THE BIG CONUNDRUM

There needs to be more clarity regarding these little bugs amongst ladies and healthcare providers. So, we decided to break it down for you. Therefore, here is the scoop on tests for Mycoplasma and ureaplasma.

What are they? Are they bacteria or viruses?

Do Myco and Urea live in the normal genital tract?

Many healthy adults have colonization, proven by Mycoplasma and Urea tests. And the percentage of women with vaginal colonization by M. hominis, M. genitalium, and Ureaplasma spp increases after puberty in proportion to the number of lifetime sexual partners. Ureaplasma Lab test research shows it has been seen to vary from 0% in never-active women to up to 70% in sexually active women.

MGen evades the immune system and alters the host’s immune system, which allows it to survive in the host’s body.

How common is it?

Infections that tests have linked to various types of Myco and urea include:

  • M. hominis
  • Pelvic inflammatory disease (PID) – not proven
  • Chorioamnionitis
  • Postpartum and postabortal fever
  • Pyelonephritis
  • Central nervous system infections
  • Septicemia
  • Wound infections, especially postoperative wounds
  • Joint infections
  • Upper and lower respiratory tract infections
  • Endocarditis
  • Neonatal bacteremia and meningitis
  • Neonatal abscesses

Can other infections co-exist with it?

Chlamydia trachomatis is the most commonly reported co-infecting organism.

How is M present in Males?

Mycoplasma infection accounts for 15 to 20 per cent of NGU cases reported annually among men in the United States. MGen detection is more frequent in men with persistent or recurrent urethritis. However, it may also be associated with balanitis (inflammation of the glans penis) and posthitis (inflammation of the foreskin).

How does M affect females?

Mycoplasma genitalium can ascend from the lower to upper genital tract after sexual transmission.

Which specimen is most accurate?

Among men, the Ureaplasma diagnostic Test performance of first-void urine specimens in detecting M. genitalium is higher than that of urethral smear specimens.

Among women, vaginal specimens are better. Moreover, in one study of 400 women, the relative sensitivity of PCR for it was 86 per cent with vaginal swabs as compared to 61 per cent with first-void urine.

When to check for it?

 If a sexually active person presents with evidence of urethritis, cervicitis, or pelvic inflammatory disease. Moreover, it is recommended that the test be done for Mycoplasma and other STIs. However, some women or men continue to have symptoms of these conditions. And that is despite the completion of appropriate therapy. Also, regardless of the initial cause, testing for Mycoplasma is recommended.

How are the infections checked?

They are checked by checking vaginal swabs or urine specimens. For women, vaginal swabs are more accurate. Moreover, some methods are difficult for the reasons described above, but most hospital labs are not prepared to culture them.

Also, RNA-based or PCR-based assays are used in kits to check for germs. However, the only drawback is that we cannot test for sensitivity to drugs through RNA-based exams.

A DNA chip assay can identify 13 urinary tract germs, including M. hominis and U. urealyticum, with relatively high sensitivity and specificity compared to Ureaplasma PCR Tests. However, it is not currently available in the US.

Which antibiotic is the best for which species?

M. GENITAL

Azithromycin is the first line of treatment because it is 100-fold more active against this organism. However, resistance is increasing. Moreover, in certain regions, the estimated rate of azithromycin resistance in isolated Myco strains has been as high as 40 per cent. Moreover, the suggested treatment dose is 1 g of azithromycin orally.

Failed or recurrent infection with M. genital

Moxifloxacin—If azithromycin fails, the next choice is moxifloxacin. However, there is also growing evidence of resistance.

HOMINIS

  • Doxycycline is for non-pregnant adults with disease caused by M. hominis
  • Clindamycin: is for infants with disease caused by M. hominis,
  • Fluoroquinolones are effective. However, there is an increasing development of resistance.
  • Azithromycin or Clarithromycin: is for infants with disease caused by Ureaplasma spp,

Which symptoms could suggest the disease for treatment in Women?

  • Recurrent Vaginal infections are not responsive or resistant to routine treatments of BV.
  • Recurring infections after sexual intercourse.
  • Persistent vaginal burning, and with negative cultures for routine culprits. Candida and Gardnella, etc, with negative Gonorrhea/ Chlamydia and Trichomonas.

Please remember that these are associations and links. And we still need robust trials and larger studies to prove these germs as primary agents of vaginal infections.

Partner treatment

There are no rules for partner referral and treatment. However, it is reasonable to screen all sexual partners for Lab cases of Myco and treat it if positive. Therefore, suppose Ureaplasma screening of sexual partners of patients with confirmed Mgen is not possible. In that case, it is reasonable to treat Mycoplasma genitalium, given the evidence.

How long does it take to grow and infect someone?

Although Ureaplasma Tests show that the incubation period of this bug remains undefined, screening should target sexual partners in the past 60 days. Moreover, treatment for partners of patients with confirmed Mycoplasma infection is the same as for patients.

Treatment:

And for Myco and Urea

  • M. hominis
  • Non-pregnant
  • Doxycycline: 100mg PO BID x 7 days

If allergy:

  • Moxifloxacin: 400mg PO daily x 10 days

Or Pregnant

  • *Clindamycin: 600mg PO every 8hrs x 7 days