From the Guidelines
There is no established percentage of patients with overactive bladder symptoms who experience full symptom remission after treatment of Mycoplasma genitalium with azithromycin. The relationship between M. genitalium infection and overactive bladder syndrome is not well-documented in medical literature 1. While M. genitalium is a known cause of urethritis, cervicitis, and pelvic inflammatory disease, its direct role in causing overactive bladder symptoms specifically has not been conclusively established. Azithromycin (typically given as a 500 mg dose on day 1, as suggested by the European Association of Urology guidelines 1) is a first-line treatment for M. genitalium, though increasing resistance has been reported. Key points to consider include:
- The lack of direct evidence linking M. genitalium infection to overactive bladder symptoms
- The potential for overactive bladder symptoms to have multiple causes beyond infection, including neurological factors, bladder abnormalities, or other conditions
- The importance of a urological evaluation for persistent overactive bladder symptoms even after successful treatment of any infections. If M. genitalium is detected in a patient with urinary symptoms, treatment is warranted, but clinicians should be aware that the primary goal is to address the infection, with the understanding that overactive bladder symptoms may require separate management approaches.
From the Research
Treatment Efficacy of Azithromycin for Mycoplasma genitalium Infection
- The efficacy of azithromycin in treating Mycoplasma genitalium (M. genitalium) infection has been studied in several research papers 2, 3, 4, 5, 6.
- A systematic review and meta-analysis published in 2015 found that the random-effects pooled microbial cure rate for azithromycin was 77.2% (95% confidence interval [CI], 71.1%-83.4%) 4.
- Another study published in 2008 reported that M. genitalium was eradicated in 101 (84%, 95% CI: 77-90%) of individuals prescribed azithromycin only pre-toc, and persisted in 19 (16%, 95% CI: 10-23%) 5.
- A meta-analysis published in 2018 found that the random effects pooled rate of treatment failure with azithromycin 1 g was 13.9% (95% CI 7.7% to 20.1%) 3.
- A systematic review and meta-analysis published in 2022 found that moxifloxacin improved the microbiologic cure rate compared with azithromycin (odds ratio [OR] 2.79,95% confidence interval [CI], 1.06-7.35) 6.
Symptom Remission after Treatment
- A study published in 2008 found that patients with persistent M. genitalium were more likely to experience persistent symptoms (91%), compared to patients in whom M. genitalium was eradicated (17%) 5.
- However, the exact percentage of patients who experience full symptom remission after treatment with azithromycin is not explicitly stated in the available research papers.
- It can be inferred that the percentage of patients who experience full symptom remission is likely related to the microbial cure rate, but further research is needed to determine the exact correlation 2, 3, 4, 5, 6.