Mycoplasma genitalium is sexually transmitted that is significantly associated with urethritis in men and cervicitis, urethritis in women. Mounting evidence supports a role in pelvic inflammatory disease (endometritis and salpingitis). M.genitalium may present as an asymptomatic infection in the urethra and rectum of males, and female genital tract. M.genitalium is very difficult to culture and diagnosis is by polymerase chain reaction (PCR) which is not widely available.
- 1g of azithromycin g taken as a single oral dose
Recent studies indicate that the current efficacy of this regimen may not exceed 85%. A test of cure 2-4 weeks following treatment is essential. The majority, but not all, cases of azithromycin failure will be symptomatic.
If treatment failure occurs, exclude reinfection from an untreated partner. Retreat both with 1g of azithromycin if there is a risk of reinfection and arrange a test of cure 2-4 weeks following retreatment. We recommend that you discuss likely azithromycin failures with a sexual health physician
Persistence following stat treatment:
- Moxifloxacin 400mg daily for 10 days (off-label use, costly)
This has been highly effective in observational studies to date. A test of cure 2-4weeks following moxifloxacin is also required.
Note: Women with symptoms suggesting PID should be treated with moxifloxacin 400mg daily for 10 days (also effective against chlamydia)
Contacts of Mycoplasma genitalium infection:
- examine and test where possible
- alway treat with 1g of azithromycin
- if the index case is suspected to have azithromcyin resistant Mycoplasma genitalium, use moxifloxacin for sexual contacts
- testing and tests of cure are recommended where possible to assist in management