From the Research
Successful elimination of Mycoplasma genitalium with antibiotic therapy may resolve overactive bladder symptoms in some patients, but symptoms can persist in others due to potential irreversible bladder damage. The most recent and highest quality study 1 suggests that high-dose tinidazole may be effective in treating M. genitalium urethritis, especially in cases where azithromycin fails. However, the study that directly addresses the question of whether successful elimination of M. genitalium resolves overactive bladder symptoms is 2, which found that treatment of genitourinary mycoplasmas with azithromycin can improve overactive bladder symptoms in women. Key points to consider include:
- Azithromycin (typically 1 gram as a single dose or 500 mg on day 1 followed by 250 mg daily for 4 days) is often the first-line treatment for M. genitalium, though resistance is increasing 3.
- If azithromycin fails, moxifloxacin (400 mg daily for 7-14 days) may be used as second-line therapy 4.
- For persistent overactive bladder symptoms after successful treatment, patients should be evaluated for other causes or chronic damage.
- M. genitalium can trigger inflammation in the urogenital tract that may lead to tissue damage and nerve sensitization in the bladder, potentially causing lasting changes to bladder function even after the infection is cleared.
- Patients should complete the full course of antibiotics even if symptoms improve, and follow up with testing to confirm eradication.
- If overactive bladder symptoms persist after confirmed eradication, treatments such as bladder retraining, pelvic floor physical therapy, or medications like anticholinergics or beta-3 agonists may be necessary to manage ongoing symptoms.