Mycoplasma Genitalium refers to a sexually transmitted disease (STD) that is caused by a pathogenic bacteria of the same name. It affects both men and women. These organisms live in the urinary and genital tracts of humans and attach themselves to the surface of the genital tract and attack the tissue of the host. Though the presence of Mycoplasma genitalium was known 30 years ago, it has been recently identified as STD and extensive research is being carried out to establish the connection between risky sexual behavior and development of Mycoplasma Genitalium. It is also proven that the risk of infection increases for those with multiple sexual partners.
Often, Mycoplasma genitalium in men is associated with urethritis and bacterial vaginosis in women. Cervicitis, pelvic inflammatory disease and Endometriosis are some of the other conditions associated with Mycoplasma genitalium in women. This condition is also known to cause infertility in women. Urethritis in men could also be caused by conditions like gonorrhoea or Chlamydia and hence these conditions are primarily ruled out before probing for Mycoplasma genitalium. Mycoplasma Genitalium Urine Test is recommended for people who have tested negative for other bacterial infections such as Chlamydia and Gonorrhea but continue to experience symptoms.
Mycoplasma genitalium does not cause symptoms at the initial stage. It usually takes 1 to 3 weeks for the symptoms to show up. And also, it often occurs in conjunction with other sexually transmitted infections. As the symptoms start to surface, it is advisable to get tested for Mycoplasma genitalium separately along with other STD related diagnostic tests.
Symptoms in men may include
Symptoms in women
Most often, Mycoplasma genitalium in women causes infection in cervix. Bleeding after sex is the most common symptom associated with Mycoplasma genitalium in women. Some of the other symptoms include:
Mycoplasma organisms are difficult to culture and identify. Diagnosis of infection is performed using nucleic acid amplification tests (NAATs). In case of men, the first passed urine and in case of women endocervical/ vaginal swab are collected to conduct test. Polymerase Chain Reaction (PCR) is a popularly followed NAAT test to detect Mycoplasma genitalium.
Mycoplasma genitalium is treated with antibiotics. The antibiotic azithromycin has been generally successful against Mycoplasma genitalium infection. But there are instances where mycoplasma genitalium has developed resistance to azithromycin. Antibiotics like moxifloxacin and doxycycline are also widely recommended to treat the condition.
Urethrogram is a diagnostic procedure to examine the urethra. Genital Urethrogram is almost always carried out on male patients with symptoms such as dribbling of urine, sense of incomplete bladder emptying, hesitancy, poor stream, urinary urgency, urinary frequency, poor bladder emptying etc.
In many patients, the most prominent indication is potential urethral stricture disease. Genital Urethrogram is an essential tool for doctors for careful examination of the images followed by best interpretation so as to plan appropriate course of treatment. In males, the urethra is the tube that caries urine and semen through the penis, outside the body. Genital Urethrogram involves taking an X-ray of the tube. Measuring 20 cm in length, there are two divisions:
Anterior ( penile and bulbar)
Posterior ( membranous and prostatic)
What is Genital Urethrogram ?
The diagnostic X-ray procedure, Urethrogram is done to study the urethra. It can be either retrograde Urethrogram or antegrade urethrogram. It may take 30-60 minutes for completion of the procedure. Depending on the need to examine the anterior or posterior urethra, either of the two is done.
Retrograde Urethrogram (RUG): Ascending study to assess the anterior urethra which is composed of the penile and bulbar urethra.
Antegrade Urethrogram: Descending study to assess the posterior urethra which is composed of the membranous and prostatic urethra.
Why do Genital Urethrogram ?
Doctors recommend Genital Urethrogram when patients express problems with poor urinary flow or problems passing urine. In older men, the reason can be attributed to enlargement of the prostate. But in young and middle aged males and male children, it might be a history of injury, infection etc.
The procedure throws light on two major aspects of the urethra. Firstly, the capacity of the bladder and its emptying ability and secondly, examination of the urethra, the narrow tube which connects the bladder to the genitals through which urine passes before leaving the body.
Indications of Genital Urethrogram
Infection: Gonococcal Urethritis, non-gonoccocal urethritis
Inflammatory: Balanitis Xerotica obliterans
Trauma: Straddle injury, pelvic fractures
Iatrogenic: Instrumentation, prolonged catheterization, trans-urethral resection of the prostate, open radical prostatectormy, urethra reconstruction.
On the appointed day, the patient is admitted in the hospital radiology department or radiology practice where the procedure is to be done. The patient will be asked to empty the bladder and put on a hospital gown. He is made to lie on an x-ray table called a fluoroscopy table in a specific position. Sterile drapes are placed over the lower body. The penis and groin will be cleaned with an antiseptic solution. A narrow catheter or a thin plastic, silicone or rubber tube will be placed into the end part of the penis from where the urine exits. A small balloon will be inflated in order to keep the catheter in place and to stop contrast medium (special dye) running out of the end of the penis.
Contrast medium is gently injected into the urethra by placing a catheter at the top of the penis. As the bladder is filled with the contrast, the patient is likely to experience some discomfort. There can be an urgent need to pass urine. At this point, the catheter will be removed. The final images of the bladder will be taken.
The X-ray table will be tilted. The patient is now in a standing position. A bottle will be handed over to pass urine. When the patient is passing urine, x-ray pictures of the bladder and the urethra will be taken to understand how well the bladder empties. The images also pin-point if there is any narrowing in the urethra.
After completion of Genital Urethrogram, it is normal to notice some blood at the tip of the penis. The patient may experience some discomfort or stinging at the end of the penis where the catheter was inserted and the balloon was inflated. This will subside after passing urine few times on the same day or the next day. The urine can be with small amount of blood too.
Are there risks associated with Genital Urethrogram ?
Three potential risks have been identified but all the three are rare instances. Allergic reaction to the dye (contrast medium), urine infection and damage to the urethra are the three possible risks associated with Genital Urethrogram. Of the three, urine infection and allergic reaction are easily manageable.
Prior to the procedure, the patient must inform the medical team if he is allergic to iodine-containing contrast. With regard to urinary infection, if it does not subside even after 36 hours of the procedure, it is best to seek medical attention. Antibiotics will be prescribed. Damage to the urethra is also rare but might occur if Genital Urethrogram is performed as an emergency procedure. In some cases, emergency surgical repair is recommended. The surgery aims at restoring urethral function and near-perfect cosmetic appearance.
Urinary Tract Infection
Under normal circumstances, the urinary system and its structure helps ward off infection. Immune defenses also play a part. The urinary tract is the body's filtering system for removal of liquid wastes. Women may be more susceptible to UTI because their urethral opening is near the source of bacteria. Women who are newly sexually active or have a new sexual partner may be at increased risk of contracting Urinary Tract Infection.
Causes for UTI infection in women
UTI treatment involves a course of antibiotics. Treatment of UTI is done with amoxicillin, trimethoprim-sulfamethoxazole or fluoroquinolones. Treating UTI caused by bladder outlet obstructions may necessitate surgery and hospitalization. Drinking plenty of water and fluids will aid in flushing away the bacteria from the urinary system. Some doctors recommend Vitamin C as it will make the urine acidic and thereby hostile to bacteria. The most important tip to prevent urinary tract infections, bladder infections, and kidney infections is to practice good personal hygiene.
Cause of Urinary Tract Infection
E. coli is the most common cause of UTI. When the infection is limited to the urethra, it is called urethritis. A bladder infection is called cystitis. If the UTI is not treated in time, the infection will travel up and infect the kidneys. Other microorganisms called Chlamydia and Mycoplasma are also known to cause UTI infection. Other causes of UTI are bladder outlet obstructions or suppressed immune system. Certain blood types enable bacteria to attach more easily to cells that line the urinary tract, causing recurrent infections.
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Bibliography / Reference
Collection of Pages - Last revised Date: February 4, 2023