Mycoplasma genitalium sexually transmitted proctitis: myth or reality?

• Published in: Hépato-gastro & oncologie digestive Vol. 30; no. 7; pp. 685 - 690
• Main Authors: Vo-Quang, Erwan, Lourtet-Hascoët, Julie, Barré, Amélie, Spindler, Lucas, Fathallah, Nadia, Aubert, Manuel, Le Monnier, Alban, de Parades, Vincent
• Format: Journal Article
• Language: English
• Published: John Libbey Eurotext 01.09.2023
• Subjects: Bacteriology; Ecology, environment; Health; Human health and pathology; Infectious diseases; Life Sciences; Microbiology and Parasitology; Santé publique et épidémiologie; Virology
• ISSN: 2115-3310; 2115-5631
• DOI: 10.1684/hpg.2023.2604

Proctitis is mainly due to sexually transmitted infections, including bacterial infections (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema Pallidum) as well as viral infections (Herpes Simplex Virus). Recently, several studies highlighted Mycoplasma genitalium role in proctitis. This bacterium is one of the main cause of urethritis in men and also lead to a number of urogenital conditions in women like cervicitis, endometritis, pelvic inflammatory disease. Nevertheless, Mycoplasma genitalium is common in anorectal samples in asymptomatic patient (less than 15%) mostly in vulnerable populations (men who have sex with men, positive for HIV). The methodology of studies highlighting the association of this bacteria with proctitis has limitations, such as the absence of a control group. Nevertheless, the higher bacterial load in rectal swabs from symptomatic patients points to a pathogenic role of Mycoplasma genitalium. In case of proctitis due to sexually transmitted infections, the European Society of Dermatology recommends second-line screening for Mycoplasma genitalium in Chlamydia trachomatis and Neisseria gonorrhoeae negative rectal samples. The high resistance of Mycoplasma genitalium to macrolides leads to suggest a diagnosis of certainty before the introduction of antibiotic treatment, which will be based on macrolides in the first line.