What is the recommended treatment for Mycoplasma hominis in males?

Treatment of Mycoplasma Hominis in Males

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

Diagnostic Approach

• 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 1
• Testing for both gonorrhea and chlamydia is recommended alongside M. hominis testing, as co-infections are common 1
• Specific testing for Mycoplasma species should be performed to guide treatment when available 1

Treatment Options

First-Line Treatment

• Azithromycin 1g orally in a single dose is recommended as first-line treatment for M. hominis infections 1
• Single-dose regimen improves compliance and allows for directly observed therapy 1
• The American College of Physicians recommends azithromycin 1g orally in a single dose due to better efficacy against Mycoplasma species compared to doxycycline 1

Alternative Treatment Options

• Doxycycline 100mg orally twice daily for 7 days can be considered as an alternative, though it has lower efficacy 2
• For patients who cannot tolerate macrolides or tetracyclines, fluoroquinolones may be considered:
  • Levofloxacin 500mg once daily for 7 days 3
  • Ofloxacin 200mg twice daily for 7 days 3

Follow-Up Recommendations

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

Management of Persistent or Recurrent Infection

• If symptoms persist with objective signs of urethritis, verify treatment compliance and possible reexposure to untreated partners 1
• For persistent infections after initial treatment, consider resistance testing if available 4
• For patients with persistent symptoms after treatment without objective signs of urethritis, extending antimicrobial therapy has not shown benefit 1

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 1
• Avoid repeated courses of the same antibiotic for persistent infections 1
• Provide single-dose azithromycin in the clinic when possible to ensure compliance 1
• Be aware that asymptomatic infections are common and can lead to continued transmission if not properly identified and treated 1
• Rising antimicrobial resistance is a concern with Mycoplasma species, particularly to macrolides, which necessitates appropriate antibiotic selection 4, 5

Special Considerations

• For highly resistant strains (though less common with M. hominis than M. genitalium), combination therapy approaches may be needed in consultation with infectious disease specialists 6
• Sexual partners should be treated simultaneously to prevent reinfection and further transmission 3
• Microbiological cure testing is not routinely necessary after treatment completion unless symptoms persist 3