Mycoplasma genitalium: the next sexually transmitted superbug?

The publication of national treatment guidelines does not usually generate headlines in national newspapers. However, the recent release of draft management guidelines for Mycoplasma genitalium infection was accompanied by high profile media coverage suggesting that it is the next sexually transmitted “superbug.”1 So what are the facts behind these headlines, and how concerned should we be?

First isolated in 1981, M genitalium is the smallest known self replicating bacterium,2 but its natural course of infection and importance for public health remain poorly understood. Most infections are probably asymptomatic and have no adverse health outcomes.34 Nonetheless, evidence that M genitalium is associated with serious genitourinary and reproductive health morbidity is accumulating.

In men, an unequivocal association exists with non-gonococcal urethritis, and it is detected in up to 40% of men with persistent and recurrent urethritis.5 There is some evidence of associations with balanoposthitis6 but no clear association with prostatitis or epididymitis.78 A study among men who have sex …