From the Research
Approximately 50-70% of patients with Mycoplasma genitalium infection will not have pyuria, and about 30-40% will have a completely normal urinalysis despite being symptomatic. This is important to recognize because relying solely on urinalysis findings to rule out urethritis can lead to missed diagnoses. Mycoplasma genitalium is a sexually transmitted infection that causes non-gonococcal urethritis in men and cervicitis, pelvic inflammatory disease, and urethritis in women. The organism is slow-growing and difficult to culture, which contributes to diagnostic challenges. Patients may present with dysuria, urethral discharge, or pelvic pain, but these symptoms can be mild or intermittent. Nucleic acid amplification testing (NAAT) is the preferred diagnostic method rather than urinalysis, as stated in the 2022 European guideline on the management of Mycoplasma genitalium infections 1.
Key Considerations
- The high rate of normal urinalysis findings in patients with Mycoplasma genitalium infection highlights the need for a high index of suspicion in patients with urogenital symptoms, even when urinalysis appears normal.
- Treatment typically involves azithromycin, but resistance is increasing, and moxifloxacin may be needed for resistant cases, as discussed in the 2016 European guideline on Mycoplasma genitalium infections 2 and the 2022 European guideline on the management of Mycoplasma genitalium infections 1.
- The 2022 guideline emphasizes the importance of macrolide resistance-guided therapy and notes that doxycycline has a cure rate of 30-40%, while azithromycin has a cure rate of 85-95% in macrolide-susceptible infections 1.
- A study from 2019 found that switching from azithromycin to doxycycline for presumptive treatment of M. genitalium, followed by resistance-guided therapy, cured ≥92% of infections, with infrequent selection of macrolide resistance 3.
Clinical Implications
- Clinicians should be aware of the potential for normal urinalysis findings in patients with Mycoplasma genitalium infection and maintain a high index of suspicion in patients with urogenital symptoms.
- Nucleic acid amplification testing (NAAT) is the preferred diagnostic method, and treatment should be guided by resistance testing, as recommended in the 2022 European guideline on the management of Mycoplasma genitalium infections 1.
- The increasing resistance to azithromycin and moxifloxacin highlights the need for ongoing monitoring and adaptation of treatment strategies, as discussed in the 2019 study on outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections 3.