Basic information Mycoplasma Genitalium
Contents
Definition
- The bacterium Mycoplasma genitalium was isolated for the first time in 19801
- There is increasing evidence that the bacterium can cause urogenital symptoms and infection
- The bacterium is also found in asymptomatic individuals
occurrence
- The prevalence of Mycoplasma genitalium depends on the population under study:
- In a South African study screening among 21-23 year-old men and women were found the prevalence of M.genitalium in women to 2.3% (21/921) in men and 1.1% (8/731)2
- In a Swedish study from a Venereology clinic found a high incidence of M.genitalium in male patients who presented with persistent or recurrent symptoms of urethritis, after being treated with doxycycline from microscopically verified non-gonorrhoisk urethritis, so 32 / 78 (41%)3
Etiology and pathogenesis
- The bacterium is found intracellularly and are very difficult to grow
- Different from other bacteria by the lack of a cell wall; This makes it insensitive to penicillins and cephalosporins
- An increasing number of studies demonstrating a strong association between M. genitalium and non-gonorrhoisk urethritis (NGU), and especially non-chlamydia NGU (NCNGU) in men and cervicitis in females, as well as an association between endometritis and M.genitalium in women4
- There is evidence that M. genitalium is transmitted through sexual transmission, including high concordance of M.genitalium genotypes in infected couple
- More patients with M.genitalium have symptomatic urethritis than asymptomatic urethritis
- Co-infection with Chlamydia trachomatis is not frequent
predisposing factors
- Sexual intercourse with infected person
ICPC 2
- U72 Urinrørsbetændelse
- X74 Pelvic inflammatory disease
ICD-10
- N34 Urinrørsbetændelse and uretrasyndrom
- N341 Infectious urethritis UNS
- N342 Other types of urethritis
- N343 urethral syndrome UNS
- N370 urethritis v disease KA
Diagnosis
diagnostic criteria
- Positive PCR for Mycoplasma genitalium
- The bacteria are difficult to grow
- In practice, the diagnosis is often the symptoms and exclusion of differential diagnoses:
- Pain during urination and possible urethral discharge in men and women; possibly slightly increased vaginal discharge in women
- Negative PCR test for Chlamydia trachomatis and possibly also negative testing for gonorrhea
Differential
- chlamydia
- gonorrhea
- Non-specific urethritis for another reason
Medical history
- in men
- Urethritis with dysuria and / or discharge
- Chronic or recurrent urethritis seen in patients who initially for non-gonorrhoisk urethritis have been treated with an inadequate acting antibiotics to M.genitalium
- It is unclear to what extent M. genitalium is the cause of complications such as epididymitis, prostatitis and reactive arthritis
- in women
- Urethritis and cervicitis with dysuria and vaginal discharge
- There is increasing studies suggest an association between M.genitalium and pelvic inflammatory disease in the form of endometritis and / or salpingitis
- It is not clear whether, and to what extent, infection with M.genitalium in women is associated with infertility
clinical findings
- Any urethral or vaginal discharge
Additional studies in general practice
- Chlamydia PCR test and the detection of gonorrhea
- Mycoplasma test
- Urine and cervical or vaginal. The urine sample is given not more than 2 hours after final urination and collected in sterile glass tip.
- Where urine samples are not available urethral swab (eSwab)
- The PCR test is the only relevant diagnostic testing to detect M. genitalium ; this is available at Statens Serum Institut, either as single study or in combination with PCR for C. trachomatis and Ureaplasma urealyticum
- indication
- Patients with symptoms and discomfort of urethritis / cervicitis
- Contacts of infection in patients with established infection
Treatment
Treatment goals
- Elimination of the microbe
Generally about the treatment
- Clinical experience and studies have shown that azithromycin has better effect than doxycycline and erythromycinfor eradication is of M. genitalium3But once dose azithromycin has been shown to induce resistance in a number of cases with urethritis5
- Verified by microscopic non-gonorrhoisk urethritis, and in response to studies become available, which is treated with tabl. doxycycline100 mg x 2 for 7 days in order to reduce the risk of developing azithromycinresistens relative to M.genitalium
Medical treatment
- azitromycin:
- azitromycin 500 mg x 1 first day of treatment and 250 mg x 1 for the subsequent four days5
- Detected by mutation, ie azithromycinresistens:
- moxifloxacin 400 mg x 1 for 7 days
Course, complications and prognosis
Progress
- Commonly is acute urethritis, but it has been documented that the condition may be chronic or recurrent
complications
- Epididymitis and prostatitis?
- Can lead to endometritis / salpingitis, and thereby chronic pelvic pain and possibly reduced fertility
Forecast
- Good with proper treatment
Follow-up
- After Checking with new urine sample or urethrapodning and cervical or vaginal should be done 4-5 weeks after treatment
