Mycoplasma genitalium infection
Mycoplasma genitalium is an emerging sexually transmitted pathogen and a leading cause of nongonococcal, nonchlamydial urethritis in men and of cervicitis and pelvic inflammatory disease in women. Diagnosis requires nucleic acid amplification testing, and treatment is resistance-guided, with doxycycline lead-in therapy followed by extended azithromycin or moxifloxacin because macrolide resistance is increasingly common.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Emerging sexually transmitted pathogen: Mycoplasma genitalium is a small, cell-wall-deficient bacterium recognized as an emerging cause of nongonococcal urethritis in men and cervicitis/pelvic inflammatory disease (PID) in women.
- Epidemiology
Sexually transmitted, person-to-person spread: M.
- Risk factors
Sexual contact with an infected partner: the direct mechanism of acquisition, as with other sexually transmitted pathogens.
- Pathophysiology
Mucosal epithelial adherence: M. genitalium adheres to and colonizes the urethral, cervical, and endometrial mucosal epithelium, initiating local inflammation.
- Clinical features
Urethritis in men: dysuria and mucopurulent or clear urethral discharge; M.
- Differential diagnosis
Neisseria gonorrhoeae urethritis/cervicitis: typically more purulent discharge, and Gram stain shows intracellular gram-negative diplococci; distinguished by NAAT or culture.
- Diagnosis
Confirmed by nucleic acid amplification testing; there is no routine screening recommendation: the diagnosis is established by a U.S.
- Management
Start with doxycycline lead-in therapy: doxycycline 100 mg PO twice daily for 7 days is given first for confirmed or strongly suspected M.
- Complications
Pelvic inflammatory disease: ascending infection can cause endometritis and salpingitis with lasting reproductive consequences.
- Prognosis
Good with resistance-guided treatment: appropriately sequenced doxycycline lead-in followed by susceptibility-directed azithromycin or moxifloxacin achieves cure in most patients.
- Prevention
Consistent barrier contraception: condom use reduces the risk of acquisition and transmission, as with other sexually transmitted infections.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Chlamydia trachomatis infection
Chlamydia trachomatis is the most commonly reported bacterial sexually transmitted infection in the United States, frequently asymptomatic, and diagnosed by nucleic acid amplification testing of urine or genital/rectal/oropharyngeal swabs. Uncomplicated genital infection is treated with a single dose of azithromycin or a course of doxycycline, complications include pelvic inflammatory disease and epididymitis, and LGV serovars require a 21-day course and are an increasing cause of proctitis.
- Trichomonas vaginalis infection
Trichomonas vaginalis is a flagellated protozoan sexually transmitted infection that presents with malodorous frothy yellow-green discharge and a strawberry cervix but is frequently asymptomatic, especially in men. Diagnosis rests on nucleic acid amplification testing of vaginal secretions, and treatment is a single 2 g oral dose of metronidazole or tinidazole with partner treatment and retesting in 3 months for high reinfection rates.
- Pelvic inflammatory disease
Pelvic inflammatory disease is an ascending polymicrobial infection of the upper female genital tract, most often caused by Neisseria gonorrhoeae, Chlamydia trachomatis, or Mycoplasma genitalium, diagnosed clinically on uterine, adnexal, or cervical motion tenderness. Most women are treated as outpatients with a single dose of ceftriaxone plus 14 days of doxycycline, while parenteral cefotetan or cefoxitin plus doxycycline, or clindamycin plus gentamicin, is reserved for hospitalized patients, with tubo-ovarian abscess and infertility among the major complications of delayed treatment.
- Infectious genital ulcers
Infectious genital ulcers are caused chiefly by herpes simplex virus and syphilis in the United States, with chancroid, lymphogranuloma venereum, and granuloma inguinale as less common causes, distinguished by ulcer pain, number, and associated lymphadenopathy, and worked up with an ordered panel of HSV NAAT, syphilis serology or darkfield, and targeted testing since a substantial minority of ulcers have no identified cause and empiric therapy is often required.