Treatment for Mycoplasma Genitalium Infection of the Vagina
The first-line treatment for Mycoplasma genitalium vaginal infection is azithromycin 1 g orally in a single dose, as it has better efficacy against this pathogen compared to doxycycline. 1
First-Line Treatment Options
- Azithromycin 1 g orally in a single dose is the preferred first-line treatment for Mycoplasma genitalium infections, with efficacy rates of 85-95% in macrolide-susceptible infections 1, 2
- An extended azithromycin regimen (500 mg on day 1 followed by 250 mg once daily for 4 days, total dose 1.5 g) may have a higher cure rate (99% vs 91% for single dose) and lower risk of developing macrolide resistance 3, 2
Alternative Treatment Options
- Doxycycline 100 mg orally twice daily for 7 days can be used as an alternative, though it has a lower efficacy of only 30-40% against M. genitalium 1, 3
- For patients with macrolide resistance or treatment failure with azithromycin:
Treatment Considerations
- Testing for macrolide resistance mutations should be performed when available to guide therapy 2
- Patients should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a multi-day regimen 1
- Sexual partners should be evaluated and treated to prevent reinfection 1
- Co-testing for other STIs like gonorrhea and chlamydia is recommended as co-infections are common 1
Follow-Up Recommendations
- Patients should return for evaluation if symptoms persist or recur after completion of therapy 1
- Test of cure is not routinely recommended if symptoms resolve 1
- For persistent infection after azithromycin and moxifloxacin failure:
Special Considerations
- The increasing prevalence of macrolide resistance is concerning, likely due to widespread use of azithromycin 1 g single dose without test of cure 4, 2
- For complicated M. genitalium infection (such as PID), moxifloxacin 400 mg once daily for 14 days is recommended 4, 2
- HIV-infected patients should receive the same treatment as non-HIV infected patients 1