Mycoplasma genitalium in men and women

The smallest microorganism that parasitizes on the cell membrane, attaching and integrating into it, Mycoplasma genitalium is recognized, according to most researchers, as an absolute pathogen, unlike its other Mollicute relatives, more common and well-known - Ureaplasma and Mycoplasma hominis, which are still classified as opportunistic microbes. All of them are causative agents of urogenital mycoplasmosis, their pathogenicity for humans in the light of modern research leaves no doubt, although infection does not necessarily lead to the development of the disease - these microorganisms are often found in practically healthy people.

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Structure mycoplasma genitalium

Scientists first encountered Mycoplasma genitalium "face to face" not very long ago, only in the early 80s of the last century. It is this mollicute that is impractical to identify using cultural analysis (growing its culture is not difficult, but it takes a very long time), light microscopy is also powerless in this case. Not a virus or a bacterium, like all representatives of mollicutes, lacking a cell nucleus (prokaryotes) and some ingredients of the cell wall, limited by a thin elastic membrane, Mycoplasma genitalium has the shape of a flask and the shortest DNA chain (genome) among all known mycoplasmas parasitizing human cells. This tiny parasite develops only on the mucous membrane of the urogenital organs of warm-blooded animals, its life cycle is completely dependent on the nutrients received from the cell on which it parasitizes. Unlike viruses, mycoplasma genitalium has DNA and RNA chains in its structure (viruses contain one or the other). Under unfavorable conditions, for example, treatment with antibiotics, the parasite can penetrate into the cell and wait there until better times. It will not develop, but it will not die either, preserving its viability. The microbe is able to migrate from the danger of being destroyed, leaving the unfavorable mucous membrane and moving to a zone of greater comfort for it. Mycoplasma genitalium is related to bacteria by pathogenicity and the ability to inhibit the immune response. It is assumed that mycoplasma genitalium can act as a pathogenic element in the development of an autoimmune process in the body of an infected person, in particular, arthritis.

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Epidemiology

These parasites prefer the cells of the mucous membrane of the body of warm-blooded mammals, mainly, they have chosen the genitourinary system. Therefore, it is clear how mycoplasma genitalium is transmitted. The main route of transmission is unprotected sexual contact of any type, kissing is absolutely safe if it is not preceded by oral sex. Mycoplasma genitalium does not parasitize on the mucous membrane of the oral cavity, but remains viable for quite a long time.

A study of this rare parasite on primates showed that when the genital mucosa is infected, a pathological process almost always develops, which gave reason to consider it a pathogenic microbe.

A study conducted in Britain demonstrated that Mycoplasma genitalium was found in almost the same number of males (1.2%) and females (1.3%) in the study group, and it was found only in people who were sexually active. Mycoplasma genitalium was never found in people in the sample who practice oral sex or who did not have sexual intercourse. The highest frequency of detection of this parasite was noted in sexually active people: the leaders of the study were males aged 25-34 years, among whom Mycoplasma genitalium was found in 2.1% of those studied. In the female group, the leaders were representatives aged 16 to 19 years - the share of those infected was 2.4%. 94% of males and 56% of females did not feel any signs of discomfort indicating the presence of a urogenital infection.

The study of mycoplasma genitalium, its transmission routes and treatment methods is not yet complete and final conclusions are yet to come.

It is quite possible that a newborn is infected by the mother during childbirth, such cases are known. Parasitic invasion threatens the baby with pneumonia, immune disorders, increased blood density, meningoencephalitis, however, more often over time, mycoplasmas cease to be detected in children - self-healing occurs. Among children with perinatal mycoplasmosis, there are many more girls than boys. Transmission of infection during pregnancy through the placenta has not yet been studied, but another genital mycoplasma (hominis) is found in amniotic fluid, so it can be assumed that genitalium can also overcome the placental barrier.

The contact-household route is unlikely, but not excluded, especially for women. In a warm, humid environment, mycoplasmas remain viable from two to six hours. Contact infection occurs through bed linen and underwear, washcloths and towels of common use, non-sterile gynecological instruments. Men are practically not infected by contact, for women, the probability of non-sexual infection is much higher.

The incubation period after infection with Mycoplasma genitalium can range from 21 to 35 days.

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Symptoms

Specific signs of mycoplasmosis have not been identified. It is rarely detected as a monoinfection; in almost 90% of cases, mycoplasma infection is detected in patients with other sexually transmitted diseases. Most often, these are chlamydia, trichomoniasis, and gonorrhea. So, if any symptoms appear that indicate infection or inflammation of the genitourinary system, it makes sense to also look for the causative agent of mycoplasmosis. Mycoplasma hominis is detected much more often during examinations, but this may be partly due to the fact that it is easier to identify.

It is assumed that the infection in most cases is asymptomatic until the body is exposed to some stress factor. When immunity is reduced, the pathogens become active and symptoms characteristic of genitourinary diseases appear. Mycoplasma genitalium in men most often causes non-gonococcal urethritis - minor transparent discharge from the penis, which is most disturbing after a night's sleep, pain during urination, and nagging pain in the pubic area. Urethritis caused by Mycoplasma genitalium is second among non-gonococcal urethritis after chlamydial urethritis and accounts for 15 to 30% of all cases in this group.

If the parasite persists in the prostate gland, then signs of its inflammation appear - frequent, not very abundant emptying of the bladder, accompanied by pain; periodic or constant pain in the lower abdomen, affecting the perineum; potency deteriorates.

Symptoms of infection correspond to inflammation of the affected organ - balanoposthitis, epidemitis. Long-term parasitic microbes in the body lead to a decrease in male fertility - a violation of the production and maturation of spermatozoa, since mycoplasma genitalium is able to parasitize on their cell membrane.

In general, mycoplasmosis is more common in women. In female genitals, they are found in cervicitis and vaginitis, trichomoniasis, gonorrhea, chlamydia, in women suffering from infertility, miscarriage, and premature babies. Mycoplasma hominis is found much more often. However, this suggests that genital mycoplasmas still play an important role in the development of pathological conditions.

Mycoplasma genitalium in women also manifests itself with non-specific symptoms typical of urogenital diseases in general. Vaginal discharge can be transparent, grayish, foamy, and also yellowish or greenish. Their abundance and color depend on the presence of other pathogens. Itching and burning during emptying the bladder, pain in the lower abdomen, and during intercourse may be observed. In women, mycoplasmosis often occurs asymptomatically. In pregnant women, mycoplasmas are detected 1.5-2 times more often (this applies to both types of genital parasites). It is believed that the presence of mycoplasmosis complicates the course of pregnancy and the process of childbirth.

Mycoplasma genitalium is mainly the cause of cervicitis. Inflammation of the cervix associated with this parasite occurs in six to ten cases out of a hundred inflammations of this localization. Studies have shown that infection with Mycoplasma genitalium can cause inflammation of the endometrium, fallopian tubes and, as a result, their obstruction and associated infertility.

Diagnostics

Male patients with symptoms of inflammation of the urethra, prostate gland, testicles and their appendages, in the presence of discharge from the penis, are subject to examination.

It is recommended to examine the genital mycoplasma infection in patients with cervicitis, symptoms of inflammation of the pelvic organs and genitourinary tract, complaining of pain in the lower abdomen and during intercourse, unusual vaginal discharge, irregular periods, as well as those planning pregnancy, with a history of miscarriages, stillborn and premature babies.

Persons of both sexes without manifestations of genitourinary diseases, but whose sexual partners were found to have Mycoplasma genitalium, are also subject to diagnostic examination.

This infectious agent is one of the smallest microbes, its visualization even with a microscope is not possible, and it also takes a very long time to cultivate, so this method is not used in routine laboratory studies. Currently, patients are prescribed a PCR test for mycoplasma genitalium. The polymerase chain reaction test is based on the use of enzymatic reagents that allow multiple copies of nucleic acid fragments characteristic of a given microorganism. It takes no more than 24 hours to determine mycoplasma genitalium DNA in biological material samples.

Basically, a smear for mycoplasma genitalium or the first portion of morning urine is used for research. In women, scrapings from the mucous membranes of the vagina or cervical canal are examined, taken before the onset of menstruation or after their end after 48 hours. In men, a smear from the urethra, sperm, and prostate gland secretion are examined. If joint pathologies are suspected, synovial fluid can be examined.

The tests are conducted both for diagnostics and to evaluate the effectiveness of treatment. Different sets of reagents are used to detect DNA or RNA using the polymerase chain reaction method. A positive test is the basis for treatment and examination of the sexual partner.

For the diagnosis of mycoplasmosis, including genital mycoplasmosis, the direct immunofluorescence method can be used, however, it has not become widespread in diagnostic practice.

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Differential diagnosis

Mycoplasma genitalium infection is differentiated from other urogenital infections – gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, and also Mycoplasma hominis.

Today, two types of mycoplasma are known that cause damage to the genitourinary system - genitalium and hominis. The second type is more common and is classified as an opportunistic microorganism, while the first, according to most experts, is considered a pathogen.

What is the difference between Mycoplasma genitalium and Mycoplasma hominis? For us, practically nothing - both of these microorganisms parasitize on the cells of the mucous membrane of the urogenital organs, and prefer the genital ones. Persisting inside, they affect the mucous membranes of the uterus, prostate gland, bladder and kidneys, causing the corresponding inflammations - endometritis, prostatitis, pyelonephritis, etc. The vast majority of infections occur sexually. Mycoplasmas can perfectly "live" on our cells, absolutely not giving away their presence, which makes some specialists doubt their pathogenicity.

For researchers, these mycoplasmas differ in shape - genitalium has a stable flask shape with a narrow neck, and hominis is polymorphic, i.e. it can take various forms, from round to branched thread. Genitalium is difficult to diagnose; before the advent of the polymerase chain reaction method, it was almost impossible to detect. It is easy to grow, but the process itself takes a lot of time and is not practical for routine diagnostic studies of patients. Hominis can be detected by enzyme immunoassay for the presence of antibodies in the patient's blood, using direct or indirect immunofluorescence, as well as by microscopy of the culture, however, the most progressive and accurate method, as in the diagnosis of genitalium, is the polymerase chain reaction.

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Treatment

The need to treat infected patients is still being debated. The widespread asymptomatic carriage gives reason to consider these microorganisms harmless and requiring no treatment. However, the majority opinion prevails, insisting on the pathogenicity of mycoplasma genitalium and the need to destroy the microbes, even if they do not cause symptoms typical of sexually transmitted infections. The fact that the carrier can infect his partner, who will become truly ill, speaks in favor of treatment; the mother can infect the child during childbirth; in addition, intrafamilial infection cannot be discounted either. And the asymptomatic carrier himself risks becoming ill with the slightest decrease in immunity.

The treatment regimen for mycoplasma genitalium involves the use of antibacterial agents, and there is no point in using drugs that are aimed at destroying the cell walls of bacteria, since the walls as such are absent.

The drugs of choice are:

• macrolides - block the synthesis of protein molecules on the ribosomes of the cell of a pathogenic microorganism, their tissue concentration exceeds the serum concentration, in addition to the antibacterial effect, they have an anti-inflammatory and immunostimulating effect;
• tetracyclines - have a similar effect;
• Fluorinated quinolones of the III-IV generation – inhibit the enzymatic activity of two pathogen enzymes at once (DNA gyrase and topoisomerase IV), blocking the construction of its DNA.

Antibiotics for mycoplasma genitalium are selected based on the patient's medical history, taking into account the results of previous treatment and the patient's tolerance (since the culture grows for a long time and sensitivity cannot be checked in the usual way). The treatment regimen also includes antifungal agents if the patient has symptoms of candidiasis; local antiseptics, such as vaginal suppositories or cream with metronidazole; probiotics to restore the vaginal biocenosis, as well as immunomodulators, vitamins, and drip infusions of detoxifying solutions.

The most common treatment for mycoplasma genitalium is Azithromycin, as the microbe is very susceptible to this macrolide antibiotic. Its sensitivity to a representative of tetracycline drugs, Doxycycline, is also quite high. These two antibiotics are usually prescribed. The standard antibacterial regimen for eradicating mycoplasma genitalium includes a single oral dose of 1000 mg of Azithromycin, followed by a weekly or ten-day course of oral Doxycycline, the daily single dose of which is 100 mg.

In vitro susceptibility testing of quinolone antibiotics has shown that the first and second generations of these drugs are not effective in treating Mycoplasma genitalium infections. Third generation drugs with the active ingredient Levofloxacin are used as alternatives for eradication of this microorganism if the basic regimen has proven ineffective.

For example, Tigeron (levofloxacin) may be prescribed for mycoplasma genitalium. The antibiotic is taken orally once a day at a dose of 500 mg per dose for ten days to four weeks. The duration of treatment is determined by the attending physician. It can be used in treatment regimens with antibacterial drugs of other groups.

Moxifloxacin, a fourth-generation fluoroquinolone, has proven to be a more effective second-line drug in studies. This bactericidal drug is chosen in the absence of sensitivity to macrolides. Monotherapy with an oral dose of 400 mg taken once a week or ten days was effective, however, cases of toxic effects on the liver were recorded. Moreover, with complex therapy in combination with, for example, Doxycycline, such a side effect was not observed.

Pristinamycin, a broad-spectrum macrolide, demonstrates high activity against Mycoplasma genitalium in vitro, to which Mycoplasma genitalium strains resistant to a combination of macrolides with Moxifloxacin are sensitive. Laboratory studies of the action of this drug are still ongoing. The action of the new antibacterial drug Solitromycin, the veterinary antibiotic Lefamulin, which are active against Mycoplasma genitalium, is also being comprehensively studied; researchers are especially interested in strains resistant to Azithromycin.

Currently, an alternative to basic drugs can be antibacterial agents of the tetracycline series - Metacycline and Tetracycline, macrolides - Clarithromycin and Erythromycin, fluoroquinolones - Levofloxacin and Pefloxacin.

In case of infection with a strain sensitive to macrolides, a standard treatment regimen is prescribed. The duration of Azithromycin is determined by the doctor; if there is no effect or resistance develops, the doctor may recommend a monotherapy with Moxifloxacin. A control test is performed after 21-28 days of treatment and, if the pathogen is still detectable, treatment is continued with Doxycycline for another two weeks.

Treatment should be prescribed by a doctor; self-medication is fraught with the risk that Mycoplasma genitalium will acquire resistance to all groups of antibacterial drugs.

Prevention mycoplasma genitalium

Considering the main route of infection with this microbe, it becomes clear that the best prevention of infection is safe sexual contact using condoms.

Compliance with basic hygiene rules - individual towels, washcloths, underwear - guarantees the exclusion of infection by contact and household means.

If infection does occur, it is necessary to complete the treatment, having received a negative test for the presence of mycoplasma genitalium. Convince your sexual partner to be examined to avoid re-infection.

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Forecast

Mycoplasmosis is not a fatal disease, but it is very unpleasant, especially in combination with other sexually transmitted infections. They are fraught with complications, infertility, impotence, loss of interest in sexual life. Therefore, it is worth making every effort to avoid infection, and if this fails, then to recover, taking the treatment process very seriously.

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