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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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| ''Mycoplasma genitalium'' infection can be divided based on the clinical presentation into:<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><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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| *Asymptomatic ''Mycoplasma genitalium'' infection
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| *Symptomatic ''Mycoplasma genitalium'' infection: symptoms are related to [[PID]] or [[cervicitis]] in women and [[urethritis]] or [[epididymitis]] in men
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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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| There are no identified genetic factors associated with ''Mycoplasma genitalium'' infection.
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| ===Associated Conditions===
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| ''Mycoplasma genitalium'' infection is associated with co-infection with other [[sexually transmitted diseases]], such as:<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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| *''Chlamydia Trachomatis''
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| *''Neisseria Gonorrhea''
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| *''Trichomonas vaginalis''
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| *[[HIV]]
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| ===Gross Pathology===
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| Gross pathology of ''Mycoplasma genitalium'' infection is related to the disease processes it may result: [[cervicitis]], [[PID]], [[urethritis]] or [[epididymitis]].
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| ===Microscopic Pathology===
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| Microscopic pathology of ''Mycoplasma genitalium'' infection is related to the disease processes it may result: [[cervicitis]], [[PID]], [[urethritis]] or [[epididymitis]].
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| ==Causes==
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| The cause of ''Mycoplasma genitalium'' infection is ''[[Mycoplasma]] genitalium''.
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| ==Differentiating Mycoplasma genitalium infection from other diseases==
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| ''Mycoplasma genitalium'' infection must be distinguished from other [[sexually transmitted diseases]], which may have a similar presentation. These include:
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| *''Chlamydia trachomatis''
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| *''Neisseria gonorrhea''
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| *''Trichomonas vaginalis''
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| *''Ureaplasma urealyticum''
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| *''Herpes simplex'' virus
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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 the United States, the prevalence of ''Mycoplasma genitalium'' was estimated as follows:<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 overall prevalence of ''Mycoplasma genitalium'' infection is 1%, which makes it more prevalent than ''Neisseria Gonorrhea'' (0.4%), but less common than ''Chlamydia Trachomatis'' (4.2%).<ref name="pmid17463380">{{cite journal |vauthors=Manhart LE, Holmes KK, Hughes JP, Houston LS, Totten PA |title=Mycoplasma genitalium among young adults in the United States: an emerging sexually transmitted infection |journal=Am J Public Health |volume=97 |issue=6 |pages=1118–25 |year=2007 |pmid=17463380 |pmc=1874220 |doi=10.2105/AJPH.2005.074062 |url=}}</ref>
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| *Between the years 2002-2011, the prevalence of ''Mycoplasma genitalium'' worldwide ranged between 4%-42%.<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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| ==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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| ===Natural History===
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| If left untreated, ''Mycoplasma genitalium'' infection can lead to persistent [[cervicitis]], [[PID]] or [[urethritis]].<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>
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| ===Complications===
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| The following complications may be the result of ''Mycoplasma genitalium'' infection:<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="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><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><ref name="pmid21285914">{{cite journal |vauthors=Wetmore CM, Manhart LE, Lowens MS, Golden MR, Whittington WL, Xet-Mull AM, Astete SG, McFarland NL, McDougal SJ, Totten PA |title=Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study |journal=Sex Transm Dis |volume=38 |issue=3 |pages=180–6 |year=2011 |pmid=21285914 |pmc=4024216 |doi=10.1097/OLQ.0b013e3182040de9 |url=}}</ref><ref name="pmid12410476">{{cite journal |vauthors=Mena L, Wang X, Mroczkowski TF, Martin DH |title=Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans |journal=Clin. Infect. Dis. |volume=35 |issue=10 |pages=1167–73 |year=2002 |pmid=12410476 |doi=10.1086/343829 |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><ref name="pmid15681728">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection |journal=Sex Transm Infect |volume=81 |issue=1 |pages=73–8 |year=2005 |pmid=15681728 |pmc=1763725 |doi=10.1136/sti.2004.010439 |url=}}</ref><ref name="pmid19704398">{{cite journal |vauthors=Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC |title=Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics |journal=Sex Transm Dis |volume=36 |issue=10 |pages=598–606 |year=2009 |pmid=19704398 |pmc=2924808 |doi=10.1097/OLQ.0b013e3181b01948 |url=}}</ref><ref name="pmid19025498">{{cite journal |vauthors=Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL |title=Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease |journal=Clin. Infect. Dis. |volume=48 |issue=1 |pages=41–7 |year=2009 |pmid=19025498 |pmc=2652068 |doi=10.1086/594123 |url=}}</ref>
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| *Complications in females include: [[cervicitis]], [[endometritis]], tubal factor [[infertility]], [[pelvic inflammatory disease]] [[(PID)]], as well as sexually active [[reactive arthritis]] (SARA).
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| *Complications in males include: [[epididymitis]], [[urethritis]], as well as sexually active [[reactive arthritis]] (SARA).
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| ===Prognosis===
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| The prognosis of ''Mycoplasma genitalium'' infection is generally excellent. Cure rates are almost 100% with the correct and prompt antibiotic treatment.<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>
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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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| Physical examination findings in ''Mycoplasma genitalium'' are related to the disease processes it may cause. These findings can be divided based on the several disease pathologies in males and females.
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| *Females:<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]]: findings include a [[purulent]] or [[mucopurulent]] cervical [[discharge]], [[vaginal]] itching, inter-menstrual, heavy or post-coital [[bleeding]]<ref name="pmid19704398">{{cite journal |vauthors=Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC |title=Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics |journal=Sex Transm Dis |volume=36 |issue=10 |pages=598–606 |year=2009 |pmid=19704398 |pmc=2924808 |doi=10.1097/OLQ.0b013e3181b01948 |url=}}</ref><ref name="pmid15681728">{{cite journal |vauthors=Falk L, Fredlund H, Jensen JS |title=Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection |journal=Sex Transm Infect |volume=81 |issue=1 |pages=73–8 |year=2005 |pmid=15681728 |pmc=1763725 |doi=10.1136/sti.2004.010439 |url=}}</ref><ref name="pmid18842689">{{cite journal |vauthors=Moi H, Reinton N, Moghaddam A |title=Mycoplasma genitalium in women with lower genital tract inflammation |journal=Sex Transm Infect |volume=85 |issue=1 |pages=10–4 |year=2009 |pmid=18842689 |doi=10.1136/sti.2008.032748 |url=}}</ref>
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| **[[PID]]: signs include lower abdominal tenderness, rebound tenderness, cervical motion, uterine or adnexal tenderness, vaginal [[discharge]] and/or [[bleeding]] and decreased bowel sounds<ref name="pmid15976596">{{cite journal |vauthors=Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL |title=Comparison of acute and subclinical pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=7 |pages=400–5 |year=2005 |pmid=15976596 |doi= |url=}}</ref><ref name="pmid11303192">{{cite journal |vauthors=Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC |title=Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=5 |pages=856–63; discussion 863–4 |year=2001 |pmid=11303192 |doi=10.1067/mob.2001.113847 |url=}}</ref>
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| *Males:
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| **present with signs of [[urethritis]], mainly urethral [[discharge]]. Urethral discharge may not be grossly evident hence, urethral milking or stripping may be needed.<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><ref name="pmid21285914">{{cite journal |vauthors=Wetmore CM, Manhart LE, Lowens MS, Golden MR, Whittington WL, Xet-Mull AM, Astete SG, McFarland NL, McDougal SJ, Totten PA |title=Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study |journal=Sex Transm Dis |volume=38 |issue=3 |pages=180–6 |year=2011 |pmid=21285914 |pmc=4024216 |doi=10.1097/OLQ.0b013e3182040de9 |url=}}</ref> Other findings include [[balanitis]] (inflammation of the glans penis) or [[posthitis]] (inflammation of the foreskin).<ref name="pmid20852310">{{cite journal |vauthors=Horner PJ, Taylor-Robinson D |title=Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis |journal=Sex Transm Infect |volume=87 |issue=1 |pages=38–40 |year=2011 |pmid=20852310 |doi=10.1136/sti.2010.044487 |url=}}</ref>
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| ==Laboratory Findings==
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| *Culture of ''Mycoplasma genitalium'' is not commonly used, as culture takes about 6 months to grow and is not widely available.<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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| *Nucleic acid amplification test (NAAT) via [[polymerase chain reaction]] [[(PCR)]] or transcription-mediated amplification (TMA) is the preferred method for isolating ''Mycoplasma genitalium''. Samples can be obtained from [[urine]], [[urethral]], [[vaginal]] or [[cervical]] swabs. However, first void urine sample is considered the best method for isolating the organism in both females and males.<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="pmid18842689">{{cite journal |vauthors=Moi H, Reinton N, Moghaddam A |title=Mycoplasma genitalium in women with lower genital tract inflammation |journal=Sex Transm Infect |volume=85 |issue=1 |pages=10–4 |year=2009 |pmid=18842689 |doi=10.1136/sti.2008.032748 |url=}}</ref><ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref><ref name="pmid18490867">{{cite journal |vauthors=Huppert JS, Mortensen JE, Reed JL, Kahn JA, Rich KD, Hobbs MM |title=Mycoplasma genitalium detected by transcription-mediated amplification is associated with Chlamydia trachomatis in adolescent women |journal=Sex Transm Dis |volume=35 |issue=3 |pages=250–4 |year=2008 |pmid=18490867 |pmc=3807598 |doi=10.1097/OLQ.0b013e31815abac6 |url=}}</ref><ref name="pmid18073017">{{cite journal |vauthors=Högdahl M, Kihlström E |title=Leucocyte esterase testing of first-voided urine and urethral and cervical smears to identify Mycoplasma genitalium-infected men and women |journal=Int J STD AIDS |volume=18 |issue=12 |pages=835–8 |year=2007 |pmid=18073017 |doi=10.1258/095646207782716983 |url=}}</ref>
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| ==X-Ray==
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| There is no role for x-ray in ''Mycoplasma genitalium'' infection.
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| ==CT==
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| [[CT]] scan may be used if ''Mycoplasma genitalium'' infection has been complicated by [[PID]]. These include thickened and fluid-filled tubes with or without free pelvic fluid.
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| ==Other Imaging Findings==
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| [[MRI]] may be used if ''Mycoplasma genitalium'' infection has been complicated by [[PID]].
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| ==Other Diagnostic Studies==
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| There are no other diagnostic studies for ''Mycoplasma genitalium'' infection.
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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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| Medical therapy is the mainstay of treatment for ''Mycoplasma genitalium'' infection. There is no role for surgery in the management of ''Mycoplasma genitalium'' infection.
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| ==Primary Prevention==
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| Since ''Mycoplasma genitalium'' infection is a [[sexually transmitted disease]], prevention must target safe sexual practices. These include:<ref name=primary-prev>LeFevre ML. USPSTF: behavioral counseling interventions to prevent sexually transmitted infections. Ann Intern Med 2014;161:894–901.</ref><ref name=gono-condom>Warner L, Stone KM, Macaluso M, et al. Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006;33:36–51.</ref>
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| *Practicing safe sex with one partner and avoiding multiple sexual partners
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| *Using condoms and/or other barrier methods
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| ==Secondary Prevention==
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| Secondary prevention in ''Mycoplasma genitalium'' infection consists of the following measures:<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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| *Prompt treatment with antibiotics to prevent complications of the infection
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| *Partner notification and evaluation: if partner does not attend evaluation for infection, then he/she can be offered the same treatment as the patient
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| *Screening for other [[sexually transmitted diseases]]
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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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