From the Guidelines
The treatment for Mycoplasma genitalium infections typically involves antibiotics, with azithromycin being the recommended first-line regimen, specifically 500 mg p.o. on day 1, as suggested by the European Association of Urology guidelines 1.
Symptoms and Treatment Overview
Mycoplasma genitalium (M. genitalium) infections can cause symptoms such as urethritis in both men and women. The symptoms may include dysuria, discharge, and pelvic inflammatory disease in women.
First-Line Treatment
The first-line treatment for M. genitalium infections is azithromycin, with a recommended dosage of 500 mg p.o. on day 1 1.
Alternative Treatments
In cases of macrolide resistance, moxifloxacin 400 mg q.d. for 7-14 days is recommended as an alternative treatment 1.
Importance of Treatment
It is crucial to treat M. genitalium infections promptly to prevent complications and reduce the risk of transmission to sexual partners.
Follow-Up
Follow-up testing is recommended 4-6 weeks after treatment to ensure the infection has cleared, as M. genitalium can persist despite treatment.
Sexual Partners
Sexual partners should also be treated to prevent reinfection, and patients should abstain from sexual activity until both they and their partners complete treatment and symptoms resolve.
Antibiotic Resistance
Antibiotic resistance is increasingly common with M. genitalium, particularly to azithromycin, which is why combination therapy is often preferred and why the most recent guidelines should always be consulted for the latest recommendations 1.
From the Research
Mycoplasma Genitalium Infection Symptoms
- In men, symptoms of Mycoplasma genitalium infection include urethritis, dysuria, and discharge 2, 3.
- In women, symptoms include vaginal discharge, dysuria, or symptoms of pelvic inflammatory disease (PID) such as abdominal pain and dyspareunia 2, 3.
- Asymptomatic infections are frequent in both men and women 2, 3.
Treatment of Mycoplasma Genitalium Infections
- Uncomplicated Mycoplasma genitalium infection can be treated with azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral) 2, 3.
- Second-line treatment and treatment for uncomplicated macrolide-resistant M. genitalium infection is moxifloxacin 400 mg od for 7-10 days (oral) 2, 3.
- Third-line treatment for persistent M. genitalium infection after azithromycin and moxifloxacin is doxycycline or minocycline 100 mg bid for 14 days (oral) 3.
- Complicated M. genitalium infection (PID, epididymitis) is treated with moxifloxacin 400 mg od for 14 days 2, 3.
- Resistance-guided therapy using doxycycline followed by sitafloxacin or 2.5 g azithromycin has been shown to be effective in treating M. genitalium infections 4.
- Combination therapy with doxycycline and sitafloxacin has also been shown to be effective in treating highly resistant M. genitalium infections 5.
Antimicrobial Resistance
- Macrolide resistance in M. genitalium is increasing, with resistance rates exceeding 50% in many regions 4.
- Quinolone resistance is also increasing, with moxifloxacin resistance being reported 4, 2, 3.
- The use of azithromycin 1 g single dose without test of cure is likely contributing to the increasing prevalence of macrolide resistance 6.