NAME: Mycoplasma genitalium
SYNONYM OR CROSS REFERENCE: G37 strain, non-gonococcal urethritis (NGU), non-chlamydial non-gonococcal urethritis (NCNGU), mucopurulent cervicitis (MPC)Footnote 1.
CHARACTERISTICS: M. genitalium is an intracellular urogenital tract gram negative flask shaped bacterium, which belongs to the Mycoplasmataceae family, in the Mollicutes classFootnote 1-Footnote 3. It is the smallest Mollicutes (0.2 µm in diameter), and lacks the genes coding for the cell wall, leading it to a parasitic and saprophytic existenceFootnote 2. Instead of a cell wall, M. genitalium possess a three-layered membrane containing sterol, which is taken up from the environment. M. genitalium uses the UGA codon to code for tryptophan rather than a stop codonFootnote 1. M. genitalium metabolize glucose. This internal pathogen grows better in a foetal calf serum containing medium. On SP4 culture medium, M. genitalium produce colonies with a “fried eggs” appearance after 50 days. Growth is accelerated to 14 days by adding 0.25 mg/ml ciprofloxacin to reduce contamination by other microorganism.
PATHOGENICITY/TOXICITY: M. genitalium is the major cause of NGU and NCNGU in men, with dysuria and/or non-spontaneous dischargeFootnote 1,Footnote 4. MPC is the female equivalent of NGU, characterized by the presence of yellow or green exudates from the cervixFootnote 3. M. genitalium is also suspected to be a cause of pelvic inflammatory disease, which is an inflammation of the feminine upper genital tract, with pelvic pain, abnormal vaginal discharge, itching, bleeding and/or odour. M. genitalium infections may be asymptomatic. M. genitalium may play a minor role in bacterial vaginosis, adverse outcomes of pregnancy, and infertilityFootnote 1. M. genitalium is also known to facilitate HIV transmissionFootnote 5.
EPIDEMIOLOGY: M. genitalium is of worldwide prevalence as it can be found in 1% of adults between 18 and 27 years old and in 7% of women of all agesFootnote 5. For women, multiple sexual partners, miscarriage, smoking, and douching are considered risk factors.
HOST RANGE: Humans are the only known host for M. genitalium, although colonization in other animals is theoretically possibleFootnote 3.
INFECTIOUS DOSE: Unknown.
MODE OF TRANSMISSION: M. genitalium is principally transmitted by sexual contactFootnote 5.
INCUBATION PERIOD: Unknown.
COMMUNICABILITY: Person-to-person transmission occurs primarily through sexual contact, although the transmission rates are lowFootnote 6.
RESERVOIR: Humans; animals may theoretically contain the pathogenFootnote 3.
ZOONOSIS: No zoonotic transmissions have been reported for this pathogen, but it is theoretically possibleFootnote 3.
DRUG SUSCEPTIBILITY: M. genitalium is susceptible to tetracyclines, macrolides, and quinolonesFootnote 7. Azithromycin, fluoroquinolones, and moxifloacin also have high efficacy against infectionFootnote 8.
SUSCEPTIBILITY TO DISINFECTANTS: Phenolic disinfectants, 1% sodium hypochlorite, 70% ethanol, formaldehyde, glutaraldehyde, iodophore, and peracedic acid are effective against M. genitalium Footnote 9.
SURVIVAL OUTSIDE HOST: If protected from evaporation, M. genitalium can survive for one hour in liquid specimenFootnote 14.
SURVEILLANCE: Monitor for symptoms. Infection can be confirmed with ELISA, immunoblots, microbial culture, and PCRFootnote 14, although many methods do not provide the level of sensitivity needed for confident diagnosis. Infections are highly difficult to diagnose because of the tricky cultivation of M. genitalium based on its fastidious nature.
Note: All diagnostic methods are not necessarily available in all countries.
FIRST AID/TREATMENT: Administer appropriate drug therapyFootnote 7. Azithromycin treatment is often well-tolerated by patients and yields good results in eradicating pathogens for nongonococcal urethritisFootnote 15.
IMMUNIZATION: None available.
PROPHYLAXIS: None available.
LABORATORY-ACQUIRED INFECTIONS: None have been reported to date.
SOURCES/SPECIMENS: M. genitalium may be found in semen, urine, prostatic secretion, amniotic fluid, and urogenital tract swabFootnote 16.
PRIMARY HAZARDS: Laboratory workers should avoid accidental parenteral inoculation and ingestionFootnote 14.
SPECIAL HAZARDS: None.
RISK GROUP CLASSIFICATION: Risk Group 2Footnote 17.
CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures.
PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashesFootnote 18.
OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activitiesFootnote 18.
SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean upFootnote 18.
DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism before disposing by autoclave, chemical disinfection, gamma irradiation, or incineration.
STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled.
REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.
UPDATED: November 2010
PREPARED BY: Pathogen regulation directorate, Public Health Agency of Canada.
Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.
Public Health Agency of Canada, 2010