Mycoplasma genitalium: An under-reported cause of sexually transmitted infection

The latest guidelines recommend testing for Mycoplasma genitalium infection in patients with non-gonococcal urethritis or with features suggestive of pelvic inflammatory disease. Routine screening can be performed in some high-risk patients. Recently a study about the demographic characteristics and clinical features of patients diagnosed with Mycoplasma genitalium was published in the Indian Journal of Dermatology, Venereology and Leprology.

It was a retrospective, observational, single-centre study including patients diagnosed with Mycoplasma genitalium by Multiplex Real-time Polymerase Chain Reaction Allplex© STI Essential Assay Q (Seegene) between September 2018 and December 2019, in a tertiary hospital in Barcelona. Clinico-demographic characteristics such as age, gender, nationality, sexual orientation, drug use, sexual risk behaviours, site of infection, presence of symptoms, coinfection with other sexually transmitted infection, HIV-related information and treatment undertaken were recorded for every patient.

Among the 196 patients included for analysis, 187 (95.4%) were male with a mean age of 36.6 ± 8.3 years, 166 (84.7%) were men having sex with men (MSM). Most patients [157 (80.1%)] reported a sexually transmitted infection and 94 (48%) disclosed chemsex use.

Urethra was the commonest location in both homosexual [77 (46.4%)] and heterosexual [10 (83.3%)] men. Most infections were asymptomatic [119 (60.7%)], while (53, 56.4%) of the urethral infections were symptomatic. Among the heterosexual individuals, 11 (55%) presented with symptoms, compared to 54 (33.1%) men who had sex with men.

Twenty seven (13.8%) patients presented with at least one other concomitant sexually transmitted infection in the same location where Mycoplasma genitalium was identified. Urethra was the commonest site of coinfection, accounting for 18 (44%) cases. Patients with coinfection reported symptoms in 18 (66.9%) cases, versus 55 (33.3%) of the non-coinfected. Neisseria gonorrhoeae was the most frequent coinfecting agent in 29 (58%) patients, followed by Chlamydia trachomatis [14 (28%)]. Overall, 143 (73%) patients had concomitant HIV infection. Most patients received treatment 149 (76%), commonest being azithromycin in a 5-day regimen in 58 (29.6%) cases.

Urethral samples demonstrated maximum yield of Mycoplasma genitalium. Men who had sex with men demonstrated more Mycoplasma genitalium infections in the rectum [73 (41.0%)] and pharynx [21 (12.7%)], which may explain the higher rates of asymptomatic infection in this group 108 (66.7%). Neisseria gonorrhoeae accounted for (58%, 29) of coinfections.

Chemsex is a growing high-risk sexual practice involving intentional sex under the influence of recreational drugs, mostly among MSM. Most patients in this study were people living with HIV and men having sex with men. More than half of the infections were asymptomatic. Urethral location and coinfection, particularly with Neisseria gonorrhoeae, influenced clinical presentation. The heterosexual group presented with symptoms more frequently than men having sex with men.

To conclude Mycoplasma genitalium is an under-reported, under-diagnosed sexually transmitted infection in the community especially in MSM. Further evidence is required to design screening programs and to assess variables that are associated with symptomatic Mycoplasma genitalium infections.

Source- Alamon-Reig F, Riera-Monroig J, González-Cordón A, Bosch J, Alsina M, Fuertes I. Mycoplasma genitalium: A descriptive study of 196 cases. Indian J Dermatol, Venereol Leprol doi: 10.25259/IJDVL_217_2021