Mycoplasma genitalium Infection in Men

J Infect Dis. 2017 Jul 15;216(suppl_2):S396-S405. doi: 10.1093/infdis/jix145.

Abstract

Mycoplasmagenitalium is one of the major causes of nongonococcal urethritis (NGU) worldwide but an uncommon sexually transmitted infection (STI) in the general population. The risk of sexual transmission is probably lower than for Chlamydia trachomatis. Infection in men is usually asymptomatic and it is likely that most men resolve infection without developing disease. The incubation period for NGU caused by Mycoplasma genitalium is probably longer than for NGU caused by C. trachomatis. The clinical characteristics of symptomatic NGU have not been shown to identify the pathogen specific etiology. Effective treatment of men and their sexual partner(s) is complicated as macrolide antimicrobial resistance is now common in many countries, conceivably due to the widespread use of azithromycin 1 g to treat STIs and the limited availability of diagnostic tests for M. genitalium. Improved outcomes in men with NGU and better antimicrobial stewardship are likely to arise from the introduction of diagnostic M. genitalium nucleic acid amplification testing including antimicrobial resistance testing in men with symptoms of NGU as well as in their current sexual partner(s). The cost effectiveness of these approaches needs further evaluation. The evidence that M. genitalium causes epididymo-orchitis, proctitis, and reactive arthritis and facilitates human immunodeficiency virus transmission in men is weak, although biologically plausible. In the absence of randomized controlled trials demonstrating cost effectiveness, screening of asymptomatic men cannot be recommended.

Keywords: Mycoplasma genitalium; antimicrobial resistance; men; nongonococcal urethritis; nucleic acid amplification test.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Azithromycin / therapeutic use
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Macrolides / therapeutic use
  • Male
  • Male Urogenital Diseases / drug therapy
  • Male Urogenital Diseases / microbiology*
  • Mycoplasma Infections / drug therapy*
  • Mycoplasma genitalium / isolation & purification*
  • Nucleic Acid Amplification Techniques
  • Sexual Partners
  • Urethritis / drug therapy
  • Urethritis / microbiology*

Substances

  • Anti-Bacterial Agents
  • Macrolides
  • Azithromycin