New STI threat

At least 252 Jamaicans tested positive for mycoplasma genitalium (MG) in 2022, nearly eight years after the sexually transmitted infection (STI), which can cause adverse pregnancy outcomes and reproductive problems, was first detected in the island.

Data obtained from Caribbean Genetics (CARIGEN) showed that of an average of 700 samples across test systems, 21 returned positive for the STI each month.

Mycoplasma genitalium is a bacteria that is mainly passed via sexual contact or exchange of sexual fluids with someone who has previously been infected.

Obstetrician and gynaecologist of Charis Women’s Wellness Centre, Dr Astrid Batchelor, explained that sexual contact may be vaginal, oral or anal and noted that MG affects one to five per cent of sexually active persons.

CARIGEN chief DNA analyst Dr Compton Beecher told The Sunday Gleaner that the percentage positivity for MG is around three per cent.

He argued that based on the fact that MG is now just as prevalent as gonorrhoea in Jamaica, he would support its inclusion in the National HIV/STI Programme.

Beecher shared that Jamaicans can test for MG in a STI9 panel or a QUAD panel at a cost of $17,000 and $10,500, respectively.

Testing is available through all collection sites CARIGEN partners with across the island, and Beecher said once a sample gets to its lab, which is based at The University of the West Indies, Mona, the turnaround time for results is three to five working days.

The chief DNA analyst said that by the end of February, MG detection will be available as a single test for $6,000.

“When our larger screens identify a mycoplasma positive and the physician treats it, we want to retest for the mycoplasma to see if the treatment works without the patient having to pay for the full panel again. Also if the physician specifically suspects mycoplasma, they can make that request only,” Beecher explained of the rationale for a single test.

In 2015 when MG was first detected locally, the National Family Planning Board had said that it was not a focus of the government agency’s National HIV/STI Programme because the diagnostic tests were costly and testing was unavailable in the public health system.

The Ministry of Health and Wellness confirmed on Thursday that it does not have any data on the STI in the public sector.

When The Sunday Gleaner queried how soon MG would be incorporated in the National HIV/STI Programme, the ministry said: “We are currently in the planning phase and should begin incorporation by May 2023.”

Testing in the public health sector is also expected to commence in May.

Greater availability of testing is welcomed as Batchelor, an obstetrician and gynaecologist, shared that MG does not always cause symptoms.

“It is possible to have it and not know. Only 50 per cent of persons are symptomatic,” she said, adding that in men, the main symptom is urethritis, which causes a watery discharge from the penis associated with pain on urination.

Women usually experience abnormal vaginal discharge, pelvic pain, painful sex, or bleeding after sex. Some women also develop pelvic inflammatory disease-like symptoms with fever, nausea and vomiting.

Batchelor also said that MG may cause reproductive problems and adverse pregnancy outcomes in women.

“In women, M. genitalium has been associated with cervicitis, pelvic inflammatory disease, infertility and adverse birth outcomes such as premature labour and has even been found to make women more susceptible to contracting HIV,” she told The Sunday Gleaner.

Batchelor said if a person has symptoms or their partner has tested positive for the bacteria, doctors usually recommend the STI9 panel test.

For this test, she said a sample of one’s urine and possibly a swab from the vagina, cervix or urethra is taken.

Generally, MG is treated with a course of antibiotics.

“Your doctor will prescribe first-line treatment with azithromycin or doxycycline. If those medications don’t eradicate the bacteria completely, another antibiotic can be used. Cure rates with the first-line antibiotics range from 67 to 87 per cent. It is important to do a post-treatment test of cure about two weeks after antibiotic use to ensure that the infection is gone. If the bacteria is still found to be present, another course of antibiotics will be given,” Batchelor said.

The health ministry maintained that the treatment options available locally are effective and form part of the syndromic management outlined in the Practical Case Management of Common STI Syndromes published in December 2020.

It also said the prevalence of MG can be reduced by engaging in safe sexual practices, which include abstinence, having one partner and using barrier methods like condoms.

Batchelor added that partners are recommended to abstain from sexual intercourse until adequate treatment is completed and symptoms resolve, if initially present.

Once both partners have been effectively treated and testing results are negative, they can engage in sexual intercourse.

Meanwhile, the Ministry of Health and Wellness said there has not been any sharp increase or decline in the prevalence of other STIs in recent years.

“The prevalence of genital discharge has remained the same for the last three years,” it told The Sunday Gleaner.

Further, the ministry said that COVID-19 has not had a significant impact on the spread or treatment of STIs.

judana.murphy@gleanerjm.com