Mycoplasma genitalium: The prevalent, highly drug-resistant new STI nobody’s testing for

Nomarski microscopy image of sperm incubated in vitro with Mycoplasma genitalium. Helle Friis Svenstrup/European Society of Human Reproduction and Embryology

Researchers have found the first evidence of sexually transmitted infection Mycoplasma genitalium in Canada. It’s highly prevalent, inordinately drug-resistant, and clinics aren’t testing for it — until recently there was no standardized test available.

Its symptoms are easily mistaken for chlamydia or gonorrhea. But treating Mycoplasma genitalium with antibiotics aimed at other infections just makes things worse, killing weaker bugs and fostering colonies of resilient superbugs.

READ MORE: ‘The war on STIs has failed’

University of Toronto epidemiologist Dionne Gesink co-authored a paper published in Canadian Family Physician earlier this year documenting the first proof the increasingly common STI is proliferating in Canada — in Toronto, specifically.

“Not only is it here, it’s as prevalent as chlamydia,” Gesink said. “It’s probably been here for a long time already, and it’s not been treated.”

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The study tested 1,193 men and women at a Toronto STI clinic. About 4.5 per cent of the men and 3.2 per cent of the women tested positive for Mycoplasma genitalium. That sounds small but it would make this one of the most common STIs out there — more than 10 times the rate of syphilis.

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Safe sex misconceptions: Here are things you should know about STIs

While almost 97 per cent of syphilis cases are among men, Gesink said, Mycoplasma genitalium prevalence is much evenly distributed between genders.

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And a high proportion of the people tested had drug-resistant strains of Mycoplasma genitalium: 58 per cent were resistant to the antibiotic macrolide; 20 per cent were resistant to fluoroquinolone.

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“People that have it are being treated, essentially, inadequately,” Gesink said.

“They’re getting a treatment that’s much lighter and it’s selecting for the most resilient bugs and those bugs repopulate.”

That’s a problem. The more you use second-line treatments, the more quickly those treatments can become ineffective.

“There’s Plan B and Plan C if the original treatment doesn’t work. But you really don’t want to go back down the line like that,” Gesink said.

READ MORE: Common STI misconceptions

Researchers are only beginning to find out what Mycoplasma genitalium does to you if it isn’t effectively treated quickly. They believe it causes pelvic inflammatory disease, infertility and epididymitis (inflammation of a coiled tube that stores and carries sperm).

Inflammation caused by this infection can also increase your risk of contracting HIV: Inflamed tissue is more easily torn or abraded. If you’re infected while pregnant, Gesink said, it can also cause pre-term labour.

And STI clinics aren’t testing for it.

“It’s hard to detect. It’s a sensitive, fragile kind of organism. But inside the body, it’s incredibly resilient,” Gesink said.

But now that she and her fellow researchers have come up with a way to detect Mycoplasma genitalium fairly reliably, Gesink would like to see Ontario and other provinces use that test widely. Otherwise the disease will keep going undetected and un-treated or under-treated.

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“They have the equipment to do it, now, and they have the test,” she said.

“From a public health perspective, yes, I think it’s worth including it as an option.”

READ MORE: Men are driving Ontario’s rising gonorrhea rate

Canadian communities are in the throes of historic STI outbreaks: Ontario’s 15-year syphilis outbreak is now considered “mature”; Alberta officially declared syphilis and gonorrhea outbreaks last month after syphilis infections soared. Syphilis rates among Edmonton men, in particular, quadrupled within a year.

Epidemiologists, clinicians and public health officials are still trying to figure out what exactly is behind the outbreak.

These diseases’ spread could be facilitated by fluid, mobile sexual networks that get more tangled — and tougher to track — thanks to hookup tools that put you in touch with people you might otherwise not find and whom you might not keep in touch with.

It could also be a matter of people being less risk-averse thanks to advances in testing for, treating and preventing STIs.


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