As the number of positive tests for mycoplasma genitalium (m-gen) continues to increase, so do questions about the mysterious disease that is causing concern and confusion throughout the adult industry.
Jamey Bell, the Medical Director at the LGBT Center of Los Angeles, answered a series of questions related to m-gen during an interview with PornCrush last week.
Q: What’s your take on all the Mgen positives lately?
A: Just like with any STI, we see spikes in cases from time to time, get folks tested and treated, and then the outbreaks will level off. Mgen is unique in that there is no recommendation for routine testing at this time. This is due to several factors, such as the slow growth of the bacteria, that some infections will clear on their own, and significant concerns about antibiotic resistance with Mgen specifically.
Q: How accurate is the test for Mgen; could many of these be false positives?
A: The FDA-approved test for Mgen, the Aptima Mycoplasma genitalium Assay, correctly identified Mgen in approximately 90% of vaginal and penile samples. The accuracy decreases with urine samples in people with vaginas. Therefore, a vaginal swab is preferred. In persons with penises, urine tests are highly accurate. The challenge is not knowing for sure how long a test could be falsely positive after completing the appropriate treatment regimen. We know with gonorrhea and chlamydia, the tests can detect non-viable bacteria for up to two weeks after treatment. PASS is currently consulting with Mgen researchers to try to get more insight into the appropriate timing of repeat testing, or "test of cure."
Q: Are biological male/female talents more or less susceptible to Mgen?
A: Well, that more so depends on the sexual activity than gender identity. Currently, it is believed that oral sex is not a major risk factor for Mgen transmission. Vaginal and anal sex seem to be the highest modes of transmission.
Q: As a medical professional, how critical do you feel testing for Mgen as part of a full panel for sex work is?
A: This is a challenge we're currently working on with the PASS Medical Advisory Panel, and top Mgen researchers. CDC does not recommend routine testing for Mgen at this time, but of course we understand recommendations for the general population don't necessarily translate to the unique sexual networks of the sex worker community and adult industry. Because Mgen is slow-growing, requires 14 days of antibiotics, has an unknown timeframe for potential false positives after treatment, and considerable antibiotic resistance concerns, it doesn't seem medically or financially feasible to test every 14 days for Mgen at this time. Again, we are diligently seeking more information and input from infectious disease experts to strategize the best long-term plan.
Q: Is there anything that can be done to reduce the risk of contracting Mgen?
A: Of course, condoms can lower the risk for STI transmission in general, but again, that strategy is not practical for the adult industry as a whole. I think the baseline testing recommended by PASS to identify and treat asymptomatic cases is an excellent start in decreasing the overall prevalence of Mgen in the community. There are many myths out there, such as urinating immediately after sex (which may help lower UTI risk but not STIs), different "washes" or douche products, etc., but none of those have been shown to reduce risk and may, in fact, irritate the mucous membranes facilitating infections.
Q: What’s the treatment for Mgen - and if it’s 7-day doxycycline, are there risks to back-to-back use of 7-day courses of strong antibiotics?
A: The treatment for Mgen is very specific and must be prescribed and taken properly in light of the antibiotic resistance with Mgen. The first line treatment regimen is Doxycycline 100mg twice a day for 7 days, immediately followed by Moxifloxacin 400mg once daily for 7 days. Azithromycin has been used for the second-week regimen but should not be used first-line in the absence of drug allergies due to significant resistance patterns. It's crucial that talent ensure they are being prescribed the proper regimen and also taking the medication exactly as prescribed. This regimen can be harsh on the GI system, leading to possible yeast infections or other side effects. I generally recommend probiotic intake while on treatment to help minimize side effects.
Q: What are the long-term effects of an undiagnosed Mgen infection?
A: As with most untreated STIs, there is an association with the possible development of Pelvic Inflammatory Disease (PID) or other reproductive issues. The direct correlation between Mgen and those possible consequences is still being studied but must be considered.
Q: Why do you think Mgen is just now becoming such a hot-button issue? Was it just not as common before, or was testing not available, etc.?
A: Although Mgen was first identified in the 1980s, it would take six months to culture and grow the organism at that time. The first test for Mgen was approved by the FDA in 2019, which, in the realm of how long we've been able to test for other STIs, that's still relatively new. Although research is ongoing, some of the existing data have been inconclusive or conflicting. We do know that Mgen can be the cause of persistent symptoms, similar to gonorrhea, chlamydia or bacterial vaginosis when those infections have been ruled out. To date, the recommendations for testing have been to test to help in the diagnosis of symptoms and when there has been a known exposure to Mgen.
Q: Does someone who just got off doxycycline that tests negative for Mgen have any immunity, or could they get it again the next day?
A: As with other bacterial STIs, there is no immunity after successful treatment of the infections, so yes, it could be possible to be re-exposed immediately. We see this somewhat frequently with gonorrhea, chlamydia, and syphilis. However, it's important to remember that exposure to any STI does not automatically result in infection. With the antibiotic resistance concerns with Mgen specifically, that's why we don't want to treat for an exposure without a confirmed positive result.