Skip to main content

Mycoplasma genitalium: Is It a Sexually Transmitted Pathogen?

Current Infectious Disease Reports volume 12, pages 306–313 (2010)Cite this article

Abstract

Mycoplasma genitalium is an emerging pathogen that has been detected in the male and female reproductive tracts. It is an established cause of nongonococcal urethritis and evidence linking it to cervicitis, endometritis, and tubal factor infertility is accumulating. Whether a pathogen is sexually transmitted has important implications for clinical management because partner management strategies are an essential part of the treatment plan for sexually transmitted infections. However, mere detection in the genital tract and associations with reproductive tract disease are insufficient to conclude that an organism is sexually transmitted. Therefore, to assess whether M. genitalium is sexually transmitted, we evaluated the literature in terms of associations with established risk factors for other sexually transmitted infections, comparisons of sexually experienced individuals to nonsexually experienced individuals, consideration of other modes of transmission, assessment of concordant infection status among sexual partners, and examination of molecular strain typing in concordantly infected partners.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Morton RS: Gonorrhoea, vol 9. London: WB Saunders; 1977. Major Problems in Dermatology.

  2. Sparling PF: Natural history of syphilis. In Sexually Transmitted Diseases, edn 3. Edited by Holmes KK, Sparling PF, Mardh P-A, et al. New York: McGraw Hill; 1999:473–485.

    Google Scholar 

  3. Schachter J, Stephens RS: Biology of Chlamydia trachomatis. In Sexually Transmitted Diseases. Edited by Holmes KK, Sparling PF, Stamm WE, et al. New York: McGraw Hill Medical; 2008:555–574.

    Google Scholar 

  4. Tully JG, Taylor-Robinson D, Cole RM, Rose DL: A newly discovered mycoplasma in the human urogenital tract. Lancet 1981, 1:1288–1291.

    Article  CAS  PubMed  Google Scholar 

  5. Jensen JS: Mycoplasma genitalium: a cause of non-gonococcal urethritis? Genitourin Med 1994, 70:363.

    CAS  PubMed  Google Scholar 

  6. Palmer HM, Gilroy CB, Claydon EJ, Taylor-Robinson D: Detection of Mycoplasma genitalium in the genitourinary tract of women by the polymerase chain reaction. Int J STD AIDS 1991, 2:261–263.

    CAS  PubMed  Google Scholar 

  7. Jensen JS: Mycoplasma genitalium: the aetiological agent of urethritis and other sexually transmitted diseases. J Eur Acad Dermatol Venereol 2004, 18:1–11.

    Article  PubMed  Google Scholar 

  8. • Totten PA, Taylor-Robinson D, Jensen JS: Genital mycoplasmas. In Sexually Transmitted Diseases, edn 4. Edited by Holmes KK, Sparling PF, Stamm WE, et al. New York: McGraw Hill Medical; 2008:709–736. This book chapter provides a comprehensive summary of the pathogenesis, biology, and epidemiology of M. genitalium.

    Google Scholar 

  9. Aral SO, Holmes KK: The epidemiology of STIs and their social and behavioral determinants: industrialized and developing countries. In Sexually Transmitted Diseases. Edited by Holmes KK, Sparling PF, Stamm WE, et al. New York: McGraw Hill Medical; 2008:53–92.

    Google Scholar 

  10. Andersen B, Sokolowski I, Ostergaard L, et al.: Mycoplasma genitalium: prevalence and behavioural risk factors in the general population. Sex Transm Infect 2007, 83:237–241.

    Article  PubMed  Google Scholar 

  11. Manhart LE, Critchlow CW, Holmes KK, et al.: Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis 2003, 187:650–657.

    Article  PubMed  Google Scholar 

  12. Hamasuna R, Imai H, Tsukino H, et al.: Prevalence of Mycoplasma genitalium among female students in vocational schools in Japan. Sex Transm Infect 2008, 84:303–305.

    Article  CAS  PubMed  Google Scholar 

  13. Huppert JS, Mortensen JE, Reed JL, et al.: Mycoplasma genitalium detected by transcription-mediated amplification is associated with Chlamydia trachomatis in adolescent women. Sex Transm Dis 2008, 35:250–254.

    Article  PubMed  Google Scholar 

  14. Pepin J, Labbe AC, Khonde N, et al.: Mycoplasma genitalium: an organism commonly associated with cervicitis among west African sex workers. Sex Transm Infect 2005, 81:67–72.

    Article  CAS  PubMed  Google Scholar 

  15. • Tosh AK, Van Der Pol B, Fortenberry JD, et al.: Mycoplasma genitalium among adolescent women and their partners. J Adolesc Health 2007, 40:412–417. This longitudinal study followed 117 adolescent girls and their male sex partners and assessed the proportion of partnerships with concordant M. genitalium infection status. M. genitalium was detected significantly more often in male partners of M. genitalium–positive women than in the male partners of women without M. genitalium infection. M. genitalium was also rarely detected in sexually naïve girls (only 1 of 65).

    Article  PubMed  Google Scholar 

  16. Soni S, Alexander S, Verlander N, et al.: The prevalence of urethral and rectal Mycoplasma genitalium and its associations in men who have sex with men attending a genitourinary medicine clinic. Sex Transm Infect 2010, 86:21–24.

    Article  CAS  PubMed  Google Scholar 

  17. Golden MR, Schillinger JA, Markowitz L, St Louis ME: Duration of untreated genital infections with Chlamydia trachomatis: a review of the literature. Sex Transm Dis 2000, 27:329–237.

    Article  CAS  PubMed  Google Scholar 

  18. Ramsey KH, Cotter TW, Salyer RD, et al.: Prior genital tract infection with a murine or human biovar of Chlamydia trachomatis protects mice against heterotypic challenge infection. Infect Immun 1999, 67:3019–3025.

    CAS  PubMed  Google Scholar 

  19. • Manhart LE, Holmes KK, Hughes JP, et al.: Mycoplasma genitalium among young adults in the United States: an emerging sexually transmitted infection. Am J Public Health 2007, 97:1118–1125. This nationally representative population-based survey tested sexually active and sexually naïve young adults for M. genitalium infection. Young adults who had reported ever engaging in vaginal sexual intercourse were significantly more likely to be infected with M. genitalium than those who reported never engaging in this. The few individuals who had never engaged in vaginal intercourse and who were M. genitalium positive reported either exclusive male same-sex behavior or were missing data on other types of sexual activity that could have resulted in sexual exposure to M. genitalium, strongly suggesting sexual transmission.

    Article  PubMed  Google Scholar 

  20. Warner L, Clay-Warner J, Boles J, Williamson J: Assessing condom use practices. Implications for evaluating method and user effectiveness. Sex Transm Dis 1998, 25:273–277.

    Article  CAS  PubMed  Google Scholar 

  21. de Visser RO, Smith AM: When always isn’t enough: implications of the late application of condoms for the validity and reliability of self-reported condom use. AIDS Care 2000, 12:221–224.

    Article  PubMed  Google Scholar 

  22. Zenilman JM, Weisman CS, Rompalo AM, et al.: Condom use to prevent incident STDs: the validity of self-reported condom use. Sex Transm Dis 1995, 22:15–21.

    Article  CAS  PubMed  Google Scholar 

  23. Bai H, Bo N, Huan L, Dong JZ: Prevalence of genital Chlamydia trachomatis infection in selected populations in China. Sex Transm Dis 1995, 22:383–384.

    Article  CAS  PubMed  Google Scholar 

  24. Winer RL, Feng Q, Hughes JP, et al.: Risk of female human papillomavirus acquisition associated with first male sex partner. J Infect Dis 2008, 197:279–282.

    Article  PubMed  Google Scholar 

  25. Gabridge MG, Taylor-Robinson D: Interaction of Mycoplasma pneumoniae with human lung fibroblasts: role of receptor sites. Infect Immun 1979, 25:455–459.

    CAS  PubMed  Google Scholar 

  26. Gourlay RN, Wyld SG, Leach RH: Mycoplasma alvi, a new species from bovine intestinal and urogenital tracts. Int J Syst Bacteriol 1977, 27:86–96.

    Article  Google Scholar 

  27. Gourlay RN, Wyld SG, Leach RH: Mycoplasma sualvi, a new species from the intestinal and urogenital tracts of pigs. Int J Syst Bacteriol 1978, 28:289–292.

    Article  Google Scholar 

  28. Bradshaw CS, Fairley CK, Lister NA, et al.: Mycoplasma genitalium in men who have sex with men at male-only saunas. Sex Transm Infect 2009, 85:432–435.

    Article  CAS  PubMed  Google Scholar 

  29. Francis SC, Kent CK, Klausner JD, et al.: Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005–2006. Sex Transm Dis 2008, 35:797–800.

    Article  PubMed  Google Scholar 

  30. Deguchi T, Yasuda M, Yokoi S, et al.: Failure to detect Mycoplasma genitalium in the pharynges of female sex workers in Japan. J Infect Chemother 2009, 15:410–413.

    Article  PubMed  Google Scholar 

  31. Lycke E, Lowhagen GB, Hallhagen G, et al.: The risk of transmission of genital Chlamydia trachomatis infection is less than that of genital Neisseria gonorrhoeae infection. Sex Transm Dis 1980, 7:6–10.

    Article  CAS  PubMed  Google Scholar 

  32. Quinn TC, Gaydos C, Shepherd M, et al.: Epidemiologic and microbiologic correlates of Chlamydia trachomatis infection in sexual partnerships. JAMA 1996, 276:1737–1742.

    Article  CAS  PubMed  Google Scholar 

  33. Viscidi RP, Bobo L, Hook EW 3rd, Quinn TC: Transmission of Chlamydia trachomatis among sex partners assessed by polymerase chain reaction. J Infect Dis 1993, 168:488–492.

    CAS  PubMed  Google Scholar 

  34. Worm AM, Petersen CS: Transmission of chlamydial infections to sexual partners. Genitourin Med 1987, 63:19–21.

    CAS  PubMed  Google Scholar 

  35. Lin JS, Donegan SP, Heeren TC, et al.: Transmission of Chlamydia trachomatis and Neisseria gonorrhoeae among men with urethritis and their female sex partners. J Infect Dis 1998, 178:1707–1712.

    Article  CAS  PubMed  Google Scholar 

  36. Thin RN, Rendell P, Wadsworth J: How often are gonorrhoea and genital yeast infection sexually transmitted? Br J Vener Dis 1979, 55:278–280.

    CAS  PubMed  Google Scholar 

  37. Anagrius C, Lore B, Jensen JS: Mycoplasma genitalium: prevalence, clinical significance, and transmission. Sex Transm Infect 2005, 81:458–462.

    Article  CAS  PubMed  Google Scholar 

  38. Falk L, Fredlund H, Jensen JS: Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis. Sex Transm Infect 2004, 80:289–293.

    Article  CAS  PubMed  Google Scholar 

  39. Falk L, Fredlund H, Jensen JS: Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection. Sex Transm Infect 2005, 81:73–8.

    Article  CAS  PubMed  Google Scholar 

  40. Keane FE, Thomas BJ, Gilroy CB, et al.: The association of Chlamydia trachomatis and Mycoplasma genitalium with non-gonococcal urethritis: observations on heterosexual men and their female partners. Int J STD AIDS 2000, 11:435–439.

    Article  CAS  PubMed  Google Scholar 

  41. Keane FE, Thomas BJ, Gilroy CB, et al.: The association of Mycoplasma hominis, Ureaplasma urealyticum and Mycoplasma genitalium with bacterial vaginosis: observations on heterosexual women and their male partners. Int J STD AIDS 2000, 11:356–360.

    Article  CAS  PubMed  Google Scholar 

  42. Hesse S, Low N, Molokwu B, et al.: Molecular typing as an epidemiological tool in the study of sexual networks. Lancet 1995, 346:976–977.

    Article  CAS  PubMed  Google Scholar 

  43. •• Hjorth SV, Bjornelius E, Lidbrink P, et al.: Sequence-based typing of Mycoplasma genitalium reveals sexual transmission. J Clin Microbiol 2006, 44:2078–2083. This molecular epidemiology study performed sequenced-based strain typing of 19 couples from nine countries who were concordantly infected with M. genitalium. In all cases (100%), both members of the couple had the same strain, providing the strongest level of evidence of sexual transmission.

    Article  PubMed  Google Scholar 

  44. •• Ma L, Taylor S, Jensen JS, et al.: Short tandem repeat sequences in the Mycoplasma genitalium genome and their use in a multilocus genotyping system. BMC Microbiol 2008, 8:130. This report describes the development of a multi-locus genotyping system. This system was used to test 31 couples concordantly infected with M. genitalium along with 74 unrelated pairs of infected individuals, both sets from the United States and Scandinavia. In concordantly infected couples, the M. genitalium genotype was identical in 87.1%, whereas only 5.4% of unrelated pairs of patients had concordant genotypes. This provides the strongest level of evidence of sexual transmission.

    Article  CAS  PubMed  Google Scholar 

  45. • Musatovova O, Baseman JB: Analysis identifying common and distinct sequences among Texas clinical strains of Mycoplasma genitalium. J Clin Microbiol 2009, 47:1469–1475. Using a DNA-based typing system, 4 of 4 (100%) of concordantly infected couples had the same sequence type, supporting the hypothesis of sexual transmission of M. genitalium.

    Article  CAS  PubMed  Google Scholar 

  46. Totten PA, Schwartz MA, Sjostrom KE, et al.: Association of Mycoplasma genitalium with nongonococcal urethritis in heterosexual men. J Infect Dis 2001, 183:269–276.

    Article  CAS  PubMed  Google Scholar 

  47. Falk L, Fredlund H, Jensen JS: Tetracycline treatment does not eradicate Mycoplasma genitalium. Sex Transm Infect 2003, 79:318–319.

    Article  CAS  PubMed  Google Scholar 

  48. Bradshaw CS, Jensen JS, Tabrizi SN, et al.: Azithromycin failure in Mycoplasma genitalium urethritis. Emerg Infect Dis 2006, 12:1149–1152.

    CAS  PubMed  Google Scholar 

Download references

Disclosure

Portions of this work were supported by the National Institutes of Health (NIAID U19 AI31448 and NIAID R01 AI072728). Dr. Manhart has received donated study drugs from Pfizer, Inc. No other potential conflict of interest relevant to this article was reported.

Author information

Affiliations

  1. Department of Epidemiology, Center for AIDS and STD, University of Washington, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104-2499, USA

    Lisa E. Manhart & Noa Kay

Authors
  1. Lisa E. Manhart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Noa Kay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa E. Manhart.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Manhart, L.E., Kay, N. Mycoplasma genitalium: Is It a Sexually Transmitted Pathogen?. Curr Infect Dis Rep 12, 306–313 (2010). https://doi.org/10.1007/s11908-010-0114-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-010-0114-3

Keywords

  • Mycoplasma genitalium
  • Sexual transmission
  • Review
  • Epidemiology