Doctors urge more research into little-known STI linked to infertility in men and women

[Leroy N. Soetoro]

https://www.nbcnews.com/health/sexual-health/doctors-sti-mgen-infertility-
men-women-rcna48824

Doctors are urging more research into a little-known sexually transmitted
infection that may be more common than thought.

Scientists have known for decades about mycoplasma genitalium, or M.
genitalium or M. gen., a sexually-transmitted infection that may cause
genital pain, bleeding and swelling, and has been linked to infertility
and miscarriage. However, it wasn't until 2019 that the first Food and
Drug Administration-approved test for M. gen. became commercially
available. Many cases may be going undiagnosed and untreated, doctors
warn.

“It’s a real concern,” said Dr. Irene Stafford, associate professor of
maternal-fetal medicine at McGovern Medical School at UTHealth Houston.
“Why are we not looking into this?”

Stafford called for more research and testing for the bacterial infection
Tuesday during the Centers for Disease Control and Prevention conference
for prevention of sexually transmitted diseases, where CDC officials
warned about an “out of control” rise in STDs.

Similar to chlamydia and gonorrhea, M. gen. is sometimes asymptomatic, but
it may lead to severe complications in both men and women. In men it can
cause urethritis, a swelling and irritation of the urethra. In women, M.
gen. is associated with cervical swelling, pelvic inflammatory disease,
miscarriage, preterm birth, and infertility. In May, a large study
published in the journal Sexually Transmitted Infection found the risk of
preterm birth increased nearly twofold among women with M. gen.

However, more research is needed to determine the longterm risks from M.
gen infection, experts said.

What are symptoms?
Because testing is relatively new, doctors don't have to report diagnosed
cases, and the CDC doesn't recommend routine screening, it’s not clear how
prevalent the STI is or who is most at risk. A patient is typically
screened for it only if symptoms persist after testing negative for other
STIs.

“We learn more about the epidemiology of sexually transmitted infections
when we have better testing methods, said Erik Munson, an assistant
professor of medical laboratory science at Marquette University in
Milwaukee.

Symptoms can include:

Pain and discomfort while urinating.
Abnormal discharge for both men and women.
Women might also experience pain in the lower abdomen and bleeding after
sex.
As many as 20% of sexually active women and 16.5% of men between the ages
of 15 to 24 may be infected with M. gen., according to Lisa Manhart, a
professor of epidemiology at the University of Washington School of Public
Health.

In comparison, chlamydia, the most commonly reported STI in the U.S.,
ranges from 4% to 7% for sexually active young women, depending on
location and risk factors.

Given its association with pregnancy complications, Stafford believes
that high-risk pregnant women should be screened for M. gen. But screening
programs can be expensive, especially without more research on risks
available to justify the costs.

“We have really good studies showing if we screen and treat chlamydia and
gonorrhea, we can actually prevent infertility and PID [pelvic
inflammatory disease],” Manhart said “We don’t have that kind of evidence
for M. genitalium.”

Superbug worries
The calls for more research have an urgency — the bug has developed
resistance to the most common antibiotic used to treat STIs, azithromycin,
or the “Z-Pack,” according to the CDC.

Another antibiotic, moxifloxacin, is effective but can cause serious side
effects, making it an especially risky choice for pregnant women. Plus,
the more moxifloxacin exposure M. gen. has, the more likely it is to
become resistant to that antibiotic, too, experts caution. Beyond
moxifloxacin, there are very few treatments for the infection.

“M. genitalium has quickly developed resistance to every antibiotic that’s
been used to treat it,” Manhart said. “We already have untreatable
infections.”

While these instances are rare, some worry that M. gen is on its way to
becoming a completely resistant superbug. Until scientists find new
treatments for the STI, public health experts are approaching its
treatment with caution.

For now, the CDC says the best strategy for treating M. gen involves
testing for antibiotic resistance before deciding which drugs to use.
Those tests aren’t FDA approved, however.

“The CDC is putting major stock in resistance testing, and right now it’s
not readily available,” Munson said.

Only a few specialized research centers can test whether the infection is
resistant to an antibiotic. While companies are working on widely
available versions, they could be years away, as well as new or repurposed
antibiotics effective against the stubborn bug, Munson said.

Experts hope more public awareness of the STI could give a much needed
boost to research efforts.

“Because the implications of untreated M. gen. on fertility and sexual
health is real,” Stafford said.


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