From the Guidelines
Mycoplasma genitalium (M. genitalium) infection is a sexually transmitted bacterial infection that requires prompt antibiotic treatment, with azithromycin 500 mg p.o. on day 1 being the recommended first-line treatment. According to the European Association of Urology guidelines on urological infections, summarized in the 2024 guidelines 1, the suggested antimicrobial therapy regimens for urethritis caused by M. genitalium include azithromycin as the primary option. Some key points to consider when treating M. genitalium infection include:
- The lack of a cell wall in the bacterium, making it naturally resistant to many common antibiotics like penicillins and cephalosporins
- Increasing antibiotic resistance, which is why alternative regimens such as moxifloxacin 400 mg q.d. 7–14 d may be necessary in cases of macrolide resistance
- The importance of testing for cure 3-4 weeks after completing treatment and notifying and treating partners from the past 3 months to prevent reinfection
- The common symptoms of M. genitalium infection, including urethritis in men (with discharge and painful urination) and cervicitis in women (with abnormal discharge, pelvic pain, or bleeding), although many infections are asymptomatic. The European Association of Urology guidelines provide a comprehensive overview of the treatment options for M. genitalium infection, and azithromycin 500 mg p.o. on day 1 is the recommended first-line treatment, with alternative regimens available for patients with macrolide resistance or other complications 1.
From the Research
Definition and Transmission of Mycoplasma genitalium Infection
- Mycoplasma genitalium is a pathogen transmitted through sexual contact 2, 3, 4.
- It is recognized as a significant cause of non-chlamydial non-gonococcal urethritis in men and cervicitis and pelvic inflammatory disease in women 3, 4.
Symptoms and Diagnosis
- Symptoms of M. genitalium infection include urethritis, dysuria, and discharge in men, and vaginal discharge, dysuria, or symptoms of pelvic inflammatory disease in women 3, 4.
- Asymptomatic infections are frequent, and diagnosis is achievable only through nucleic acid amplification testing (NAAT) 3, 4.
- NAAT diagnosis should be followed by an assay for macrolide resistance 3, 4.
Treatment and Resistance
- The current guidelines recommend azithromycin as the first-line treatment and moxifloxacin as a second-line treatment 2, 3, 4.
- Azithromycin has a cure rate of 85-95% in macrolide-susceptible infections, but resistance is increasing 3, 5, 4.
- Moxifloxacin can be used as second-line therapy, but resistance is also increasing 2, 3, 4.
- Doxycycline has a low cure rate of 30-40%, but does not increase resistance 3, 4.