Written on July 29, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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The common sexually transmitted diseases (STDs) you have probably heard about are gonorrhea, syphilis, and chlamydia. Over 2.5 million cases of these three STDs were reported in 2021. Some STDs are less talked about. One of these is Mycoplasma genitalium, also called Mgen. Data from the National Health and Nutrition Examination Survey from 2017-2018 reported an overall prevalence rate of around 1.7% in Americans 14 to 59 years of age. Though Mgen is not as common as other STDs, it is still essential to understand the infection and the Mycoplasma genitalium treatment options available for you.
Mgen was first identified in the early 1980s as a bacteria from the urogenital tract. The bacteria belong to the scientific classification class called Mollicutes and the genus Mycoplasma. The Mycoplasma genus has hundreds of species, and one of these is Mgen. Mycoplasmas are unique in that these bacteria have no cell wall.[4,5] It is also a very slow-growing bacteria, requiring up to six months to grow in the lab.
Mgen is a genital and urinary mucosal organism that spreads through direct sexual contact with an infected person.[2,4] After chlamydia, it is the second most common cause of nongonococcal urethritis, or inflammation of the urethra not caused by gonorrhea. Mgen is a common cause of recurrent or resistant urethritis and female cervicitis. This STD causes up to 20% of all nongonococcal urethritis and approximately 40% of all recurrent or persistent urethritis infections.
In men, Mgen can cause urethritis with or without symptoms.[2,5] When present, symptoms include dysuria, urethral pruritus, and purulent or mucopurulent urethral discharge. Other signs and symptoms men may experience are urinary frequency, testicular pain, epididymis tenderness, and suprapubic pain.
Mgen can cause cervicitis and pelvic inflammatory disease (PID) in women.[2,5] Cervicitis often presents with no symptoms, but if present can include vaginal discharge, dysuria, pelvic discomfort, and vaginal itching. Symptoms of PID caused by Mgen may involve mild to severe pelvic pain, abdominal pain, abnormal vaginal discharge, and bleeding. Other signs and symptoms women may experience are foul-smelling discharge, cervical tenderness, and vaginal irritation.
Mgen can also infect the rectum and pharynx in men and women. Rectal and pharynx infections of Mgen are often asymptomatic, though that is not always the case.[2,5]
Most of the time, a Mgen infection is diagnosed with presentation of clinical symptoms and exclusion of chlamydia and gonorrhea infections. Currently, two lab tests known as nucleic acid amplification testing (NAAT) are approved by the U.S. Food and Drug Administration to detect Mgen.[2,6] Urine samples are adequate for NAAT testing in men, but in women, the preferred specimen is a vaginal swab. Other sample types include urethral, penile, and endocervical swabs. In cases where your healthcare provider suspects Mgen infection but cannot get testing for diagnostic confirmation, they can still start treatment.[5,6]
Once your healthcare provider determines or suspects you are infected with Mgen, they can initiate antibiotic therapy for treatment.[5,6] The antibiotics used to treat Mgen are doxycycline and azithromycin or moxifloxacin. Doxycycline is classified as a tetracycline antibiotic, and azithromycin and moxifloxacin are both macrolide antibiotics. The antibiotic resistance of Mygen influences the choice of antibiotic regimen.
Treatment regimens with antibiotics are centered on a two-stage therapy approach based on resistance testing because of the high resistance with Mgen. Cure rates of more than 90% have been reported with therapy based on resistance results; therefore, macrolide-resistance testing should be used when possible. If resistance testing is available, your healthcare provider may recommend a regimen that starts with doxycycline and is followed by azithromycin or moxifloxacin.
The dosing and frequency of the medications are from the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines for Mgen resistance. If macrolide-resistant testing is unavailable and Mgen is confirmed with a NAAT test approved by the FDA, your healthcare provider can recommend doxycycline followed by moxifloxacin therapy.
It is important that you discuss your sexual health with your healthcare provider. Everlywell offers on-demand STD appointments online with a certified clinician. If you think you may have been exposed to an STD or STI, you can book a virtual call and speak to a healthcare provider within two hours.