What is the recommended treatment for Mycoplasma hominis infection in males?

Treatment of Mycoplasma Hominis Infection in Males

For Mycoplasma hominis infection in males, azithromycin 1g orally in a single dose is the recommended first-line treatment due to its superior efficacy compared to other antibiotics. 1, 2

Diagnostic Approach

• Before treatment, confirm urethritis through one of the following: mucopurulent discharge, Gram stain showing >5 WBC per oil immersion field, or positive leukocyte esterase test on first-void urine 3
• Test for both gonorrhea and chlamydia, as co-infections are common 3, 2
• When available, specific testing for Mycoplasma species should be performed to guide treatment 1

Treatment Options

First-Line Treatment

• Azithromycin 1g orally in a single dose 1, 2
  • Offers better efficacy against Mycoplasma species compared to doxycycline 2
  • Single-dose regimen improves compliance and allows for directly observed therapy 3

Alternative Regimens

• Doxycycline 100mg orally twice daily for 7 days 1, 2
  • Less effective with only 30-40% cure rate for Mycoplasma genitalium 2, 4
• Erythromycin base 500mg orally four times daily for 7 days 3
• Erythromycin ethylsuccinate 800mg orally four times daily for 7 days 3
• Ofloxacin 300mg orally twice daily for 7 days 3
• Levofloxacin 500mg orally once daily for 7 days 3

Follow-Up Recommendations

• Patients should return for evaluation if symptoms persist or recur after completion of therapy 3, 1
• Abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a multi-day regimen 3, 2
• Partners should be evaluated and treated to prevent reinfection 3, 1
• Test for other STIs including syphilis and HIV as part of comprehensive care 3, 1

Management of Persistent or Recurrent Infection

• For patients with persistent symptoms after treatment without objective signs of urethritis, extending antimicrobial therapy has not shown benefit 3
• If symptoms persist with objective signs of urethritis:
  • Verify treatment compliance and possible reexposure to untreated partners 3
  • Consider testing for Trichomonas vaginalis 3
  • For documented treatment failures, consider resistance testing when available 5, 6

Special Considerations

• For patients with macrolide-resistant infections (if resistance testing is available), moxifloxacin 400mg orally once daily for 7 days is recommended 5, 6
• For highly resistant infections that have failed multiple regimens, combination therapy with doxycycline and a fluoroquinolone may be necessary 7, 8

Treatment Pitfalls to Avoid

• Do not treat based on symptoms alone without confirming urethritis, except in high-risk patients unlikely to return for follow-up 3
• Avoid repeated courses of the same antibiotic for persistent infections 3
• Single-dose azithromycin should be provided in the clinic when possible to ensure compliance 3
• Be aware that asymptomatic infections are common and can lead to continued transmission if not properly identified and treated 3