Mycoplasma Genitalium: Easy to detect, hard to treat

Mycoplasma genitalium (MGEN) is a common sexually transmitted infection that has been mainly associated with urethritis in men and is characterised by high rates of antimicrobial resistance. Understanding of the natural history of the infection is incomplete. In this STI podcast, Dr Fabiola Martin meets Dr Emma Sweeney, Prof Catarina Brashaw and Prof Nicola Low to discuss key populations affected by MGEN, review strategies for testing and treatment, and highlight important knowledge gaps and research needs. Join us in this informative episode!

Facts and Highlights

  • MGEN is a relatively common and often indolent infection, typically involving the urogenital and rectal tracts. Its estimated prevalence is 1% in the general population of developed countries and 4% in developing countries; infection is particularly common in men who have sex with men and sex workers.
  • Most people are asymptomatic and clear the infection without developing disease. Some patients present with urethritis, proctitis, post-coital bleeding, cervicitis, and pelvic inflammatory disease (PID).
  • Testing for MGEN by molecular methods has become routinely available in many countries. However, testing should be limited to symptomatic patients and to sexual contacts of patients who have tested MGEN positive. Asymptomatic screening is discouraged.
  • The prevalence of macrolide and quinolone resistant MGEN is estimated to be approximately 50% and 7%, respectively in urban centres. Where available, macrolide or quinolone resistance testing should be used to guide tailored antibiotic treatment.
  • Although cervicitis and PID have been described in women, reassuringly a recent systematic review found no association between MGEN infection and spontaneous abortion or preterm birth.

Additional Resources:

Adverse pregnancy and perinatal outcomes associated with Mycoplasma genitalium: systematic review and meta-analysis

 Macrolide and quinolone resistance in mycoplasma genitalium: data from a UK sexual health clinic

Mycoplasma genitalium testing in clinical practice: prevalence and resistance rates in a south london sexual health clinic

Prevalence of mycoplasma genitalium infection, antimicrobial resistance, and symptom resolution following treatment

Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009–2019

Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis

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