Mycoplasma Genitalium (AKA Mgen)

Mycoplasma Genitalium (AKA Mgen)

Sexual Transmitted Infections in Children? Dr. Jackson, are you gonna have us talk to teens about sex again?  Yes. Yes I am. Whether I am in Charlotte or B’awlmer (currently hanging out as Faculty at Johns Hopkins), I will strive to make us all uncomfortable… so that we can be more comfortable in having important conversations with our pediatric patients! Clearly, STIs are important infections to consider and we have discussed several before (ex, PID, epididymitis, TOA, and Pseudoparalysis of Parrot). There, however, is a new kid on the block named Mycoplasma Genitalium (AKA Mgen) that is causing a splash. Let us take a minute to catch up to this evolving issue:

Mycoplasma Genitalium: Basics

  • In the US, prevalence of sexually transmitted infections (STIs) are highest among adolescents and young adults.
  • Anyone who has unprotected sex is at risk for contracting an STI. Stigma has played a significant role in care for marginalized groups, leading to many health disparities. Therefore, CDC does not recommend risk-factor-based screening.
  • Mycoplasma Genitalium is an emerging pathogen.
    • 40% of persistent or recurrent urethritis in males
    • 10–30% of women with clinical cervicitis in females
  • Similarly to gonorrhea, trichomoniasis and chlamydia, Mgen can progress to PID.
  • As previously mentioned by Dr. Richardson, adolescents use the Emergency Department as their Primary Care resource often. So taking advantage of Mgen testing adolescents in the peds ed is key.

Mycoplasma Genitalium: The Dx

Teens may not be forthcoming about recurrent symptoms with patients or partners in the room. Like the HEADSS, it’s best to respect their privacy and interview patients alone. 

Similar to other more common STIs, patients will present with:

  • Penile or vaginal discharge
  • Dysuria
  • Rectal pain, constipation
  • Pain/bleeding after sex
  • Bleeding between periods
  • Chronic abdominal pain
  • PID, with a prevalence from 4% to 22%
  • Pregnancy loss

Mycoplasma has no cell wall and is slow growing, so NAAT testing is the best test for symptomatic adolescents and young adults. It’s important to ask how patients are having sex. The NAAT for Mgen is FDA approved for urine and genital samples.

Mycoplasma Genitalium: Treatment

  • Our go to empiric STI treatment of ceftriaxone and azithromycin won’t do.
  • Unfortunately, there is a lot of antibiotic resistance in the community, so a two step treatment is recommended.
  • Most EDs don’t have resistance information available. 
    • If Mgen is resistant to macrolides or unknown:
      • Doxycycline 100 mg BID  for 7 days
      • Then moxifloxacin 400 mg daily for 7 days
    • If Mgen is macrolide sensitive:
      • Doxycycline 100 mg BID for 7 days
      • Azithromycin 1 g once, then 500 mg daily for 4 days
  • For cases of Mgen in pregnancy teens, ID consult is recommended

Moral of the Morsel

  • Don’t ignore it! Persistent STI symptoms isn’t always non-adherence. Think of Mycoplasma Genitalium (AKA Mgen)!
  • Keep a low threshold for testing! Especially when patients have been seen multiple times of STI complaints. 
  • Ignorance may not be blissful! If we don’t ask, we won’t know!
  • Don’t treat it like cervicitis or PID. Doxycycline for 7 days, followed by Moxifloxacin for 7 more days!.

Seña AC, Lensing S, Rompalo A, et al. Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy. J Infect Dis 2012;206:357–65. PMID:22615318 https://doi.org/10.1093/infdis/jis356

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00128-6/fulltext

https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm

https://stacks.cdc.gov/view/cdc/159414

https://www.sciencedirect.com/science/article/abs/pii/S0735675724000123

Author

Kendra Jackson
Kendra Jackson
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