Mycoplasma genitalium infection treatment
January 19 2016

A relatively new sexually transmitted infection has surpassed Neisseria gonorrhea in prevalence among young adults in the US.

Mycoplasma genitalium was first identified in the 1980s. It can cause inflammation of the urethra (the urinary passage from the bladder), in men, and inflammation of the cervix and the lining of the uterus in women, possibly leading to infertility. However, it seems many cases of the infection are symptom-free.

Mycoplasma genitalium has been causally linked with nongonococcal urethritis in men and cervicitis, pelvic inflammatory disease, preterm birth, spontaneous abortion, and infertility in women, yet treatment has proven challenging.  Randomized trials demonstrated poor efficacy of doxycycline and better, but declining, efficacy of single-dose azithromycin therapy. Treatment failures after extended doses of azithromycin similarly increased, and circulating macrolide resistance is present in high levels in several areas. Moxifloxacin remains the most effective therapy, but treatment failures and quinolone resistance are emerging.

Int J STD AIDS. 2014 Feb 11. Mycoplasma genitalium: a review. M. genitalium) was first isolated from the urethral swabs of two symptomatic men with urethritis in 1980. Published prevalence rates vary greatly between populations studied. A number of urogenital conditions have been ascribed to M. genitalium, which is recognised to cause a sexually transmitted infection. The association of M. genitalium with non-specific urethritis is now well established, but the evidence supporting its role in both male and female infertility remains inconclusive. Laboratory methods are challenging and there is a lack of test standardisation. The recommended treatment of the infection is azithromycin as a single 1 gm dose. However, in recent years a macrolide resistance has been observed. More studies are required to establish the clinical importance of M. genitalium in urogenital conditions, particularly infertility, and to establish the role for screening and treatment in high-risk populations.

Mycoplasma prevalence
The prevalence this infection is higher among individuals living with a sexual partner and among blacks.

Many Mycoplasma genitalium infections are asymptomatic, like chlamydial infections. There are no commercial tests to detect the organism. It is not clear whether Mycoplasma genitalium-infected persons require or benefit from treatment -- and if so, what antimicrobial therapy should be recommended. American Journal of Public Health, June 2007.