Mycoplasma Infections

Men feel a mild burning sensation in their urethra (the tube that runs through the penis and drains urine from the bladder out of the body) during urination and may have a clear or cloudy discharge from the penis. There may be only a small amount of discharge, and symptoms may be mild. However, early in the morning, the opening of the penis is often red and blocked by dried secretions. Occasionally, symptoms are more severe, and men may have a frequent urge to urinate, pain when urinating, and a discharge of pus from the penis.

Women with infection of the cervix (the lower part of the uterus that protrudes into the upper part of the vagina) may have few or no symptoms. But some have frequent urges to urinate, pelvic pain, pain when urinating, and a discharge of yellow pus from the vagina or the urethra. Sexual intercourse may be painful for women.

Mycoplasma can also be spread during oral sex, causing infection of the throat (pharyngitis). Pharyngitis can cause a sore throat. Mycoplasma can also be spread during anal sex, causing rectal pain or tenderness and a yellow discharge of pus and mucus from the rectum.

Complications of Mycoplasma infections

Mycoplasma infections can have serious long-term consequences for women, even when they have no or only mild symptoms.

In women, complications of chlamydia include:

• Scarring of the fallopian tubes

• Infection of the fallopian tubes (salpingitis)

• Infection of the membrane that lines the pelvis and abdominal cavity (peritonitis)

The infection may spread up the reproductive tract and infect the uterus, the tubes that connect the ovaries to the uterus (fallopian tubes), and sometimes the area around the ovaries (see figure Pathway From the Vagina to the Ovaries). In some women, the infection spreads to the lining of the pelvis and abdominal cavity (peritoneum), causing peritonitis. These complications together are called pelvic inflammatory disease (PID) and cause severe lower abdominal pain and sometimes fever.

Potential complications of pelvic inflammatory disease include severe infection throughout the body (sepsis), chronic abdominal pain, and scarring of the fallopian tubes. The scarring can cause infertility and mislocated (ectopic) pregnancies.

Pathway From the Vagina to the Ovaries

In women, some organisms can enter the vagina and infect other reproductive organs. From the vagina, these organisms can enter the cervix and uterus and may reach the fallopian tubes and sometimes the ovaries.

• Usually, nucleic acid amplification testing (NAAT)

• Sometimes screening of sex partners

Doctors suspect mycoplasmal infections based on a person's symptoms, such as a discharge from the penis or vagina, or on risk factors, such as age or high-risk sexual activity.

Doctors do not routinely test or screen for mycoplasmal infections. However, testing is recommended for people who have repeat infections of the urethra, rectum, or cervix and for sex partners of people who have a sexually transmitted infection caused by Mycoplasma. Doctors may test people who have pelvic inflammatory disease for mycoplasmas.

In most cases, doctors diagnose mycoplasmal infections by doing NAAT to detect the bacteria’s unique genetic material, its DNA or RNA (which are nucleic acids). NAAT uses a process that increases the amount of the bacteria's DNA or RNA so that it can be more easily identified. Usually, a swab or sample of the discharge from the penis, cervix, or vagina or, in men, a urine sample is used. A vaginal swab or urine sample can often be collected by people themselves. If a urine sample can be used, men can avoid the discomfort of having a swab inserted into the penis.

If doctors suspect infection of the throat or rectum, samples from those sites are tested.

• Antibiotics

• Simultaneous treatment of sex partners

Mycoplasmal infections are treated first with the antibiotic doxycycline and then with azithromycin or moxifloxacin, which is given after treatment with Mycoplasmal infections are treated first with the antibiotic doxycycline and then with azithromycin or moxifloxacin, which is given after treatment withdoxycycline is finished.

Infected people and their sex partners should abstain from sexual intercourse for at least 1 week after the infected person has completed treatment.

People can do the following to help reduce their risk of mycoplasmal infections and other STIs:

• Practice safer sex, including using a condom every time for oral, anal, or genital sex.

• Reduce the number of sex partners and not have high-risk sex partners (people with many sex partners or who do not practice safer sex).

• Practice mutual monogamy or abstinence.

• Seek prompt diagnosis (for repeat symptoms) and treatment to prevent spread to other people.

• Identify sexual contacts if infected for the purposes of counseling and treatment.

The following English-language resource may be useful. Please note that The Manual is not responsible for the content of this resource.

1. Centers for Disease Control and Prevention (CDC): About Mycoplasma genitalium