What is genital mycoplasma and should you be tested for it?
If you have been experiencing chronic urinary symptoms, chronic pelvic pain, repeated sexually transmitted infections, or are struggling to conceive, you may want to consider getting tested for a genital mycoplasma infection.
There has been some increased attention in the research lately surrounding small bacteria that may be playing a sneaky role in chronic pelvic/bladder pain, sexually transmitted infections, and even unexplained male and female infertility. Although there are limited recommendations to test for or treat these yet, we are seeing strong patterns of correlation in the literature. Mycoplasma infection may be worth investigating in certain people and should be a bigger part of infertility evaluation and in chronic pelvic/bladder pain.
These organisms are types of bacteria that are in the Mycoplasmataceae family. There are several strains that live in the genital and urinary tract and are collectively referred to as “genital mycoplasma”. Three main species seem to be linked to reproductive issues and are important to test for: mycoplasma hominis, mycoplasma genitalium, and ureaplasma urealyticum. These bacteria are the smallest known bacteria and don’t have any cell-walls, which make them tricky to find and treat. These bacteria have a pointed structure that allow them to stick to cells along the genital and urinary tract. They can also hide from our immune system and go undetected for months or even years, because they can change the type of proteins on their surface.
Genital mycoplasma bacteria can live in our bodies without causing harm or benefit to us, which is known as a “commensal relationship”. The prevalence of these bacteria are not fully understood, but studies have found that these bacteria are present in up to 68% of sexually active women! Although these bacteria are often found in healthy people, they are also present when there are symptoms.
Genital mycoplasmas can be transmitted through sexual activity, and partners of infected people should be tested and treated. However, these bacteria are found in people who are not sexually active, so these cannot be classified as true sexually transmitted infections. Mycoplasma genitalium is a major known cause (10-35%) of non-gonococcal urethritis in men. These bacteria can also co-exist with other known pathogens that cause bacterial vaginosis, pelvic inflammatory disease, and urethritis.
RISK FACTORS FOR GENITAL MYCOPLASMA INFECTIONS INCLUDE:
Young age (less than 25)
Smoking
Nonwhite race
Recent sexual intercourse
Increased number of sexual partners (more than 2 partners within the last year)
SYMPTOMS TO WATCH FOR:
Urinary frequency
Urinary urgency
Pain with urination
Pain with sexual activity
Chronic vaginal discharge with negative vaginitis or UTI tests
Urethral discharge in men
Abnormal vaginal bleeding
Unexplained infertility
LINKS TO MALE AND FEMALE INFERTILITY:
We are seeing these bacteria present more often in infertile men and women compared to fertile men and women:
One review study found that mycoplasma hominis and ureaplasma urealyticum are significantly associated with male infertility.
A 2020 study found that mycoplasma hominis, mycoplasma genitalium, and ureaplasma urealyticum were all higher in infertile women compared to fertile women.
For example, mycoplasma genitalium was found in 12.7% of infertile women, but only in 3% of fertile women!
The same study found that mycoplasma hominis and ureaplasma urealyticum were higher in infertile men compared to fertile men.
For example, ureaplasma urealyticum was found in 21.1% of infertile men, but only in 3% of fertile men!
Another 2020 review study looked at infertility and negative pregnancy outcomes and found that mycoplasma genitalium was a significant risk factor for infertility and preterm birth. Mycoplasma hominis was significantly associated with infertility and premature rupture of membranes (PROM).
LINKS TO CHRONIC PELVIC PAIN, PAINFUL BLADDER, AND INTERSTITIAL CYSTITIS:
Clinical research around these conditions and genital mycoplasma infection are limited, but a correlation is present. It is difficult to determine causation without more clinical trials, but increased amounts of the genital mycoplasma bacteria are found in patients with chronic pelvic pain conditions.
A study examined women with chronic urinary symptoms and found that 48% of women had mycoplasma hominis and ureaplasma urealyticum on their culture. When the women were treated with antibiotics, there was a statistically significant reduction in pain level and urinary frequency.
Another study found that chronic bladder pain in women was reduced with the use of doxycycline, even though no pathogens were found on standard testing. Doxycycline is one of the standard treatment options for genital mycoplasma infections, so more research is needed to better determine the role these bacteria play in chronic bladder pain.
HOW TO TEST FOR GENITAL MYCOPLASMA:
Although testing for genital mycoplasma requires a specific kind of test, the testing options are much less invasive and cost less than other tests for chronic pelvic/bladder pain and infertility.
Vaginal, endocervical, or urethral swab with polymerase chain reaction (PCR) DNA analysis
Vaginal, endocervical, or urethral swab with nucleic acid amplification test (NAAT)
Urine culture (using first morning void)
HOW TO TREAT GENITAL MYCOPLASMA INFECTIONS:
Because these bacteria can be a normal finding, the decision to treat when presence of bacteria is discovered should be determined with shared decision making between you and your doctor.
Many antibiotics target the cell wall in bacteria, but mycoplasma species don’t have a cell-wall, so antibiotic choices are more limited.
The bacteria often are resistant to antibiotic treatment, so testing the specific bacteria for antibiotic resistance before starting treatment may also increase treatment efficacy.
Testing for cure should also be included to make sure the bacteria have been eradicated
Examples of antibiotics used may include tetracyclines, flouroquinolones, and macrolides
Don’t forget to treat any sexual partners with the same antibiotic course.
If you have been experiencing pelvic or urinary tract symptoms or are struggling to conceive, consider asking your doctor about testing for a mycoplasma infection for you and your partner. The research is still emerging in this area, and my goal is to help educate my patients about these sneaky bacteria who may have been flying under the radar for too long.
If you are interested in learning more or talking with me about testing and treatment options, let’s work together! Schedule an appointment here.