Mycoplasma genitalium Test and STD Treatment Approaches

Associations with Disease Syndromes

Male Urethritis

MGen is linked with acute, persistent, and recurrent urethritis and is an accepted cause of male urethritis. No new data with Mycoplasma has emerged to change this conclusion.

Male Infertility

Limited available STD test evidence does not support the role of Mgen as a cause of male infertility. Although an increasing number of studies have investigated this possibility, many have evaluated sperm quality rather than infertility. Studies enrolling fertile and infertile men have reported no association.

Female Cervicitis

Earlier evidence on the relationship between M. genitalium and cervicitis was somewhat unclear. This is partly because of varying STD definitions, but it generally supports an association. This issue remained the case in four newer studies. Furthermore, in those studies, two showed extra risk; one had extra risk only among a subset of persons, and one reported no extra risk.

Pelvic Inflammatory Disease

Data remain conflicting on the association of M. genitalium with PID, as reflected in the 2 testing studies. Studies since 2014 continued this trend, demonstrating a statistically significant 2-fold extra risk for histologic endometritis (29), a nonsignificant ≈3-fold increase in risk for incident PID, and no association. But there are no general testing plans in the absence of such trials.

Female Infertility

In vitro, inoculation of M. genitalium into fallopian tube tissue damages and destroys cilia. It suggests that Mycoplasma might impair female fertility. Also consistent with this finding is the 2-fold increased risk for infertility in meta-analysis. This is especially true among studies shown for other causes of infertility. However, more recent studies have reported mixed results. In 2 studies, testing was used to detect antibodies showing previous infection. 1 saw a significantly longer time to conception, whereas the other reported no association with tubal factor infertility. Three STD studies used nucleic acid testing (NAAT), which detects active infection, and tests found that the Mycoplasma genitalium infection was more common among infertile than fertile women.

Preterm Delivery

Evidence remains limited on the relationship between M. genitalium infection and preterm delivery. Early checks show a 2-fold extra risk for preterm delivery, stronger among studies for other infections. However, two more recent studies have low M. genitalium levels (0%–1%) and could not see an association. In a third study, M. genitalium infection was more common in women in Australia who experienced a preterm birth than in those who did not (15.4% vs. 2.3%), but this difference was not significant.

Should you do it?

Screening, Lab testing, and checks for cure each have different goals.

Asymptomatic individuals undergo testing to limit therapy and disease and prevent infection. Symptomatic individuals undergo lab exams to target and kill the specific disease. Remedial checks are done to end the spread. Recommendations for any exams are usually based on solid evidence.

Screening

Gonorrhea and Chlamydia infections are often asymptomatic in women. Effective treatment is readily available, and for chlamydia, trial data shows a lower risk of PID in screened and treated individuals. Mgen meets only 1 of these rules: infections are often asymptomatic.

Test data on the risk for sequelae from untreated Mycoplasma genitalium infections in women are less robust than data for chlamydia. There is no evidence of adverse sequelae in men, although such data are sparse. Given the high rates of resistance and the advent of treatment failures, effective treatment is not readily available for all infected persons (see section on treatments).

Benefits of Screening 

STD screening and treating asymptomatic persons for M. genitalium could reduce transmission and spread. However, reductions in prevalence following the start of sexually transmitted programs do not always occur, as shown by the increasing prevalence of chlamydia in the United States. If detected infections are treated, Mgen Home tests can reduce the likelihood of infection resistance, leading to a lower resistance population.

Harms of Screening 

If asymptomatic infections do not cause sequelae, Mycoplasma Home testing and treatment will result in wasted usage. On an individual level, antibiotics might disrupt balance and lead to other health conditions. Adverse effects associated with antibiotics are occasionally serious. More widespread antibiotic use speeds the growth and spread of resistance at a population level. Multidrug-resistant M. genitalium infections are often refractory to STD treatment. Anecdotal reports suggest that infections can lead to anxiety and stress that would not occur in the absence of testing.