Mycoplasma genitalium: Difference between revisions
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Mycoplasma genitalium
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== Clinical Manifestations == |
== Clinical Manifestations == |
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+ | * Asympomatic in 40-75% of sexually active women and up to 70% in sexually active men |
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* [[Non-gonococcal urethritis]] or cervicitis, especially if resistant to standard treatment for gonorrhoea and chlamydia |
* [[Non-gonococcal urethritis]] or cervicitis, especially if resistant to standard treatment for gonorrhoea and chlamydia |
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+ | ** 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) |
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− | * [[Pelvic inflammatory disease]] |
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+ | * Complications in women include [[pelvic inflammatory disease]], infertility, and [[sexually-acquired reactive arthritis]] |
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+ | * Complications in men include [[epididymitis]] and [[sexually-acquired reactive arthritis]] |
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+ | * Ocular infection can cause [[conjunctivitis]] |
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== Differential Diagnosis == |
== Differential Diagnosis == |
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== Management == |
== Management == |
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+ | === Canadian Guidelines === |
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+ | * Suspected cervicitis or urethritis: |
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⚫ | |||
⚫ | |||
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+ | * Suspected or confirmed macrolide-resistance: [[Is treated by::moxifloxacin]] 400 mg PO daily for 7 days |
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+ | * 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]] |
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+ | * Unclear if test-of-cure is required; if done, wait at least 3 weeks before sending NAAT |
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+ | === American Guidelines (2021) === |
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− | {{DISPLAYTITLE:''Mycoplasma genitalium''}} |
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+ | |||
+ | * 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 |
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+ | * 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 |
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+ | * Test-of-cure not recommended for asymptomatic people |
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+ | * If symptoms are persistent, treat with [[moxifloxacin]] |
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+ | |||
+ | === European Guidelines (2016) === |
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+ | |||
+ | * Macrolide-susceptible: [[azithromycin]] 500 mg p.o. on day one, followed by 250 mg daily on days 2 to 5 |
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+ | * Macrolide-resistant, or second-line: [[moxifloxacin]] 400 mg p.o. daily for 7 to 10 days |
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+ | * Third-line: |
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+ | ** [[Doxycycline]] 100 mg p.o. twice daily for 14 days (eradication in about 30%) |
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+ | ** [[Pristinamycin]] 1 g p.o. four times daily for 10 days |
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+ | * Complicated infection involving [[PID]] or [[epididymitis]]: [[moxifloxacin]] 400 mg p.o. daily for 14 days |
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+ | * Test-of-cure is recommended as routine, collected at least 3 weeks after start of treatment |
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+ | |||
+ | == Further Reading == |
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+ | |||
+ | * [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] |
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+ | * [https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm CDC Guidelines] |
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+ | * 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''}} |
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[[Category:Infectious diseases]] |
[[Category:Infectious diseases]] |
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[[Category:Sexually-transmitted infections]] |
[[Category:Sexually-transmitted infections]] |
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
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
Further Reading
- Canadian STI Guidelines
- CDC Guidelines
- 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2016;30:1650-1656. doi: 10.1111/jdv.13849