AMG BACKGROUNDER

The recent news of the appearance of mycoplasma genitalium in Jamaica does not necessarily mean that it came out of nowhere, but that it is only now being detected at numbers that are appreciable. Here’s more in-depth information about this little-known STI.

What is mycoplasma genitalium?

Mycoplasma genitalium is a small pathogenic bacterium that lives in humans’ genital and urinary tracts. It may not have been identified in sufficient numbers in Jamaica before now, but the medical and research fields have know about its presence for more than thirty years. Four scientists first reported the existence of this “fastidious” bacteria in the medical journal The Lancet in June 1981. It was one of the first bacteria to have its genome fully sequenced.

How is it transmitted?

Transmission can occur through any sexual activity that involves the exchange of bodily fluids and can infect the mucous membranes of the cervix, urethra, anus, and throat. Many STIs, including mycoplasma genitalium, are often passed from one partner to another without either partner knowing. In fact, infection by mycoplasma genitalium is quite common. According to Stephen Berger in “Infectious Diseases of Jamaica”, as many as 70% of sexually-active people are colonised with the bacteria, which is endemic or potentially endemic to all countries.

Why news of it now?

In Jamaica and many places around the globe, health providers do not routinely screen patients for mycoplasma genitalium. The bacteria is not high on the priority list for sexually-transmitted infections (STIs), for it is not well known, infection is not widespread, and tests for it are extremely expensive. Health centres and other facilities around the country are not likely to have the resources to identify it. But Caribbean Genetics (CARIGEN), a specialised private DNA testing company owned by the University of the West Indies, is equipped with the tools to find mycoplasma genitalium in DNA samples. The scientists there are now seeing an undisclosed, but surprising, number of samples with this bacteria, possibly indicating an increase in infections.

What are its signs and symptoms?

It is important to emphasize that many people with STIs do not experience any signs or symptoms and do not know they are infected. This is the same for mycoplasma genitalium. If someone does develop symptoms, they will usually appear within one to three weeks. However, its incubation period is unknown, so it is uncertain exactly how long after the initial infection symptoms may appear.

Signs and symptoms of infection may include inflammation of the urethra (urethritis), inflammation of the cervix (cervicitis), genital discharge with mucus or pus, pain during sex, or burning while urinating. Urethritis and cervicitis are common in the cases of mycoplasma genitalium, so upon finding that a patient has these, health providers may rule out other STIs. Discharge, pain during sex, and burning are common to other STIs, which can make this infection challenging to accurately diagnose without a test.

Are there complications from infection?

Complications from mycoplasma genitalium are rare in healthy adults. In cases of STIs such as chlamydia and gonorrhea, if a person does not get treatment, the infection can lead to conditions such as infertility and pelvic inflammatory disease (PID). However, systematic studies linking mycoplasma genitalium to complications are sparse. Evidence from various studies provides some support for correlation between mycoplasma genitalium and infertility or PID, but in many instances the evidence is conflicting and inconclusive. Furthermore, many people have mycoplasma genitalium and another STI simultaneously, making it difficult to determine which STI causes complications. As such, it is wise not to assume that this STI automatically will cause PID or infertility.

How is it diagnosed?

To diagnose, either urine, urethral, vaginal, or cervical swabs are sent to a laboratory. Scientists use nucleic acid amplification tests (NAATs), which identify DNA sequences that are present only in the specific organism being tested, to determine what the bacteria is. But NAATs are only available in select research facilities, rather than being commercially available in health centres and medical facilities. This is a limitation to widespread and routine identification of the infection.

Is treatment available?

Mycoplasma genitalium can be treated with antibiotics. Azithromycin is the first line of treatment and should be obtained from a licensed health provider. Like with many antibiotics, resistance to azithromycin is increasing and has currently been found on three continents. Since it is relatively new to the Jamaican population, antibiotic resistance might not yet be of great concern until more information is obtained.

Persons who receive treatment generally respond within one to two weeks. During this time, they should refrain from intimate activities in which bodily fluids are exchanged. Three to four weeks after first receiving treatment, they should return to their health provider for repeat testing. Occasionally, a second round of treatment may be needed for a complete cure.

An additional consideration is that mycoplasma genitalium is a cofactor in HIV transmission, which means that having it can make it easier to acquire and transmit HIV. This does not make it more difficult to treat in people living with HIV. Everyone, regardless of HIV status, should receive the same course of treatment to cure the bacterial infection.

How can it be prevented?

In order to safeguard from getting this infection (and other STIs), it is best to engage in safer sex practices. Using external (male) or internal (female) condoms, dental dams, and lubricants during intimate and sexual acts can prevent the transmission of mycoplasma genitalium. Getting tested for STIs regularly is also important, and those who can safely do so should encourage their partners to get tested as well.

While screening and vaccination are generally good preventive measures for some STIs, screening for mycoplasma genitalium in the general population is not a common practice, and there is no vaccination against it. More research in the Jamaican context is necessary in order to determine whether screening is beneficial.

Keep calm and be informed

There is no need to worry. As undesirable as they are, sexually-transmitted infections exist, and mycoplasma genitalium is simply another one to be aware of at this time. The best thing concerned individuals can do is to be sexually responsible adults who take care of self and partners by using condoms and getting routine testing. As the oft-cited adage so honestly states, an ounce of prevention is better than a pound of the cure.

Image Credit: Paul Keller

Sherine Andreine Powerful, Senior Editor

Sherine Powerful is a Diasporic Jamaican and public health practitioner specializing in global health, sexual and reproductive health, sexual violence prevention, and health promotion and communications. She holds a BA from Yale University and an MPH from Columbia University.