43rd ICAAC
A meeting of the American Society for Microbiology

September 14-17, 2003, Chicago, IL


For more information on any presentation at the 43rd ICAAC contact Jim Sliwa, ASM Office of Communications at jsliwa@asmusa.org



EMBARGOED UNTIL:  Monday, September 15, 9:00 a.m.

(Session 67, Paper 640)

David Martin
LSU Health Sciences Center
New Orleans, LA,
Phone: (504) 568-5031

Mycoplasma genitalium is a newly recognized cause of sexually transmitted disease. It was first isolated from 2 of 13 men with nongonococcal urethritis (NGU – a syndrome in men characterized by burning on urination and a penile discharge) in 1982. Though subsequent attempts to culture the organism from men with NGU in the 1980’s failed because of its fastidious growth requirements, it was clearly demonstrated that the prototype strain caused NGU in chimpanzees. Despite that increasing number of investigators working on the organism very only a few more strains have been isolated to date further attesting to the difficulties of working with the organism. Clinical research did not begin to move forward until the early 1990’s with the development of specific DNA amplification assays. Subsequently numerous studies of NGU in men using PCR assays have been reported from around the globe. These have established a strong association of the organism with this syndrome – it appears to cause 20% to 25% of all cases. Furthermore, based on a few preliminary studies, it appears that M. genitalium is difficult to eradicate from the male urethra with the standard antibiotics used to treat NGU. More specifically it appears that it is resistant to doxycycline which is one of the main drugs recommended in the United States to treat NGU. These findings are relevant to the observation that M. genitalium may cause chronic NGU.

While understanding the role of M. genitalium in male NGU is important, from a public health point of view it is more important to determine if the organism causes upper genital tract disease in women (endometritis, pelvic inflammatory disease, infertility, and ectopic pregnancy) and whether or not it might be a cofactor in HIV transmission as is the case with many of the other sexually transmitted diseases. One study has shown an association between mucopurulent cervicitis in women and M. genitalium using archived specimens from the 1980’s. In another study M. genitalium has been found to be associated with plasma cell endometritis among African women with lower abdominal pain, though the prevalence of the organism in endometrial and/or cervical specimens from cases was relatively low (16%). Serologic studies have suggested a link to female infertility. Though the organism has been identified in the urine of HIV infected males, a study of its effect on genital tract HIV shedding has not been reported. Currently, laboratory diagnosis is dependent upon "home-brew" DNA amplification assays, but recent work at our center with an M. genitalium specific version of Gen-Probe’s transcription mediated amplification assay looks promising. The reagents for this test are available to researchers in the field and will make it much easier to conduct further clinical studies of the roll of this newly discovered pathogen in human disease. In conclusion and to answer the question posed by the session title, a generally available standardized diagnostic assay for M. genitalium is within reach. Considerably more research is needed to determine if there really is a rationale for recommending its widespread application.