Red ribbons for AIDS and Sexual Health Awareness [Image: Sexual Health Buckinghamshire, NHS, United Kingdom]
International news outlets covered the following study carried out at University College London recently, much to my excitement. As a member-at-large of the International Organization for Mycoplasmology Board of Directors and the Secretary General of the United States Organization for Mycoplasmology, I am thrilled to see attention paid to these underdiagnosed but critically important pathogens. The study discussed the prevalence of a sexually transmitted pathogen, Mycoplasma genitalium (“Mge”). Mge has historically been extremely difficult to diagnose, with a small number of experts* serving as reference laboratories for its identification. There is no equivalent of the rapid Strep screen or the molecular gonorrhea test that can yield a quick and accurate diagnosis. This is a very serious concern for three important reasons:
1.) Mycoplasmas, and especially Mge, require specialized antibiotic treatment in order to completely cure a patient. Since many of the symptoms are the same as chlamydia or gonorrhea, it can be difficult for doctors, PAs, and ARNPs to know which infection a patient currently has. This is quite important, since Mge like all mycoplasmas only responds to certain drugs, and the medication needs to be taken for a longer course to eliminate the infection. Failure to eliminate the infections leads to antibiotic resistant strains. Eliminating the infection is critically important when considers point 2, and especially point 3, and caregivers cannot decide on the best course of treatment without a reliable way to diagnose the infection.
2) Mge infection is significantly associated with pelvic inflammatory disease, impaired fertility and adverse pregnancy outcomes. Because of this untreated Mge infection is likely to have long-term consequences on one’s future ability to conceive children, and increases the likelihood of miscarriage or preterm birth should an infected woman become pregnant.
3.) Mge infection has been associated with increased rates of HIV infection. While on the surface this may seem incidental- exposure to one sexually transmitted pathogen indicates that you may have been exposed to multiple- additional research indicated that the relationship between the two organisms was a bit more sophisticated. One study showed that Mge-infected patients showed increased shedding of HIV viral particles. In other words, patients infected with both Mge and HIV were more likely to infect their partners. The bad news didn’t end there, though. Mge-infected individuals were also more likely to become infected with HIV, because the Mge bacteria are very, very good at recruiting HIV’s favorite target cells to the genital tract. Taken together, Mge infection would seem to both make HIV-negative patients more susceptible to infection and HIV-positive patients into “super-spreaders”. The “new STD” is not new, nor is it necessarily more prevalent, but it is getting more attention through improved specialized tests. Finding a rapid, sensitive, and specific way to diagnose this infection should be a priority, and I am hopeful these articles are important step in that direction.
A "valentine" made from M. genitalium cells, courtesy of our friends at the Balish Laboratory
*NOTE: Laboratories featuring worldwide experts in the diagnosis of Mge can be found at the University of Alabama Birmingham, Washington University, Louisiana State University, The Johns Hopkins University, and Statens Serum Institut