What are mycoplasma

Mycoplasma - sexually transmitted disease or not?

Like chlamydia, mycoplasmas are “incomplete” bacteria that require the support of cells to multiply. Therefore, these bacteria are not to be prepared on nutrient media, as is usually the case, but require complex culture processes for cultivation. It is therefore understandable that these bacteria have actually only been easily detected in clinical samples in recent years thanks to the use of methods for genome detection (e.g. PCR).

Not all "STI" germs are relevant
In addition to two types of mycoplasma (M. genitalium, M. hominis) we also know two types of ureaplasma (U. urealyticum, U. parvum) which are found in genital secretions. But the meaning of these rarely studied pathogens is unclear. Since newer detection methods now all named germs in addition to the gonococci, chlamydia and Gardnerella known as sexually transmitted diseases (STI) vaginalisprove in a sample, we have to deal more with positive results of these possibly irrelevant germs.

Recent studies suggest that the two Ureaplasma species are probably insignificant germs in the genital tract, as they are widespread and usually do not cause any symptoms of illness. The same seems to be true for M. hominis to be the case.

M. genitalium: to be taken seriously
It is probably different with M. genitalium. Recent studies suggest that the germ could actually also be important as an STI. So found Sonnenberg et al. in a study of around 4500 young, healthy people in England, an MG-positive result of 1.2%. It was shown that the infection rate only increased with the onset of sexual activity and that M. genitalium found more frequently in people who had more sexual partners (Fig.). Most were symptom-free, women sometimes reported bleeding after sex.

Another study (Trent et al, 2018) showed that the likelihood of M. genitalium Evidence was significantly higher in people who also reported other STIs. It now seems well established that M. genitalium is actually an STI to be taken seriously. A recently published meta-analysis (Baumann 2018) suggests that M.genitaliumprimarily in men who have sex with men (MSM) and in sex workers. Almost 10 years ago, a Scandinavian study in women found the symptoms of M. genitalium (Moi et al, 2009). Here, too, it was found that the infection in women, if symptomatic at all, was mostly limited to urogenital symptoms (urinary urgency, pain, discharge) and that the vaginal smear was more frequently positive than the urine test.

We definitely have to take the pathogen seriously. We also know that the pathogen is also becoming more resistant to antibiotics. We are unsure about the symptoms that M.genitalium can trigger. Most of the time, the infections are asymptomatic. The extent to which infections can also lead to PID (infections of the small pelvis in women) and infertility is controversial. In men it is suspected that the germ can also cause inflammation of the glans penis (balanitis) or the foreskin (postitis or balanopostitis) (Horner, 2011). In any case, we cannot say today that the diagnosis and treatment of asymptomatic carriers of M. genitalium leads to a reduction in long-term effects. For this reason, we currently do NOT recommend carrying out a diagnosis for M. genitalium.

Ideal approach in development
Due to the great uncertainty in dealing with M.genitalium and the rapid increase in resistant germs is currently being worked on in England on a new guideline (see Editorial Hughes et al, 2018). Until we have guidelines for dealing with the pathogen in Switzerland, we will adhere to the following guidelines:

  • No screening of asymptomatic individuals for M. genitalium
  • Pathogens look for symptoms such as urethritis or PID
  • In the case of positive evidence, genetic resistance testing and targeted antibiotic therapy whenever possible
  • Always treat partners at the same time

In the next few years, more information on this little-noticed STI will certainly be added. We stay tuned ...

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