After I resumed my sex life (before symptoms came back) I had always protected vaginal sex, but I did and received oral sex without condom. My questions are:

1- how dangerous/bad is this disease mycoplasma genitalium? Am I going to be ok?

2- my doctor recommended await for the culture result to check which antibiotics the M.genitalium is more sensitive. Is this a smart move? Is there any standard 100% reliable antibiotic recommendation for the M.genitalium?

3- in practical how probable is that I could have transmitted it by unprotected oral sex while i didn’t know I had it? I’m with guilty conscience because I can’t contact one person I received oral sex. Is it real risk or only theoretical?

4- if it was gonorrhea I knew it was recent for the incubation period, but as it is m.genitalium, does it has a standard incubation period? Do I have to contact any one I eventually had unprotected sex lots of months ago or last years?

Many thanks!

You must be seeing a sophisticated doctor or clinic in regard to STDs. There aren't very many clinics world wide that have testing available for M. genitalium, and those that do probably have lknoweldgeable experts. Your doctor(s) probably could answer these questions as well as I can. Directly to them:

1. Because M gen is relatively newly discovered -- and more important, was almost impossible to diagnose until a few years ago -- research into iits clinical impact, complications, etc is incomplete. From what is known so far, there seem to be few if any complications in men:  urethritis only, no epididymitis reported, no infertility, etc. In women, there are conflicting data on whether M gen causes pelvic inflammatory disease (PID, the most common serious compication of gonorrhea or chlamydia), but it doesn't seem to be common, if it causes PID at all. There are no reports of female infertility with M gen, unlike gonorrhea and chlamydia. For 50 years we have been mostly unaware of M gen and therefore we have been treating undiagnosed infections (e.g., NGU of unknown cause) with drugs now known to not be effective. Yet we know that men with nonchlamydial NGU and their female partners rearely if ever get serious complications. This expernece suggests that M gen probably is mostly a fairly harmless infection. But as I said, more research is needed (and is underway in several research centers). 

2. That your doctor is able not only to test for M genitalium but also learn its antibitotic sensitivities is another indication that you are in the care of a sophisticated expert. Such testing is very smart, something that most STD clinics and doctors cannot do. Moxifloxacin is the most consistently reliable antibiotic against M gen, but if sensitivity testing shows your strain is susceptible to azithromycin or doxycycline, they would be preferred.

3. The few studies yet done suggess that M gen infrequently infects the mouth or throat and therefore infrequently transmitted by oral sex. Again, more research is needed and underway.

4. The incubation period -- the time from acquiring infection to onset of symptoms -- has not yet been studied. Since it is generally 7-14 days for NGU, I would imagine M gen is in that range. However, a high proportion of infected persons (maybe 50% or more or men and even more women) may never develop symptoms; for those persons, the incubation period doesn't mean anything. 

I hope these commnts are helpful. Since your doctor apparently is very knowledgeable about all this, I strongly suggest you ask him or her the same questions. Also give my greetings and convey my respect. You could print out this thread as a framework for discussion; I would be interested to know whether s/he agrees with all this. 

HHH, MD

I think now I’m in good hands after other 3 doctors that could not diagnose what I have. M.genitalium exam was difficult to find here, just few laboratories do it, and without cover from health insurance.

I think it was the first time I was glad to have a positive disease result (because at least finally discovered what it was).

In regards to your interest to know my doctor opinion and outcome, If possible to maintain this thread open for some few days,  I’ll definitely report here final outcome after the culture result is ready and what was the doctor opinion/choice regarding the disease and how to treat it!

Best regards 

So my positive mycoplasma genitalium by PCR didn’t appear in the culture (I read that mg is very difficult to grow culture). Instead it appeared some other bacteria:

Secretion:

Escherichi colli

Semen:

My doctor’s guess is that the sample got contaminated in the laboratory (otherwise I would be felling other symptoms if I indeed had all these bacterias)

It also came back positive culture for fungus candida parapsilosis

Urine culture came back negative.

We decided to treat for the MG (moxifloxacin 400mg/day for 10days) and for the candida (itraconazole 200mg/day 5 days) and then observe what’s going to happen.

Please if possible could you respond to these other questions?

- when you said it is uncommon for mouth contamination due to oral sex, but If contaminated in oral sex, the MG would manifest only in mouth or it would go down for the women reproductive system?

- As I already tried so many antibiotics I’m  very anxious if now with moxifloxacin it will work. Does it is very effective? If it fails is there another option? My doctor couldn’t respond to that, only said if not cured with moxifloxacin it will have to be studied in more details (I suspect he didn’t want to scare me but if it doesn’t work will be very big trouble)

- if moxifloxacin works and I have a negative test 2 weeks after end treatment I’m totally mg free? Or it stays latent in body undetected?

- Does MG cures at its own with time?

Best regards!

All the organisms identifed in your cultures are entirely normal. I agree with your doctor that all probably are contaminants, although probably not in the laboratory. They're just normal bacteria in and around your genital tract. In the absence of symptoms and/or evidence of urinary tract inflammation, they mean nothing. (Congratulations on the normal results.)

I agree it is reasonable for you to be treated with moxifloxacin. It is not know whether M. gen is naturally cleared over time, but probaby it is. It probably is usually harmless anyway, so once this treatment is done, you should move on with no further worries. In all honest, if I knew I had it myself, I wouldn't care.

This will have to be your last question on this forum about all this. I hope the discussion had been helpful.