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Case of the Month - September 2016

Answer to Q1

Mycoplasma genitalium (M. genitalium) is one of the smallest prokaryotes capable of replication, lacks a cell wall and has a characteristic pear/flask shape with a terminal tip organelle (1). M. genitalium has several virulence factors that are responsible for its pathogenicity. These includes its ability to adhere to host epithelial cells, the release of enzymes and the ability to evade the host immune response by antigenic variation. The term “genital mycoplasmas” refers to a category of several different species of sexually transmitted bacteria most notably Mycoplasma genitalium, but also less common species, such as Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum.

M. genitalium is an emerging cause of sexual transmitted infections (STIs) and has been implicated in urogenital infections of men and women around the world (2). More than 25 years after its initial isolation from men with non-gonococcal urethritis (NGU), M. genitalium is now recognised as an important aetiological agent of acute and persistent male NGU. In women, M genitalium has been significantly associated with both cervicitis and pelvic inflammatory disease (PID) (2). The role of this organism in male urogenital disease is a significant advancement in our knowledge of STIs, but its role in the inflammatory reproductive tract diseases of women is still not very clear.

Currently, there are no evidence-based guidelines specifically for the treatment of M. genitalium infection. Within South Africa, M. genitalium pathogens are treated under the terminology associated with STI syndromic management, i.e. male urethritis syndrome (MUS), vaginal discharge syndrome (VDS) and lower abdominal pain syndrome (LAP). (3). Doxycycline is dispensed as part of the antibiotic cocktail for each of these syndromes, primarily to treat Chlamydia trachomatis. M. genitalium has been associated with HIV co-infections in a number of previous studies (4). An urgent consensus is required on how best to treat M. genitalium infections, particularly in areas with substantial burden of HIV infection.

In comparison with other STIs there is less information about the global prevalence of M. genitalium. The prevalence of M. genitalium in men with non-chlamydial NGU (NCNGU) ranges from 10%-45% and in general population from 1% to 3.3% (5).

Question 2: With which gynaecological disorders is M. genitalium significantly associated?

Continue to Answer 2