Transmission of Mycoplasma Genitalium in women.
Mycoplasma genitalium infection is a sexually transmitted disease and globally, its prevalence is estimated to range between 1 to 4 percent among men and 1 to 6.4 percent among women. It is shown in studies that its prevalence in the US is placed between Chlamydia trachomatis (2.3%) and gonorrhoea (0.4%).
The risk level of contracting Mycoplasma genitalium for women (lower in men or women?)
The risk of contracting M. genitalium is similar among men and women. Men and women share similar risk factors such as young age (<20 to 22 years of age), smoking, recent sexual intercourse and increasing number of sexual partners.
The risk a person infected with Mycoplasma genitalium of acquiring another sexually transmitted infection with bacteria such as Chlamydia trachomatis at the same time is also higher and has frequently been reported among high-risk men and women.
Signs & symptoms for women
M. genitalium infection in women can cause a variety of conditions such as cervicitis and pelvic inflammatory disease. Although some women with cervicitis can have no symptoms, those with symptoms may present with an abnormal vaginal discharge which may or may not have pus, bleeding between menses or after sexual intercourse, painful urination, pain during sexual intercourse or vulvovaginal irritation. Women who have cervicitis but do not have symptoms may be diagnosed with cervicitis at the time of physical examination by the doctor during which a speculum examination is performed and tenderness is felt when the cervix is examined.
Complications from Mycoplasma genitalium for women
M. genitalium can ascend from the lower to upper genital tract after sexual transmission and this can lead to a condition called pelvic inflammatory disease (PID). Symptoms of PID may include mild to severe pelvic pain or pain in the lower abdomen. The symptoms of cervicitis as previously mentioned may also occur concurrently with abdominal pain.
PID may have long term complications which may result in infertility, ectopic pregnancy and chronic pelvic pain.
Testing and treatment options for women
There are challenges surrounding testing of Mycoplasma genitalium and this is in part due to the nature of the bacteria and lack of availability of test kits in Singapore. M. genitalium is very slow to grow (1-2 months) and is also difficult to isolate. These challenges can lead to issues of treatment difficulty and growing antibiotic resistance.
Nevertheless, at Dr Tan & Partners, they provide testing for Mycoplasma genitalium which can be performed in Singapore (previously samples were sent to Mayo Clinic, US) which involves detection of M. genitalium DNA and results are available within 7 to 10 days.
Treatment of M. genitalium involves use of antibiotics such as azithromycin, moxifloxacin and doxycycline.
Repeating a test a few weeks after initial treatment (also called test-of-cure) is important in those with M. genitalium infection given increasing antibiotic resistance rates.
Pregnant with Mycoplasma genitalium – what are the risks?
Studies have shown a 2-fold increase in risk for preterm delivery and spontaneous abortion associated with M. genitalium infection during pregnancy. This risk is greater than the association with Trichomonas vaginalis infection in pregnancy. As the prevalence of M. genitalium in low-risk populations is generally low, universal testing of pregnant women for M. genitalium is not warranted.
Can a mother pass it on to her unborn child/ newborn child?
There is very limited data available to suggest whether a pregnant woman infected with M. genitalium can pass the infection to the unborn child/newborn. One study found a mother whose vaginal specimen was positive for M. genitalium delivered an infant with low birth weight who developed acute respiratory distress. M. genitalium was isolated from the infant’s respiratory secretions soon after birth.
Given challenges in isolating the bacteria, it is likely not much is known about the effects of M. genitalium on infants born from mothers with the infection and further studies are needed to confirm this.