Mycoplasma genitalium is emerging as a relatively new cause of urethritis and cervicitis. Few clinicians are aware of its role in causing pelvic inflammatory disease. Current assays performed by Public Health Ontario utilize a culture method of detection, which is insufficient to detect the presence of mycoplasma genitalium as it is difficult to culture.
Current Canadian guidelines do not recommend testing for mycoplasma genitalium. Testing is only recommended in individuals experiencing persistent symptoms of cervicitis and urethritis after treatment for chlamydia and gonorrhea and having a negative “Test of Cure” (a negative PCR test) after completing treatment.
A first catch urine sample (20-60ml) can be provided at any major laboratory (Life Labs, Dynacare) with the appropriate paperwork. This is sent first to Public Health for review and then to Winnipeg’s National Microbiology Lab. Many lab technicians are unfamiliar with this test, and might tell you to obtain a swab. We've confirmed with The National Microbiology Lab that urine samples are sufficient provided they're 1st catch (initial part of the urine stream). Ideally, wait 2 hours from your last void to provide the sample.
Currently, the lab performs PCR testing using the assay Anyplex II STI-7. The assay detects for the presence of the following organisms: Mycoplasma Homonis (MH), Mycoplasma Genitalis (MG), Ureaplasma Urealyticum (UU) and Ureaplasma Pervum (UP).
Typically lab results take 14 days for turn-around time and you will be provided with a copy of the report from the National Microbiology Lab. If you are positive, treatment should follows guideline recommendations.
Initial treatment for mycoplasma genitalium is azithromycin. Due to rising rates of resistance, treatment failure can occur (an estimated cure rate of 65-75%). In these scenarios, 2nd line treatment can be completed per CDC guidelines - doxycycline 100mg twice daily for 7 days followed by moxifloxacin 400mg daily for 7 days.
You should not be tested if you do not have symptoms. Treatment with antibiotics can result in a number of serious side effects, including clostridium difficile infection which can be very dangerous. Antibiotics, in particular, fluoroquinolones like moxifloxacin can have a number of other side effects including headaches, dizziness and effects on your heart’s electrical rhythm (QT interval).