Experts warn that a little-known sexually-transmitted infection could become an untreatable superbug because doctors are mistaking it for Chlamydia. Even in Nigeria, experts say it can cause infertility in women, reports Sade Oguntola.
Scientists have warned that Mycoplasma genitalium (MG), a rare sexually transmitted infection (STI), that can make women infertile may turn out the next superbug.
Hundreds of thousands of people might not know they have Mycoplasma Genitalium. It’s been around since the 1980s, but a new study has finally found a link between the bacteria and infertility even in Nigeria.
In a study, researchers found the M. genitalium to be commoner in women with infertility. They had accessed the extent of involvement of M. genitalium in the cause and course of infertility among 402 women (267 infertile and 135 fertile) that were referred to two hospitals in Ibadan between March and November 2015.
The 2017 study published in the International Journal of Reproductive Biomedicine was entitled “The prevalence of, and risk factors for, Mycoplasma genitalium infection among infertile women in Ibadan: A cross-sectional study.”
It involved Dr Tinuade Adesola Ajani; Dr Timothy Olusesan Oluwasola and Professor Rasheed Ajani Bakare from the University College Hospital (UCH), Ibadan in collaboration with Dr Mustapha Ajani at the Babcock University, Ilishan-Remo, Ogun State.
It found that M. genitalium infection was commoner in women with infertility than those without infertility. It was 16.1 per cent among patients with infertility and 2.2 per cent among women without infertility.
There was a slightly higher prevalence of M. genitalium among those with secondary infertility 27 (17.3 per cent) as against 16 (14.4 per cent) of those with primary infertility although the difference is not statistically significant.
“The germ has been around, but we did not pay much attention to it, even when people are being managed for infertility. It is often not considered because to make a culture of it is difficult. That was one of the reasons why we decided to do that study to establish the fact that the organism is related to infertility,” said Dr Oluwasola, a consultant obstetric and gynaecologist, UCH, Ibadan.
Dr Oluwasola declared that women with more than one-lifetime sexual partner, that drink alcohol, whose husbands have other sexual partners, that are serial monogamists and within the low socio-economic status stand a higher chance of contracting the germ.
“Women whose husbands have other sexual partners are 13 times at risk of contracting the germ; that is the strongest association that we saw with this sexually transmissible infection,” he added.
Women who have more than one lifetime sexual partner are 10 times at risk of the infection. In addition, being a serial monogamist increases the risk by six times and those with low socioeconomic status have tripled the risk of infection.
The increase in the probability of acquisition of infection among participants whose husbands have other sexual partners was likely driven by its association with sexual activity.
Mycoplasma genitalium is a bacterium that can cause inflammation of the urethra in men, causing watery discharge from the penis and making it painful to urinate.
In women, it can cause inflammation of the reproductive organs (womb and fallopian tubes) too, causing pain and possibly a fever and some bleeding during and after sex.
In men, it can cause watery discharge or pain and burning when passing urine. But 90 per cent of men and more than half of women will have no symptoms at all.
It is more common in people of non-white ethnicity, smokers, and those with a greater number of sexual partners. It is often present at the same time as other infections such as Chlamydia.
Rates are higher in young people of both sexes, and in older age groups of men. M. genitalium does not always cause symptoms and will not always need treatment, but it can be missed or mistaken for a different sexually transmitted infection, such as Chlamydia.
As most people are unaware of the infection, the true complication rate is not known. But M. genitalium infection can cause pelvic inflammatory disease, which can leave some women ultimately infertile.
Its’ most serious complications include premature birth, miscarriage and stillbirth. But it can also complicate and increase the severity of the symptoms of HIV and other viral infections.
According to Dr Oluwasola, infertility as a result of the infection could occur when the organism persists in the body, causing damage to the woman’s fallopian tube.
He declared that whether a woman’s infertility problem will be reversed after treatment is dependent on the extent of the damage it might have caused in the woman’s body.
“The infertility is a consequence of that infection. So that is why we cannot say that automatically the infertility will be reversed. But its treatment may be able to improve the chances of getting pregnant. When other interventions are carried out, over time, they may be able to conceive,” he stated.
1. genitalium infection can be treated with antibiotics, but data suggest that some commonly used antibiotics used to treat the problem are already not working. Certain strains of bacteria had mutated so antibiotics are no longer able to kill them.
The global resistance of M. genitalium to the most widely used antibiotic, azithromycin, has reached from 30 to 100 per cent. With only doxycycline (which is effective in just 30 to 40 per cent of cases) pristinamycin and minocycline left as alternative treatments for M. genitalium, it is understandable that British Association of Sexual Health and HIV (BASHH) has concerns for the future.
BASHH’s first official guidelines on the management of M. genitalium guidelines now recommend that M. genitalium is treated with a seven-day course of the antibiotic doxycycline, followed by a course of azithromycin.
For now, there is no routine test for M. genitalium, but Dr Oluwasola said the infection can be diagnosed using the conventional Polymerase chain reaction (PCR) machine.
He said, “Its routine screening should be incorporated into the current protocol for microbiological evaluation of infertile women.”
Also, he recommends that individuals with symptoms of a sexually transmitted infection (STI) visit the hospital to ensure they are properly treated.
“Everyone can protect themselves from STIs by consistently and correctly using condoms with new and casual partners during sex, including anal and oral sex,” he declared.
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