The British Association for Sexual Health and HIV (BASHH) have released new draft guidelines on Mycoplasma genitalium. Due to emerging resistance, they have raised concerns that it could become the next super-bug, in the same vein as the recent super strain of gonorrhoea.

What is Mycoplasma genitalium?

To summarise, it is a bacteria that can cause genital infections in men and women. It is not specifically categorised as an STI, but it is transmitted via sexual contact; and whilst it is lesser known compared to other STIs, it is thought to be one of the main causes of non-gonococcal urethritis (NGU).

It can sometimes present symptoms similar to that of chlamydia or gonorrhoea, although it can also be asymptomatic in many cases, especially for women. Around one in a hundred people are thought to be carrying Mycoplasma, and the president of BASHH was reported as saying that up to 3,000 women in the UK could develop fertility problems over the next decade, due to having pelvic inflammatory disease caused by the bacteria.

What are the symptoms and why is it dangerous?

When it does present symptoms, these include pain during sex or urination and a watery discharge from the penis or vagina. Women can also feel pain in the pelvic area. Mycoplasma is the smallest bacterium known to man and often difficult to identify as it grows very slowly (over weeks or even months). This means that choosing appropriate antibiotics for it is more challenging. Furthermore, BASHH has reported that Mycoplasma has developed a resistance to some antibiotics.

Because of this, BASHH has recommended that testing for Mycoplasma should be undertaken for people with non-gonococcal urethritis and women with pelvic inflammatory disease symptoms. However, they also say that there is insufficient data to recommend routine screening for the bacteria where there are no symptoms.

How is it diagnosed and treated?

Currently, Mycoplasma can only be diagnosed with a nucleic acid amplification test (NAAT) which detects the presence of the bacteria in a clinical specimen (such as urine or a swab).

In terms of treatment, there are several schools of thought on what is the best option but there is no universal approach to treating Mycoplasma. The new BASHH draft guidelines, published yesterday, recommend two different courses of treatment.

  • For uncomplicated infections, they recommend doxycycline followed by azithromycin as the preferred option.
  • For complicated infections, they recommend moxifloxacin.

This should be followed by a test of cure to ensure that the infection has gone.

Despite the potential of Mycoplasma to develop into a serious infection, it is not available for testing in all clinics yet. This is why the report has recommended that testing be more widespread throughout the country with a more extensive sexual health screening process. This would also mean that more samples can be collected and a better understanding of the bacteria would be developed to stop the potential spread of the infection.