An Emerging STI Requiring Advanced Testing
Mycoplasma genitalium is a small but significant sexually transmitted bacterium. Often missed by standard STI tests, it's now recognised as an important cause of urethritis, cervicitis, and PID. Rising antibiotic resistance makes proper testing essential.
Mycoplasma genitalium (M. gen) is a sexually transmitted bacterium increasingly recognised as a significant pathogen. It's one of the smallest known bacteria, lacking a cell wall, which makes it naturally resistant to common antibiotics like penicillin. M. gen causes urethritis in men and cervicitis and PID in women. Antibiotic resistance is rising rapidly, making resistance-guided treatment essential.
M. gen requires specific PCR testing - it's not detected by standard bacterial cultures. We can test urine, vaginal swabs, or rectal swabs. Importantly, resistance testing should be performed on positive samples to guide treatment. If you've had persistent symptoms despite treatment for other infections, M. gen testing is recommended.
Due to high resistance rates, treatment should be guided by resistance testing. First-line is typically azithromycin if susceptible. Macrolide-resistant strains require moxifloxacin or other alternatives. A test of cure 3-5 weeks after treatment is essential. Partner treatment is important to prevent reinfection. Untreated infection can persist for years.
Testing for M. gen requires specific PCR technology and isn't yet part of routine screening in many settings. It's relatively newly recognised as an important pathogen. We recommend M. gen testing if you have symptoms, persistent infections, or multiple partners. As awareness grows, testing is becoming more available.
Possibly. M. gen causes similar symptoms to chlamydia and isn't detected by chlamydia tests. If you have persistent symptoms after completing chlamydia treatment, M. gen is an important possibility. We can test specifically for M. gen and other causes of persistent urethritis or cervicitis.
M. gen develops resistance very quickly. Around 50% or more of strains in the UK are now resistant to azithromycin (first-line treatment). Using the wrong antibiotic or not completing treatment promotes resistance. This is why we recommend resistance testing before treatment and test of cure afterwards.
Yes, sexual partners from the past 3 months should be tested and treated if positive. Even if asymptomatic, partners can be infected and reinfect you. Both partners should avoid sex until treatment is complete and test of cure is negative. This prevents ping-pong reinfection.
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