Mycoplasma Genitalium guide: Etiology and epidemiology
Etiology and epidemiology of Mycoplasma genitalium.
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Etiology
Mycoplasmas are small facultative anaerobic bacteria (0.2-0.3 μm) without a cell wallFootnote 1, Footnote 2. They are pleiomorphic and cannot be Gram stained or identified by light microscopy.
Genital mycoplasmas belong to the Mollicutes class in the family Mycoplasmataceae, which includes two genera: Mycoplasma and Ureaplasma. Footnote 1, Footnote 2
Seven Mycoplasma species have been identified in the genital tract including M. genitalium which has emerged as an important cause of genital tract infections. Associations between M. genitalium and non-chlamydial and non-gonococcal urethritis have been reported.
Epidemiology
M. genitalium is an emerging sexually transmitted pathogen. Limited information is available about the prevalence of M. genitalium in Canada and its local antimicrobial resistance (AMR) patternsFootnote 3, Footnote 4.
International prevalence estimates for M. genitalium range from 1% to 4% in men and 1% to 6% in women. Prevalence is as high as 38% in those who are at a higher risk for sexually transmitted infection (STI) Footnote 5.
The National Longitudinal Study of Adolescent Health from the U.S. reported a 1% prevalence of M. genitalium in adults between the ages of 18-27Footnote 6.
The National Survey of Sexual Attitudes and Lifestyles Survey from the UK found that 1.2% of men and 1.3% of women between the ages of 16-44 years had an M. genitalium infection. Among those with M. genitalium, 56% of men and 94% of women were asymptomatic Footnote 7.
A large systematic review and meta-analysis found that people with M. genitalium were twice as likely to acquire human immunodeficiency virus (HIV). The reasons for this are unclear Footnote 8.
Associations have been reported between M. genitalium and C. trachomatis and N. gonorrhoeae infections in some settings Footnote 9, Footnote 10, Footnote 11, Footnote 12. In a multi-site Canadian study, M. genitalium was detected in 13.4% of women with C. trachomatis and in 5.4% of women without C. trachomatis Footnote 3.
A Toronto study of 1,193 people who attended a sexual health clinic reported that 4.5% of men and 3.2% of women tested positive for M. genitalium, and that 50% and 40% respectively were symptomatic Footnote 4.
An Alberta study of people at two STI clinics reported a prevalence of 5.3% in men and 7.2% in women. Correlates of M. genitalium in females included younger age, Indigenous Peoples, non-Caucasian ethnicity and C. trachomatis and N. gonorrhoeae co-infections Footnote 13.
References
- Footnote 1
Cazanave C, Manhart L, Bébéar C. Mycoplasma genitalium, an emerging sexually transmitted pathogen. Médecine et maladies infectieuses. 2012;42(9):381-392.
- Footnote 2
Taylor-Robinson D, Jensen JS. Mycoplasma genitalium: From chrysalis to multicolored butterfly. Clin Microbiol Rev. 2011;24(3):498-514. doi: 10.1128/CMR.00006-11 [doi].
- Footnote 3
Chernesky MA, Jang D, Martin I, et al. Mycoplasma genitalium antibiotic Resistance–Mediating mutations in canadian women with or without chlamydia trachomatis infection. Sex Transm Dis. 2017;44(7):433-435.
- Footnote 4
Gesink D, Racey CS, Seah C, et al. Mycoplasma genitalium in toronto, ont: Estimates of prevalence and macrolide resistance. Canadian Family Physician. 2016;62(2):e96-e101.
- Footnote 5
Manhart LE, Broad JM, Golden MR. Mycoplasma genitalium: Should we treat and how? Clinical Infectious Diseases. 2011;53(suppl_3):S129-S142.
- Footnote 6
Manhart LE, Holmes KK, Hughes JP, Houston LS, Totten PA. Mycoplasma genitalium among young adults in the united states: An emerging sexually transmitted infection. Am J Public Health. 2007;97(6):1118-1125.
- Footnote 7
Sonnenberg P, Ison C, Clifton S, et al. The epidemiology of mycoplasma genitalium in the british population: Findings from the third national survey of sexual attitudes and lifestyles (natsal-3): O31. Hiv Medicine. 2014;15:11.
- Footnote 8
Mavedzenge SN, Weiss HA. Association of mycoplasma genitalium and HIV infection: A systematic review and meta-analysis. AIDS. 2009;23(5):611-620.
- Footnote 9
Mobley VL, Hobbs MM, Lau K, Weinbaum BS, Getman DK, Sena AC. Mycoplasma genitalium infection in women attending a sexually transmitted infection clinic: Diagnostic specimen type, coinfections, and predictors. Sex Transm Dis. 2012;39(9):706-709. doi: 10.1097/OLQ.0b013e318255de03 [doi].
- Footnote 10
Huppert JS, Mortensen JE, Reed JL, Kahn JA, Rich KD, Hobbs MM. Mycoplasma genitalium detected by transcription-mediated amplification is associated with chlamydia trachomatis in adolescent women. Sex Transm Dis. 2008;35(3):250-254. doi: 10.1097/OLQ.0b013e31815abac6 [doi].
- Footnote 11
Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC. Mycoplasma genitalium compared to chlamydia, gonorrhoea and trichomonas as an aetiological agent of urethritis in men attending STD clinics. Sex Transm Infect. 2009;85(6):438-440. doi: 10.1136/sti.2008.035477 [doi].
- Footnote 12
Mena L, Wang X, Mroczkowski TF, Martin DH. Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in new orleans. Clinical Infectious Diseases. 2002;35(10):1167-1173.
- Footnote 13
Gratrix J, Plitt S, Turnbull L, et al. Prevalence and antibiotic resistance of mycoplasma genitalium among STI clinic attendees in western canada: A cross-sectional analysis. BMJ Open. 2017;7(7):e016300-2017-016300. doi: 10.1136/bmjopen-2017-016300 [doi].
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