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Mycoplasma Genitalium Infection

Sexually transmitted
The bacterium Mycoplasma genitalium has been known for long, but its significance as a pathogen has been confirmed over the recent years.
Must be considered in the differential diagnosis of urethritis and cervicitis where the aetiology of symptoms is unclear after chlamydia Chlamydial Urethritis and Cervicitis and gonorrhoea Gonorrhoea have been excluded.
Asymptomatic people should not be screened.
Encountered in about 5% of patients attending sexually transmitted diseases clinics in the Nordic countries.

Mycoplasma genitalium is the smallest known bacteria.
Clinical picture resembles that of Chlamydia infection.
Asymptomatic infections are common.
Mycoplasma causes urethritis in men, cervicitis in women, and it may also cause pelvic inflammatory disease Pelvic Inflammatory Disease (PID).

Detection of the nucleic acid from a mucous membrane or first-void urine sample http://www.dynamed.com/condition/mycoplasma-and-ureaplasma-genito-urinary-infections#MOLECULAR_TESTING
If there is suspicion of a strain resistant to azithromycin, antimicrobial sensitivity testing may be additionally performed.
The sample is recommended to be taken only in symptomatic patients when tests for chlamydial and gonococcal infections as well as clean-voided urine have proven negative.
- particularly of men with unclear urethritis (urethral discharge and burning on urination)
- of women with lower abdominal pain, burning on urination and increased leucorrhoea
- if a permanent sexual partner has been diagnosed with Mycoplasma genitalium infection.

Strains resistant to macrolides (> 30%) and, increasingly, also quinolones are a problem.
In new European practice guidelines, first-line treatment is azithromycin http://www.dynamed.com/condition/mycoplasma-and-ureaplasma-genito-urinary-infections#EFFICACY, 500 mg on the first day and 250 mg daily from day 2 to day 5.
- The efficacy of azithromycin is 85-95%.
If azithromycin treatment fails or the strain is known to be resistant to it, moxifloxacin http://www.dynamed.com/condition/mycoplasma-and-ureaplasma-genito-urinary-infections#EFFICACY 400 mg once daily for 7 days is used (taking into account the warnings related to the medication).
A follow-up sample 4 weeks after the treatment is recommended if the symptoms persist.
Permanent sexual partner should be investigated and treated simultaneously with the same antimicrobial drug as the patient.
Unprotected sex is to be avoided during the treatment.

Taylor-Robinson D, Jensen JS. Mycoplasma genitalium: from Chrysalis to multicolored butterfly. Clin Microbiol Rev 2011;24(3):498-514. [PubMed]
Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis 2015;61(3):418-26. [PubMed]
Jensen JS, Cusini M, Gomberg M, et al. 2021 European guideline on the management of Mycoplasma genitalium infections (in press). The International Union against Sexually Transmitted Infections (IUSTI) http://iusti.org/treatment-guidelines/.