Mycoplasm--new STD on the block

[+ keroscenefire]

Doctors are concerned about a newly emerging STD with some antibiotic resistance. Mycoplasm genitialium (called MG) is a disease caused by bacteria that lack a cell wall, which already means many antibiotics like penicillin are ineffective against the disease. MG can cause painful urethritis.

Most doctors don't test for MG unless other tests come back negative and the patient continues to have symptoms (pain in the urethra and a watery discharge, though many men are asymptomatic). Many common antibiotics that work for gonorrhea or chlamydia do not work for MG. There is some evidence of antibiotic resistance against MG as well.

The main takeaway is that MG is out there and if you experience symptoms that don't go away after initial treatments, you may want to have your doctor test for MG as well. Fortunately, there are still antibiotic treatments and the MG should be treatable for most people.

Edited September 27, 2022 by keroscenefire
Removed mention of PID, which men do not get.

[Guest]

13 hours ago, keroscenefire said:

... if left untreated can cause pelvic inflammatory disease, which can lead to infertility. 

Most doctors don't test for MG ...

Unfortunately, I don't think there's a commercially available test for this (someone correct me if I'm wrong). Fortunately, men don't have to worry about getting PID. 

[+ keroscenefire]

6 hours ago, Unicorn said:

Unfortunately, I don't think there's a commercially available test for this (someone correct me if I'm wrong). Fortunately, men don't have to worry about getting PID. 

You can get a nucleic acid amplification test, but yes typically it is only done if they rule out other causes of symptoms. And you are right about PID. 

[+ nycman]

13 hours ago, Unicorn said:

Unfortunately, I don't think there's a commercially available test for this (someone correct me if I'm wrong). Fortunately, men don't have to worry about getting PID. 

There is. Typically they can even run it off the same swab or urine sample 
that you send for GC/Chlamydia. It’s statistically more common than GC 
and less common than Chlamydia. I’m not sure I understand the logic in 
waiting for test results or a treatment failure of the other two before testing 
for mycoplasma, but I’m not the CDC.

[josh282282]

Hi all

(Primary care physician here)

 Plz dont let the article mislead you. Mycoplasma is most certainly not a new STI (its Sexually Transmitted Infections now, not STDs). I've know about mycoplasma for many years.  Unfortunately,  and till more  recently,  testing for mycoplasma was harder. But I've been using a urine test for my patients for mycoplasma for a handful of years now, so testing has definitely been available for some time. It's just some doctors dont keep up with the medical literature. (Unicorn: I most certainly dont mean you as I respect you & your fund of knowledge greatly. If I recall correctly,  you did hospital medicine before you retired so this is not your field so I would not expect you to know these details.  It's out patient primary care doctors who serve gay men who most certainly should know).

But let's be more thorough. Many sexually active gay men SAY they get tested regularly for STIs but in my professional opinion,  they are sadly mistaken.  A FULL battery of STIs has ALL of the below tests.  And yes these tests are commercially available. 

1) urine testing for gonorrhea,  chlamydia,  trichomoniasis (are you aware of this fun STI & getting tested for it, right?), ureaplasma (another lesser known STI but still plenty common), and todays topic, Mycoplasma. 

2) blood work to test for syphilis (an RPR) and HIV. 

3) A swab of your throat and anus for gonorrhea & chlamydia.

So, YES, if you have not had your throat/anus swabbed then NO, you are NOT STI tested. Wait, you say your doctor/clinic doesn't do swabs? Get a new doctor because a full battery of STI tests includes swabs of your anus & throat. And testing includes mycoplasma & ureaplasma testing, too.   Unfortunately there are too many doctors who say they serve the Gay community but arent up to date. Please request good care.  

Many of us on this forum are quite sexually active (good for us!!!) & getting a full battery of STI testing every 3 months, yes, every 3 months is important for good genital health.  As a physician who treats many gay men in a large city on the east Coast, I test my gay patients oh-so-frequently and treat STIs all week long.  

Treatment per the CDC which I use for mycoplasma is:

If M. genitalium is detected by an FDA-cleared NAAT: Doxycycline 100 mg orally 2 times/day for 7 days, followed by moxifloxacin 400 mg orally once daily for 7 days

 

 

Much love to all,

Josh 

 

PS.  I use Labcorp,  not Quest so I'm unsure what Quest offers. I think if I recall correctly I first heard of the mycoplasma/ureaplasma tests in 2018, but I could be off by a year. 

 

Edited September 28, 2022 by josh282282
Clarification

[Guest]

No, I did outpatient medicine. As of when I retired almost 2 years ago, we were told there were no commercially available tests for ureaplasma or mycoplasma. I also have not heard of them discussed at any CME courses I've attended or taken online, which I've continued to take. What I can recall from lectures is if symptoms persist, treat empirically with doxy for 2 weeks. So I've learned something new here. If I ever go back and volunteer, I'll ask the lab of where I'm working if they can test for mycoplasma urethritis. I'm surprised to learn that testing is available in commercial labs. I've never seen in ordered by anyone anywhere, including by urologists who've been referred patients for persistent symptoms of urethritis. I took this opportunity to look at STD panels from a number of labs around here, such as Quest, and haven't seen it offered. Also, the CDC doesn't mention it in their usual testing recommendations:

https://www.cdc.gov/std/prevention/screeningreccs.htm

They do mention that Mycoplasma genitalium testing by NAAT is a possibility:

https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm

I'm curious as to which lab you use that offers such testing...

It looks as though the FDA first approved of this testing in early 2019, so maybe the events of 2020 preventing the dissemination of that information?

https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-test-aid-diagnosis-sexually-transmitted-infection-known-mycoplasma

 

Edited September 28, 2022 by Unicorn

[Lewis H]

For us lay people, how does one get this? If it's in the penis, Do you have to be the recipient of oral sex, or can you get it?