From the Guidelines
The recommended treatment duration for chronic Mycoplasma genitalium (M. genitalium) urethritis is 7-14 days, with azithromycin 500 mg on day 1, and in cases of macrolide resistance, moxifloxacin 400 mg once daily for 7-14 days. When considering the treatment of M. genitalium urethritis, it is essential to prioritize the most recent and highest quality evidence, which in this case is the 2024 European Association of Urology guidelines on urological infections 1. The guidelines suggest that the first-line treatment for M. genitalium urethritis is azithromycin, with a dosage of 500 mg on day 1, and alternative regimens include moxifloxacin 400 mg once daily for 7-14 days in cases of macrolide resistance. Key points to consider in the treatment of M. genitalium urethritis include:
- The importance of treating all sexual partners to prevent reinfection
- The need for patients to abstain from sexual activity until treatment completion and symptom resolution
- The recommendation for follow-up testing 3-4 weeks after treatment to confirm cure, as M. genitalium is difficult to eradicate and recurrence rates are high. It is crucial to note that M. genitalium has high rates of antimicrobial resistance, which necessitates the use of alternative regimens such as moxifloxacin in cases of macrolide resistance, as outlined in the guidelines 1.
From the Research
Treatment Duration for Chronic Mycoplasma genitalium Urethritis
- The treatment duration for chronic Mycoplasma genitalium (M. genitalium) urethritis varies depending on the antibiotic regimen used 2, 3, 4, 5.
- For uncomplicated M. genitalium infection, azithromycin is recommended as the first-line treatment, with a duration of 5 days (500 mg on day 1, then 250 mg on days 2-5) 2, 3.
- For second-line treatment or macrolide-resistant M. genitalium infection, moxifloxacin is recommended for 7-10 days 2, 3.
- In cases of persistent M. genitalium infection after azithromycin and moxifloxacin treatment, doxycycline or minocycline may be used for 14 days 3.
- The treatment duration for complicated M. genitalium infection, such as pelvic inflammatory disease (PID) or epididymitis, is typically 14 days with moxifloxacin 2, 3.
Factors Affecting Treatment Duration
- The presence of macrolide resistance mutations can affect the treatment duration and choice of antibiotic regimen 2, 3, 6.
- Reinfection risk is also an important consideration in determining the treatment duration and follow-up testing 5.
- The choice of antibiotic regimen and treatment duration should be guided by the results of nucleic acid amplification testing (NAAT) and macrolide resistance testing 2, 3.