Can Mycoplasma genitalium infection cause overactive bladder symptoms?

From the Guidelines

Mycoplasma genitalium infection is a potential cause of overactive bladder symptoms, and testing should be considered in patients presenting with symptoms alongside genital discharge, pelvic pain, or after a new sexual partner. Mycoplasma genitalium is a sexually transmitted infection that typically causes urethritis in men and cervicitis in women, but the inflammation it causes can extend to the bladder and trigger symptoms such as urinary frequency, urgency, and nocturia that mimic overactive bladder 1. According to the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder, a urinalysis should be performed in all patients with symptoms suggestive of OAB, and urine culture should be performed if urinalysis is suggestive of infection and/or hematuria 1.

Key Considerations

• The connection between Mycoplasma genitalium infection and bladder symptoms occurs because the inflammation from urethral or cervical infection can irritate bladder nerves and trigger detrusor muscle overactivity.
• Proper diagnosis requires specific nucleic acid amplification tests (NAATs) as this organism cannot be cultured using standard methods.
• Treatment typically involves antibiotics such as doxycycline 100mg twice daily for 7 days followed by azithromycin 1g on day one then 500mg daily for 3 more days, or moxifloxacin 400mg daily for 7-14 days for resistant cases.
• The impact on a patient’s quality of life (QoL) is significant, and many suffer with symptoms for an extended period of time before seeking medical advice 1.

Recommendations

• Testing for Mycoplasma genitalium should be considered in patients presenting with overactive bladder symptoms alongside genital discharge, pelvic pain, or after a new sexual partner.
• A urinalysis should be performed in all patients with symptoms suggestive of OAB, and urine culture should be performed if urinalysis is suggestive of infection and/or hematuria 1.
• Treatment should be individualized based on the patient’s needs, desires, and side effect tolerance, and may involve a combination of therapies 1.

From the Research

Mycoplasma Genitalium and Overactive Bladder Symptoms

• Mycoplasma genitalium infection is known to cause various genitourinary symptoms, but its association with overactive bladder symptoms is not as well-defined.
• A study from 2010 2 found that genitourinary mycoplasmas, including Mycoplasma genitalium, were present in 42.8% of women with overactive bladder symptoms, and treatment with azithromycin led to significant improvements in symptoms.
• Another study from 2017 3 suggested that Mycoplasma species, including M. genitalium, may play a role in hyperactive bladder and interstitial cystitis/painful bladder syndrome, but their role is still controversial.
• The 2022 European guideline on the management of Mycoplasma genitalium infections 4 does not specifically mention overactive bladder symptoms as a common manifestation of M. genitalium infection.
• However, a systematic review from 2017 3 recommended that urethral swab for PCR analysis of Mycoplasma and Ureaplasma should be performed in the context of symptomatic sterile leukocyturia, chronic urethritis, and suspected hyperactive bladder or interstitial cystitis/painful bladder syndrome.

Treatment and Resistance

• Azithromycin is the preferred treatment for M. genitalium infection, but resistance to this antibiotic is increasing 5, 6.
• The 2022 European guideline 4 recommends azithromycin as the first-line treatment for M. genitalium infection, but also emphasizes the importance of macrolide resistance-guided therapy.
• Moxifloxacin is an alternative treatment option, but resistance to this antibiotic is also increasing 6.
• Pristinamycin and solithromycin may be of clinical benefit for multidrug-resistant M. genitalium infections 6.