Mycoplasma genitalium: Difference between revisions

Latest revision as of 12:10, 10 April 2024

Clinical Manifestations

Asympomatic in 40-75% of sexually active women and up to 70% in sexually active men
Non-gonococcal urethritis or cervicitis, especially if resistant to standard treatment for gonorrhoea and chlamydia
- Symptoms include increased or altered vaginal discharge (in women), dysuria and urinary urgency, urethral discharge (in men), balanoposthitis (in men), and proctitis (in men who have sex with men)
Complications in women include pelvic inflammatory disease, infertility, and sexually-acquired reactive arthritis
Complications in men include epididymitis and sexually-acquired reactive arthritis
Ocular infection can cause conjunctivitis

Differential Diagnosis

See non-gonococcal urethritis

Management

Canadian Guidelines

Suspected cervicitis or urethritis:
- Not previously treated with azithromycin: Azithromycin 500 mg PO on day one followed by 250 mg PO daily for days two to five
- Previously treated with azithromycin: moxifloxacin 400 mg PO daily for 7 days
Suspected or confirmed macrolide-resistance: moxifloxacin 400 mg PO daily for 7 days
Suspected or confirmed pelvic inflammatory disease: moxifloxacin 400 mg PO daily for 14 days, in addition to standard treatment for PID
Unclear if test-of-cure is required; if done, wait at least 3 weeks before sending NAAT

American Guidelines (2021)

Macrolide-susceptible: doxycycline 100 mg p.o. twice daily for 7 days followed by azithromycin 1 g p.o. once followed by 500 mg po.o. daily for 3 more days
Macrolide-resistant, or testing unavailable: doxycycline 100 mg p.o. twice daily for 7 days followed by moxifloxacin 400 mg p.o. daily for 7 days
Test-of-cure not recommended for asymptomatic people
If symptoms are persistent, treat with moxifloxacin

European Guidelines (2016)

Macrolide-susceptible: azithromycin 500 mg p.o. on day one, followed by 250 mg daily on days 2 to 5
Macrolide-resistant, or second-line: moxifloxacin 400 mg p.o. daily for 7 to 10 days
Third-line:
- Doxycycline 100 mg p.o. twice daily for 14 days (eradication in about 30%)
- Pristinamycin 1 g p.o. four times daily for 10 days
Complicated infection involving PID or epididymitis: moxifloxacin 400 mg p.o. daily for 14 days
Test-of-cure is recommended as routine, collected at least 3 weeks after start of treatment

@@ Line 1: / Line 1: @@
 == Clinical Manifestations ==
+* Asympomatic in 40-75% of sexually active women and up to 70% in sexually active men
 * [[Non-gonococcal urethritis]] or cervicitis, especially if resistant to standard treatment for gonorrhoea and chlamydia
+** Symptoms include increased or altered vaginal discharge (in women), dysuria and urinary urgency, urethral discharge (in men), balanoposthitis (in men), and proctitis (in men who have sex with men)
-* [[Pelvic inflammatory disease]]
+* Complications in women include [[pelvic inflammatory disease]], infertility, and [[sexually-acquired reactive arthritis]]
+* Complications in men include [[epididymitis]] and [[sexually-acquired reactive arthritis]]
+* Ocular infection can cause [[conjunctivitis]]
 == Differential Diagnosis ==
@@ Line 10: / Line 14: @@
 == Management ==
+=== Canadian Guidelines ===
-* [[Is treated by::Azithromycin]] 500 mg PO on day one followed by 250 mg PO daily for days two to five
+* Suspected cervicitis or urethritis:
-* Alternative is [[Is treated by::moxifloxacin]] 400 mg PO daily for 7 days
+** Not previously treated with azithromycin: [[Is treated by::Azithromycin]] 500 mg PO on day one followed by 250 mg PO daily for days two to five
+** Previously treated with azithromycin: [[Is treated by::moxifloxacin]] 400 mg PO daily for 7 days
+* Suspected or confirmed macrolide-resistance: [[Is treated by::moxifloxacin]] 400 mg PO daily for 7 days
+* Suspected or confirmed [[pelvic inflammatory disease]]: [[Is treated by::moxifloxacin]] 400 mg PO daily for 14 days, in addition to standard treatment for [[Pelvic inflammatory disease|PID]]
+* Unclear if test-of-cure is required; if done, wait at least 3 weeks before sending NAAT
+=== American Guidelines (2021) ===
-{{DISPLAYTITLE:''Mycoplasma genitalium''}}
+* Macrolide-susceptible: [[Is treated by::doxycycline]] 100 mg p.o. twice daily for 7 days followed by [[Is treated by::azithromycin]] 1 g p.o. once followed by 500 mg po.o. daily for 3 more days
+* Macrolide-resistant, or testing unavailable: [[Is treated by::doxycycline]] 100 mg p.o. twice daily for 7 days followed by [[Is treated by::moxifloxacin]] 400 mg p.o. daily for 7 days
+* Test-of-cure not recommended for asymptomatic people
+* If symptoms are persistent, treat with [[moxifloxacin]]
+=== European Guidelines (2016) ===
+* Macrolide-susceptible: [[azithromycin]] 500 mg p.o. on day one, followed by 250 mg daily on days 2 to 5
+* Macrolide-resistant, or second-line: [[moxifloxacin]] 400 mg p.o. daily for 7 to 10 days
+* Third-line:
+** [[Doxycycline]] 100 mg p.o. twice daily for 14 days (eradication in about 30%)
+** [[Pristinamycin]] 1 g p.o. four times daily for 10 days
+* Complicated infection involving [[PID]] or [[epididymitis]]: [[moxifloxacin]] 400 mg p.o. daily for 14 days
+* Test-of-cure is recommended as routine, collected at least 3 weeks after start of treatment
+== Further Reading ==
+* [https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/mycoplasma-genitalium/treatment-follow-up.html Canadian STI Guidelines]
+* [https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm CDC Guidelines]
+* 2016 European guideline on ''Mycoplasma genitalium'' infections. ''J Eur Acad Dermatol Venereol''. 2016;30:1650-1656. doi: [https://doi.org/10.1111/jdv.13849 10.1111/jdv.13849]{{DISPLAYTITLE:''Mycoplasma genitalium''}}
 [[Category:Infectious diseases]]
 [[Category:Sexually-transmitted infections]]