmes KK, Dutro SM, Eschenbach DA, Stevens CE, Totten PA |title=Mucopurulent cervicitis and Mycoplasma genitalium |journal=J. Infect. Dis. |volume=187 |issue=4 |pages=650–7 |year=2003 |pmid=12599082 |doi=10.1086/367992 |url=}}</ref>
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| *In the early 1990s, [[polymerase chain reaction]] (PCR) was developed, which allowed for diagnosis of '''''[[Mycoplasma genitalium]]'''''.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid12599082">{{cite journal |vauthors=Manhart LE, Critchlow CW, Holmes KK, Dutro SM, Eschenbach DA, Stevens CE, Totten PA |title=Mucopurulent cervicitis and Mycoplasma genitalium |journal=J. Infect. Dis. |volume=187 |issue=4 |pages=650–7 |year=2003 |pmid=12599082 |doi=10.1086/367992 |url=}}</ref><ref name="pmid16877571">{{cite journal |vauthors=Ross JD, Jensen JS |title=Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment |journal=Sex Transm Infect |volume=82 |issue=4 |pages=269–71 |year=2006 |pmid=16877571 |pmc=2564705 |doi=10.1136/sti.2005.017368 |url=}}</ref>
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| *Since 1993, the role of '''''[[Mycoplasma genitalium]]''''' as a cause of non-gonococcal [[urethritis]] has appeared in literature following the advances in [[polymerase chain reaction]] (PCR).<ref name="pmid16877571">{{cite journal |vauthors=Ross JD, Jensen JS |title=Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment |journal=Sex Transm Infect |volume=82 |issue=4 |pages=269–71 |year=2006 |pmid=16877571 |pmc=2564705 |doi=10.1136/sti.2005.017368 |url=}}</ref>
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| ==Pathophysiology==
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| ===Pathogenesis===
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| ====Mode of Transmission====
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| *'''''[[Mycoplasma genitalium]]''''' is recognized as a sexually transmitted disease ([[STD]]) with the mode of transmission being through direct [[genital]]-to-[[genital]] contact and subsequent inoculation of infected secretions. Transmission of '''''[[Mycoplasma genitalium]]''''' has also been implicated in [[penis|penile]]-[[anal]] intercourse. <ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
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| *'''''[[Mycoplasma genitalium]]''''' is less likely to be transmitted via oro-genital contact, as carriage in the [[oropharynx]] is low. <ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
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| *Whether or not '''''[[Mycoplasma genitalium]]''''' is vertically transmitted from mother to [[newborn]] is yet to be studied. However, the [[bacterium]] has been isolated from the respiratory tract of [[newborns]]. <ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
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| ====Incubation Period====
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| The [[incubation period]] of '''''[[Mycoplasma genitalium]]''''' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
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| ====Infectious Dose====
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| The infectious dose of '''''[[Mycoplasma genitalium]]''''' is unknown yet.<ref name="Public Health Agency of Canada">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.</ref>
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| ====Factors facilitating the pathogenesis of '''''[[Mycoplasma genitalium]]'''''====
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| The following virulence factors have been implicated in the pathogenesis of '''''[[Mycoplasma genitalium]]''''': <ref name="pmid21734246">{{cite journal |vauthors=Taylor-Robinson D, Jensen JS |title=Mycoplasma genitalium: from Chrysalis to multicolored butterfly |journal=Clin. Microbiol. Rev. |volume=24 |issue=3 |pages=498–514 |year=2011 |pmid=21734246 |pmc=3131060 |doi=10.1128/CMR.00006-11 |url=}}</ref><ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid23391789">{{cite journal |vauthors=Sethi S, Singh G, Samanta P, Sharma M |title=Mycoplasma genitalium: an emerging sexually transmitted pathogen |journal=Indian J. Med. Res. |volume=136 |issue=6 |pages=942–55 |year=2012 |pmid=23391789 |pmc=3612323 |doi= |url=}}</ref>
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| *Adhesion molecules: '''''[[Mycoplasma genitalium]]''''' has the ability to attach to different types of cells, including [[red blood cells]], [[respiratory]] cells, [[fallopian tube]] cells, as well as [[sperm]] cells. It is believed that the attachment to [[sperm cells]] facilitates the spread of '''''[[Mycoplasma genitalium]]''''' to the [[female]] [[genital tract]]. MgPa, a major adhesion in attachment protein complex, facilitates not only [[adhesion]] to [[epithelial]] cells, but also the motility of '''''[[Mycoplasma genitalium]]'''''.
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| *[[Intracellular]] localization: '''''[[Mycoplasma genitalium]]''''' is a facultative intracellular organism and this allows for its survival both inside and outside of cells.
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| *[[Antigenic]] variation: '''''[[Mycoplasma genitalium]]''''' is able to generate surface lipoprotein with high frequency, which helps it evade the human [[immune system]].
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| *Toxins: '''''[[Mycoplasma genitalium]]''''' has a [[calcium]]-dependent membrane associated nuclease known as MG-186. MG-186 is capable of degrading [[host]] cell [[nucleic acid]], hence providing a source of [[nucleotides]] for the growth and pathogenesis of '''''[[Mycoplasma genitalium]]'''''.
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| *Enzymes: Glyceraldehyde 3-phosphate dehydrogenase [[(GADPH)]] acts as a [[ligand]] to the [[receptors]] [[mucin]] and [[fibronectin]], found on [[vaginal]] and [[cervical]] [[epithelium]].
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| *Immunological response: '''''[[Mycoplasma genitalium]]''''' possesses an immunogenic protein, MG-309, which secretes pro-inflammatory [[cytokines]], such as IL-6 and IL-8. MG-309 exerts its effect via attaching to a [[toll-like receptor]], hence activating nuclear factor kappa B ([[NF-kB]])
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| ===Genetics===
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| ===Associated Conditions===
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| ===Gross Pathology===
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| ===Microscopic Pathology===
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| ==Causes==
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| ==Differentiating Mycoplasma genitalium infection from other diseases==
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| ==Epidemiology and Demographics==
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| The incidence and prevalence of '''''Mycoplasma genitalium''''' is not well established, because more than half of the women who tested positive were asymptomatic.<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref>
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| *In one study done in the United States to estimate the prevalence of '''''Mycoplasma genitalium''''', the following results were obtained:<ref name="pmid27307460">{{cite journal |vauthors=Getman D, Jiang A, O'Donnell M, Cohen S |title=Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States |journal=J. Clin. Microbiol. |volume=54 |issue=9 |pages=2278–83 |year=2016 |pmid=27307460 |pmc=5005488 |doi=10.1128/JCM.01053-16 |url=}}</ref>
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| **The prevalence in all females aged 14-70 years old is 16.3%.
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| **The prevalence in all males aged 18-78 years old is 17.2%.
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| **Infection in both males and females was more prevalent in those younger than 30 years of age.
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| **The prevalence of '''''Mycoplasma genitalium''''' infection was higher than '''''Chlamydia Trachomatis''''' and '''''Neisseria Gonorrhea''''', while in males it was higher than '''''Neisseria Gonorrhea''''' but comparable to that of '''''Chlamydia Trachomatis'''''.
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| ==Risk Factors==
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| There several risk factors that have been identified with '''''[[Mycoplasma genitalium]]''''' infection. These risk factors include:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid12599082">{{cite journal |vauthors=Manhart LE, Critchlow CW, Holmes KK, Dutro SM, Eschenbach DA, Stevens CE, Totten PA |title=Mucopurulent cervicitis and Mycoplasma genitalium |journal=J. Infect. Dis. |volume=187 |issue=4 |pages=650–7 |year=2003 |pmid=12599082 |doi=10.1086/367992 |url=}}</ref><ref name="pmid20679963">{{cite journal |vauthors=Hancock EB, Manhart LE, Nelson SJ, Kerani R, Wroblewski JK, Totten PA |title=Comprehensive assessment of sociodemographic and behavioral risk factors for Mycoplasma genitalium infection in women |journal=Sex Transm Dis |volume=37 |issue=12 |pages=777–83 |year=2010 |pmid=20679963 |pmc=4628821 |doi=10.1097/OLQ.0b013e3181e8087e |url=}}</ref>
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| *High risk sexual behavior, defined as having >3 new sexual partners in the past year
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| *Being engaged in sexual contact with persons with [[STDs]], particularly '''''[[Mycoplasma genitalium]]'''''
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| *Non-white race
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| *Having a black partner
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| *Young age (<20 years old)
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| *[[Smoking]]
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| *Having less than high school education
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| *Having an annual income of less than $10,000
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| *Risk factors specific to [[females]] includes:
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| **Frequent douching
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| **Proliferative phase of the [[menstrual cycle]]
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| **History of spontaneous [[miscarriage]]
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| **Undergoing procedures that breach the [[cervical]] barrier
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| **Use of [[Depo-Provera]] for [[contraception]]
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| ==Screening==
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| There are no recommendations for screening for '''''[[Mycoplasma genitalium]]'''''.<ref name= "USPSTF"> United States Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=mycoplasma+genitalium Accessed on Oct. 6, 2016.</ref>
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| ==Natural history, Complications and Prognosis==
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| ==History==
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| The presenting symptoms of '''''[[Mycoplasma genitalium]]''''' are related to the disease processes it may cause. Presenting symptoms can be divided based on gender:
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| *Females: 40-75% of women infected with '''''[[Mycoplasma genitalium]]''''' are asymptomatic. However, when symptoms are present, they are usually related to the disease process '''''[[Mycoplasma genitalium]]''''' resulted. These include:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid17448398">{{cite journal |vauthors=Tosh AK, Van Der Pol B, Fortenberry JD, Williams JA, Katz BP, Batteiger BE, Orr DP |title=Mycoplasma genitalium among adolescent women and their partners |journal=J Adolesc Health |volume=40 |issue=5 |pages=412–7 |year=2007 |pmid=17448398 |pmc=1899169 |doi=10.1016/j.jadohealth.2006.12.005 |url=}}</ref><ref name="pmid16533338">{{cite journal |vauthors=Korte JE, Baseman JB, Cagle MP, Herrera C, Piper JM, Holden AE, Perdue ST, Champion JD, Shain RN |title=Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium |journal=Am. J. Reprod. Immunol. |volume=55 |issue=4 |pages=265–75 |year=2006 |pmid=16533338 |doi=10.1111/j.1600-0897.2005.00359.x |url=}}</ref>
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| **[[Cervicitis]]: presents with [[vaginal]] [[discharge]], [[vaginal]] itching, inter-menstrual, heavy or post-coital [[bleeding]]
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| **[[PID]]: presents with pelvic discomfort or lower abdominal pain, painful sexual intercourse ([[dyspareunia)]] vaginal [[discharge]] and/or [[bleeding]]
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| **[[Urethritis]]: presents with pain on urination ([[dysuria]]) or [[urethral]] [[discharge]]
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| *Males: tend to be more symptomatic than females and present with symptoms of [[urethritis]], which include urethral [[discharge]] and [[dysuria]].<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid15295128">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis |journal=Sex Transm Infect |volume=80 |issue=4 |pages=289–93 |year=2004 |pmid=15295128 |pmc=1744873 |doi=10.1136/sti.2003.006817 |url=}}</ref><ref name="pmid7721285">{{cite journal |vauthors=Jensen JS, Orsum R, Dohn B, Uldum S, Worm AM, Lind K |title=Mycoplasma genitalium: a cause of male urethritis? |journal=Genitourin Med |volume=69 |issue=4 |pages=265–9 |year=1993 |pmid=7721285 |pmc=1195084 |doi= |url=}}</ref><ref name="pmid16326846">{{cite journal |vauthors=Anagrius C, Loré B, Jensen JS |title=Mycoplasma genitalium: prevalence, clinical significance, and transmission |journal=Sex Transm Infect |volume=81 |issue=6 |pages=458–62 |year=2005 |pmid=16326846 |pmc=1745067 |doi=10.1136/sti.2004.012062 |url=}}</ref>
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| ==Physical Examination==
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| ==Laboratory Findings==
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| ==X-Ray==
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| ==CT==
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| ==Other Imaging Findings==
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| ==Other Diagnostic Studies==
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| ==Medical Therapy==
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| '''''[[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:<ref name="pmid27605499">{{cite journal |vauthors=Jensen JS, Cusini M, Gomberg M, Moi H |title=Background review for the 2016 European guideline on Mycoplasma genitalium infections |journal=J Eur Acad Dermatol Venereol |volume= |issue= |pages= |year=2016 |pmid=27605499 |doi=10.1111/jdv.13850 |url=}}</ref><ref name="pmid26975162">{{cite journal |vauthors= |title=Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines |journal=J Miss State Med Assoc |volume=56 |issue=12 |pages=372–5 |year=2015 |pmid=26975162 |doi= |url=}}</ref><ref name="pmid16877571">{{cite journal |vauthors=Ross JD, Jensen JS |title=Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment |journal=Sex Transm Infect |volume=82 |issue=4 |pages=269–71 |year=2006 |pmid=16877571 |pmc=2564705 |doi=10.1136/sti.2005.017368 |url=}}</ref>
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| *[[Doxycycline]] has poor efficacy for '''''[[Mycoplasma]] genitalium'''''.
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| *For uncomplicated '''''[[Mycoplasma]] genitalium''''' infection susceptible to [[macrolides]], [[azithromycin]] given as a single 1g dose or 500mg on day 1 followed by 250mg on days 2-5 may be used. Another [[macrolide]] that may be used is [[josamycin]] 500mg, given 3 times daily for 10 days.
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| *For uncomplicated [[macrolide]] resistant '''''[[Mycoplasma]] genitalium''''' infection, [[moxifloxacin]] 400mg once daily is given for 7-10 days.
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| *[[Pristinamycin]] 1g 4 times daily is given for 7-10 days when both [[azithromycin]] and [[moxifloxacin]] fail.
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| *For complicated '''''[[Mycoplasma]] genitalium''''' infection, [[moxifloxacin]] 400mg once daily is used for 14 days.
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| ==Surgical Therapy==
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| ==Primary Prevention==
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| ==Secondary Prevention==
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| ==References==
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| [[Category:Infectious Disease]]
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| [[Category:Primary Care]]
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| [[Category:Gynecology]]
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| [[Category:Urology]]
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| {{WH}}{{WS}}
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| {{Reflist|2}}
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