Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 28, Number 8—August 2022
CME ACTIVITY - Online Report

Weighing Potential Benefits and Harms of Mycoplasma genitalium Testing and Treatment Approaches

Author affiliations: University of Washington, Seattle, Washington, USA (L.E. Manhart); University of Alabama at Birmingham, Birmingham, Alabama, USA (W.M. Geisler); Monash University and University of Melbourne, Melbourne, Victoria, Australia (C.S. Bradshaw); Statens Serum Institut, Copenhagen, Denmark (J.S. Jensen); Tulane University, New Orleans, Louisiana, USA (D.H. Martin)

Cite This Article

Introduction

CME Logo

Medscape CME ACTIVITY

In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at https://www.medscape.org/journal/eid; and (4) view/print certificate.

Release date: July 20, 2022; Expiration date: July 20, 2023
Learning Objectives

Upon completion of this activity, participants will be able to:

  • Describe associations of Mycoplasma genitalium with reproductive, urologic, and perinatal complications, according to an updated systematic review

  • Identify indications for M. genitalium testing, according to an updated systematic review

  • Determine management of M. genitalium infections, according to an updated systematic review

CME Editor

Jill Russell, BA, Technical Writer/Editor, Emerging Infectious Diseases.

CME Author

Laurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has the following relevant financial relationships: formerly owned stocks in AbbVie Inc.

Authors

Lisa E. Manhart, PhD, MPH; William M. Geisler, MD, MPH; Catriona S. Bradshaw, MBBS, PhD; Jørgen S. Jensen, MD, PhD; and David H. Martin, MD.

Top

Abstract

Since Mycoplasma genitalium was identified 40 years ago, much of the epidemiology has been described, diagnostic tests have been developed and approved, and recommended treatment approaches have been identified. However, the natural history remains incompletely understood, and antimicrobial resistance has rapidly increased. This review summarizes evidence published since the US Centers for Disease Control and Prevention 2015 Sexually Transmitted Diseases Treatment Guidelines. Data on sequelae remain insufficient, macrolide resistance is common, and fluoroquinolone resistance is increasing. Potential benefits of testing and treatment include resolving symptoms, interrupting transmission, and preventing sequelae. Potential harms include cost, patient anxiety, and increasing antimicrobial resistance.

Mycoplasma genitalium causes 20%–30% of male urethritis cases (1,2) and has been associated with a 2-fold increased risk for female cervicitis, preterm delivery, and pelvic inflammatory disease (PID) (3). It has also been linked to tubal-factor infertility in sero-epidemiologic studies, even after accounting for previous chlamydial infection (4,5). Despite these strong observational data, relatively few prospective studies of reproductive and perinatal complications of M. genitalium exist, and a separate meta-analysis of the association with PID restricted to cohort studies (n = 2) observed a smaller, nonstatistically significant association (6). Coupled with this epidemiologic conundrum are substantial treatment challenges. Doxycycline is only 30%–40% effective (7), and the efficacy of azithromycin and moxifloxacin has declined substantially (8,9) since the Centers for Disease Control and Prevention (CDC) 2015 Sexually Transmitted Diseases Treatment Guidelines were written. The reasons for the low efficacy of doxycycline are unclear, but treatment failures after azithromycin and moxifloxacin are caused by the emergence and spread of antimicrobial resistance (10). In a recent meta-analysis, detection of macrolide resistance mutations worldwide rose from 10% before 2010 to 51% in 2016–2017 (p<0.0001). Detection of the quinolone resistance–associated mutation most clearly linked to treatment failure (S83I) was 4.3% (10), although prevalence as high as 84% has been observed in China (11). Among urethritis cases in the United States during 2017–2018, macrolide resistance–associated mutations were detected in 64.4% and quinolone resistance–associated mutations in 11.5% (1).

Methods

This systematic review of the evidence was guided by 2 types of key questions (Table): informational questions outlining data published since the 2015 update to the CDC treatment guidelines and discussion questions outlining how the evidence should inform guidelines. We identified articles published in English since the 2015 treatment guidelines (January 1, 2015–November 30, 2021) by using the search terms mycoplasma AND genitalium OR M. genitalium to search PubMed. One investigator (L.E.M.) reviewed abstracts and manuscripts for inclusion. All authors verified included papers. In this article, we focus on new evidence on disease syndromes and antibiotic therapy and the implications for testing and treatment strategies.

Results

Identifying Evidence

We identified 743 papers. Of these, we excluded 150 by title and 195 after abstract review; 398 articles underwent full-text review (Figure). Articles did not distinguish birth sex from gender identity, so we use the terms male or men and female or women.

Associations with Disease Syndromes
Male Urethritis

M. genitalium is consistently and strongly associated with acute, persistent, and recurrent urethritis (12) and is an accepted cause of male urethritis. No new data have emerged to change this conclusion.

Epididymitis

Evidence to determine whether M. genitalium causes epididymitis remains insufficient. Only case reports have been published (1315), and no new studies have compared M. genitalium prevalence in men with and without epididymitis.

Male Infertility

Limited available evidence does not support a role for M. genitalium as a cause of male infertility. Although an increasing number of studies have investigated this possibility, many evaluated sperm quality rather than documented infertility. Studies enrolling fertile and infertile men have reported no association (1619).

Proctitis

Prevalence of rectal M. genitalium infection in a recent meta-analysis was higher among men with rectal symptoms than in men without rectal symptoms (16.1% vs. 7.5%; p = 0.039) (20). However, few studies included both symptomatic and asymptomatic men (2124), and results from those studies are inconsistent. No association was observed between M. genitalium and proctitis (odds ratio 0.8; 95% CI 0.45–1.35) in ≈1,000 men who have sex with men (MSM) in Australia (23), yet a later study from Australia found MSM with proctitis were significantly more likely to have M. genitalium than MSM without proctitis (risk difference 4.3%; 95% CI 1.1%–7.5%) (24).

Female Cervicitis

Earlier evidence on the relationship between M. genitalium and cervicitis was somewhat conflicting, partly because of varying definitions of cervicitis, but generally supported an association (3). This inconsistency remained the case in 4 newer cross-sectional studies. Of those studies, 2 demonstrated increased risk (25,26), 1 demonstrated increased risk only among a subset of persons (27), and 1 reported no increased risk (28).

Pelvic Inflammatory Disease

Data remain conflicting on the association of M. genitalium with PID, as reflected in the 2 published meta-analyses (3,6). Studies published since 2014 continued this trend, demonstrating a statistically significant 2-fold increased risk for histologic endometritis (29), a nonsignificant ≈3-fold increase in risk for incident PID (30), and no association (31). No randomized trials testing whether screening and treatment of M. genitalium reduces PID incidence have been conducted. In the absence of such trials, there are no population-based screening recommendations.

Female Infertility

In vitro inoculation of M. genitalium into fallopian tube tissue results in damage and destruction of cilia (32), suggesting that M. genitalium might impair female fertility. Consistent with this finding is the 2-fold increased risk for infertility in meta-analysis, especially among studies accounting for other microbial causes of infertility (3). More recent studies have reported mixed results. In 2 studies, serologic testing was used to detect antibodies indicative of previous infection; 1 observed a significantly longer time to conception (33), whereas the other reported no association with tubal factor infertility (34). Three studies used nucleic acid amplification testing (NAAT), which typically detects active infection, and found that M. genitalium infection was more common among infertile than fertile women (3537).

Ectopic Pregnancy

Data on ectopic pregnancy remain limited. No association was seen among women in Sweden using first-generation serologic assays (38), but a study in Saudi Arabia using NAAT to detect M. genitalium in fallopian tube tissue demonstrated a 2-fold increased risk for ectopic pregnancy among women (39). Additional studies will be required to determine whether M. genitalium causes ectopic pregnancy.

Preterm Delivery

Evidence remains insufficient on the relationship between M. genitalium infection and preterm delivery. An earlier meta-analysis demonstrated a 2-fold increased risk for preterm delivery, which was stronger among studies accounting for other infections (3). However, 2 more recent studies observed low M. genitalium prevalence (0%–1%) and were unable to evaluate an association (40,41). In a third study, M. genitalium infection was more common in women in Australia who experienced a preterm birth than in those who did not (15.4% vs. 2.3%), but this difference was not statistically significant (42). Adequately powered studies are needed.

Other Perinatal Outcomes

Evidence for an association between M. genitalium infection and spontaneous abortion is conflicting. An initial meta-analysis reported significantly increased risk in M. genitalium–infected persons (3), but subsequent studies did not (4346). Using NAAT, M. genitalium has been detected in the endotrachea of neonates (47), bronchoalveolar lavage samples from children 0–5 years (48), and ocular samples from infants born to infected mothers (49), suggesting that transmission of M. genitalium during vaginal delivery might occur. However, positive NAATs might only reflect residual DNA; larger studies are needed to determine the extent of maternal-to-child transmission.

Who Should Be Tested for M. genitalium?

Screening, diagnostic testing, and tests of cure each have different goals. Screening tests are undertaken in asymptomatic persons to provide treatment, limit sequelae, and prevent transmission. Diagnostic tests are performed in symptomatic persons to direct treatment at a specific pathogen and eliminate the organism. Tests of cure are undertaken to confirm eradication of pathogens. Recommendations for each type of testing are typically grounded in a robust body of evidence. When there is less robust evidence, as with M. genitalium, potential benefits must be weighed against potential harms.

Screening

Screening at-risk women for gonorrhea and chlamydia is recommended in the United States because infections are frequently asymptomatic (50); robust data exist on risk for sequelae from untreated infections (51); effective treatment is readily available (52,53); and, for chlamydia, data from a randomized trial demonstrated decreased risk for PID in persons screened and treated (54). M. genitalium meets only 1 of these criteria: infections are frequently asymptomatic (≈30%–60% in clinic populations) (55,56). Data on the risk for sequelae from untreated M. genitalium infections in women are less robust than data for chlamydia. Prospective studies of sequelae in women are limited, challenging our ability to infer cause (3,6). No evidence of adverse sequelae in men exists, although such data are sparse. Given the high rates of macrolide resistance and the advent of fluoroquinolone treatment failures, effective treatment is not readily available for all infected persons (10) (see section on antimicrobial therapies). Finally, randomized controlled trials evaluating whether screening and treatment of M. genitalium infections could prevent PID and perinatal complications are costly; to date, none have been undertaken despite the articulated need (57). Some population subgroups have higher risk for PID, and screening and treatment in those subgroups might yield greater benefit, but this possibility has not been assessed.

Benefits of Screening for M. genitalium

Screening and effectively treating asymptomatic persons for M. genitalium could theoretically reduce transmission and population-level prevalence (58). However, reductions in prevalence after implementing screening programs for sexually transmitted infections do not always occur, as demonstrated by increasing chlamydia prevalence in the United States (59). This increase has been offset by some declines in PID, although PID rates have slightly increased in recent years (60). If identified infections could be effectively treated while minimizing the selection of resistance, screening could reduce the likelihood of transmitted resistance, leading to subsequent reductions in the population-level prevalence of antimicrobial resistance.

Harms of Screening for M. genitalium

If asymptomatic infections do not cause sequelae, screening and treating will result in unnecessary antibiotic exposure. On an individual level, antibiotics might disrupt a person’s microbiota and lead to other health conditions, and adverse effects associated with antibiotics are occasionally serious (61). On a population level, more widespread antibiotic use speeds the emergence and spread of antimicrobial resistance, and multidrug-resistant M. genitalium infections are often refractory to treatment. Anecdotal reports suggest that treatment-refractory infections can lead to anxiety and depression that would not occur in the absence of screening. Consistent with earlier assessments (57), screening asymptomatic persons for M. genitalium is not recommended in the 2021 CDC Sexually Transmitted Infections Treatment Guidelines (62).

Diagnostic Testing

Etiologic management is increasingly recommended over syndromic management in clinical care (63) and requires accurate diagnostic tests. Given the time and difficulty in culturing M. genitalium (64), NAATs are the preferred method of detection. Two NAATs are approved by the US Food and Drug Administration: the Aptima Mycoplasma genitalium assay (Hologic, https://www.hologic.com) and the Cobas TV/MG assay (Roche Diagnostics, https://diagnostics.roche.com). Both tests have good sensitivity and specificity when recommended specimen types are used (urine for men and vaginal swab for women) (65). Several other NAATs are available in other countries, including assays that incorporate the detection of macrolide-resistance mutations. The ResistancePlus MG assay (SpeeDx, https://plexpcr.com), S-DiaMGRes assay (Diagenode, https://www.diagenode.com), and RealAccurate TVMGres assay (PathoFinder, https://www.pathofinder.com) are approved for use in Australia, the United Kingdom, Europe, and Canada. To date, no assays to detect macrolide resistance have been approved by the US Food and Drug Administration, although 1 company has developed analyte-specific reagents for use in laboratory-developed tests (Hologic).

Benefits of Diagnostic Testing

The clinical manifestations of M. genitalium and Chlamydia trachomatis infections are similar (66), yet antibiotics recommended for syndromic treatment of urethritis and cervicitis have low efficacy against M. genitalium (67,68). Diagnostic testing for M. genitalium when patients first seek care would enable providers to rapidly follow nonspecific syndromic therapy with a regimen more effective against M. genitalium. This practice would shorten the time to appropriate therapy, reduce the duration of infection, more rapidly alleviate symptoms, likely reduce risk for sequelae, reduce opportunities for transmission to partners, and lead to fewer interactions with the healthcare system.

Harms of Diagnostic Testing

Diagnostic testing to determine etiology and appropriate therapy might increase healthcare costs. Detecting M. genitalium results in additional treatment, potentially with expensive antimicrobial drugs that can have serious adverse effects. Even when symptoms resolve, a positive test result might exacerbate patient distress. Sequelae in men are uncommon, and the debate over sequelae in women has led some to believe asymptomatic M. genitalium infections are not of sufficient concern to warrant treatment. If asymptomatic infections truly do not warrant treatment, the cost might outweigh the benefits; however, this possibly has not been studied. The 2021 CDC treatment guidelines recommend diagnostic testing only for persons with persistent or recurrent symptoms (62).

Tests of Cure

Tests of cure are undertaken to confirm pathogen eradication, preventing transmission and reinfection. Because NAATs detect both viable and nonviable DNA/RNA, explicit time frames for tests of cure have been outlined, ranging from 7–14 days after therapy for pharyngeal gonorrhea to ≈28 days for chlamydia in pregnant persons (69). Macrolide-sensitive M. genitalium infections are cleared relatively quickly after azithromycin therapy (70); when tests of cure are performed, the timeframe is similar to that for gonorrhea and chlamydia. Australian guidelines recommend a test of cure 14–21 days after treatment (71).

Benefits of Tests of Cure

The primary benefit of tests of cure is verifying that the organism has been successfully eradicated, which is key for pathogens that cause serious sequelae, particularly during asymptomatic infection. Because M. genitalium sometimes recrudesces after symptoms resolve (72), a test of cure would identify the need for additional therapy earlier, in turn reducing the risk of infecting sex partners, potentially with resistant strains not detected initially or selected during treatment. Finally, patients might appreciate confirmation that they are cured and not contagious.

Harms of Tests of Cure

A positive test of cure indicates either treatment failure or reinfection. Cases of reinfection are usually retreated with the same antibiotic, whereas cases of treatment failure are typically treated with an alternative antibiotic. When the risk for long-term sequelae is high, the benefit of assuring eradication outweighs the harm of additional antibiotic pressure. When the risk for sequelae is low or uncertain, the potential harm of additional antibiotics might outweigh the benefit of confirming eradication. Despite some evidence that M. genitalium can result in adverse sequelae in women, numerous outstanding questions about natural history remain. These questions include uncertainty over the frequency of upper reproductive tract sequelae, frequency of spontaneous clearance, clinical significance of asymptomatic infections, and transmission risk with low organism load that persists after treatment. Given these outstanding questions, the benefit of tests of cure is currently unknown. The 2021 CDC treatment guidelines only recommend tests of cure when resistance testing is not available and moxifloxacin cannot be used (62).

Which Antimicrobial Therapies Should Be Used against M. genitalium?

Azithromycin (1 g, 1 dose) was recommended over doxycycline (100 mg 2×/d for 7 days) for M. genitalium in the 2015 treatment guidelines. Moxifloxacin was recommended for azithromycin treatment failures (69). The 2021 guidelines removed single-dose azithromycin from recommended therapies (62), primarily because of increasing antimicrobial resistance (10).

Doxycycline

Doxycycline is now the recommended first-line therapy for nongonococcal urethritis and cervicitis in the United States (62) and in many other countries globally. However, microbiologic cure rates of M. genitalium infection after doxycycline treatment are low, ranging from 30% to 45% in 3 randomized trials of urethritis treatment (67,68,72). Little data are available for women, and no new trials have been performed. Estimates of doxycycline efficacy remain unchanged.

Azithromycin

The efficacy of azithromycin for M. genitalium infection declined over time through 2015 (8), and more recent studies observed microbiologic cure rates as low as 52% (73). Selection for macrolide resistance typically occurs in ≈10%–12% of M. genitalium–infected persons receiving single-dose azithromycin therapy (7376), and this regimen is no longer recommended in most contexts (71,77). Some studies have evaluated extended-dose azithromycin (1.5 g given over 5 days) and a meta-analysis suggested less frequent selection of macrolide resistance with this regimen (78). However, a historical comparison reported no difference in efficacy or in selection for macrolide resistance between the 2 regimens (73). Presence of macrolide-resistance mutations in the 23S rRNA gene is strongly correlated with microbiologic treatment failure after azithromycin, and the global prevalence of these mutations increased from 10% before 2010 to 51% in 2016–2017 (10). In 6 US sexual health clinics, the prevalence of macrolide resistance was 64% (range 59.6%–75.9%) and higher in MSM (75.7%) (1).

Moxifloxacin

Although the efficacy of moxifloxacin for M. genitalium was initially high (100%), it declined to 89% in studies during 2010–2017 (9). Sitafloxacin, a more potent fluoroquinolone, has somewhat higher cure rates but is not available in many countries including the United States. Multiple mutations in the parC gene have been reported, but only some have been correlated with moxifloxacin treatment failure. The S83I mutation is most common and most strongly associated with treatment failure; it has been detected in 4.3% of infections globally (10). Additional mutations in the gyrA gene (M95I and D99N) likely have a synergistic effect (79), but GyrA mutations are rarely assessed.

Resistance-Guided Therapy

Where diagnostic assays that can detect macrolide resistance mutations are available, sequential resistance-guided therapy is feasible and results in higher cure rates. Under sequential resistance-guided therapy, initial empiric treatment with doxycycline is followed by a second antibiotic (either azithromycin or moxifloxacin) on the basis of the pathogen’s susceptibility profile. Tetracycline resistance in M. genitalium develops infrequently, and treatment with doxycycline reduces the organism load, subsequently limiting development of resistance to the second antibiotic (80). In Australia, where this approach was developed, macrolide-susceptible infections are treated with high-dose azithromycin (1 g, then 500 mg/d for 3 days) after the initial doxycycline regimen, whereas macrolide-resistant infections are treated with moxifloxacin (400 mg/d for 7 days) after the initial doxycycline regimen. In a setting where macrolide resistance was high (>70%) and quinolone resistance moderate (13%–22%), cure rates for doxycycline followed by azithromycin were 95.4% and 92.0% for doxycycline followed by moxifloxacin; selection for macrolide resistance occurred in only 4.6% (81). Given high macrolide resistance in the United States, the 2021 CDC treatment guidelines recommend resistance-guided therapy where possible and sequential treatment with doxycycline followed by moxifloxacin when resistance testing is not available (62).

PID Treatment

Recommended outpatient PID treatment in the 2015 CDC treatment guidelines consisted of antimicrobial drugs for empiric treatment of gonorrhea and chlamydia (a cephalosporin and doxycycline). This regimen had limited effectiveness against M. genitalium; cure rates were as low as 56% (69,82). More recent data demonstrated cure rates of ≈95% for PID treatment regimens that incorporated metronidazole, regardless of whether the regimen included azithromycin or moxifloxacin (83). Similarly, persistent cervical M. genitalium infections were significantly less common among patients receiving a PID regimen with metronidazole than in patients not taking metronidazole (84). Metronidazole targets anaerobes and is thought to lack activity against M. genitalium (85), suggesting that eradicating anaerobes might enhance M. genitalium clearance. However, this hypothesis has not yet been evaluated.

Alternative Antibiotics

Minocycline (100 mg orally 2×/d for 14 days) and pristinamycin (1g 3×/d for 10 days) in combination with doxycycline (100 mg 2×/d for 10 days) have been used to treat M. genitalium–infected patients when other antibiotics have failed. Minocycline cured 71% (25/35) patients in a sexual health clinic in Australia, and pristinamycin cured ≈75% (55/73) patients (86). Minocycline is widely available, but pristinamycin is not in many areas, including the United States. MICs for lefamulin are low (87), but no efficacy data for M. genitalium infection in humans have been published. Gepotidacin also has low MICs and in vitro experiments suggest combination therapy with doxycycline might improve efficacy, but this possibility has not been tested in vivo (88). Longer durations of doxycycline have not been tested in comparative studies, but a recent study found 59% of patients with macrolide resistant infections experienced microbiologic cure after a 14-day regimen (89). Combination therapy using doxycycline and moxifloxacin yielded microbiologic cure rates equivalent to those observed using sequential therapy (90), suggesting efficacy but no advantage over resistance-guided therapy. Combination therapy using doxycycline and sitafloxacin has been more effective (91).

Sex Partner Management

Concordance of M. genitalium infection was 40%–50% in heterosexual partnerships and 27% in MSM partnerships in a recent meta-analysis (6). The lower observed concordance in MSM may reflect inclusion of persons tested at only one anatomic site. When both partners were tested at the urethra and rectum, concordance was 42% (92). This result suggests that partners of M. genitalium–positive patients should be tested and treated to reduce the risk for reinfection. This strategy is recommended in guidelines from Europe, the United Kingdom, and Canada (9395), although testing of partners is not specified in Canada. Australia guidelines also recommend contact tracing for heterosexuals and ongoing partners of symptomatic MSM (71). No evidence suggests that partner infections have differential antimicrobial susceptibility. The 2021 CDC treatment guidelines recommend testing and treating infected partners with the same antibiotic provided to the index patient (62).

Conclusion

M. genitalium is now an established sexually transmitted infection that poses substantial challenges for developing optimal testing and treatment approaches. Antimicrobial resistance has grown rapidly, and untreatable infections have begun to appear. New antimicrobial drugs and better antimicrobial stewardship of existing antibiotics are urgently needed. Resistance-guided therapy is a vital tool to reduce antibiotic pressure and maintain the efficacy of existing antimicrobials. However, only some diagnostic tests incorporate the detection of antimicrobial resistance, limiting our ability to use this tool. Concerns about the rapid spread of resistance have led to recommendations to limit testing and treatment for M. genitalium infections to patients with symptoms. Rigorous and adequately powered clinical trials of screening and treatment of M. genitalium in women are critically needed. Without a better understanding of the natural history of infection, particularly the risk for sequelae, the benefits and harms of testing and treatment approaches cannot be truly weighed.

Top

Acknowledgments

This work was supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (grant numbers R01AI110666, U19AI113173, R01AI61019 to L.E.M.) and by the US Centers for Disease Control and Prevention/DHHS (grant number NU62PS924587 to Nicholas Van Wagoner for W.M.G.).

L.E.M. has received research funding and honoraria from Hologic, Inc., and Nabriva Therapeutics. W.M.G. has received research funding and honoraria from Hologic, Inc. C.S.B. has received institutional funding to support research on M. genitalium from Speedx Pty. Ltd., diagnostic test kits from Hologic, Inc., and Cepheid and donation of a pharmaceutical for evaluation for the treatment of M. genitalium from Nabriva Therapeutics. J.S.J. has received research funding and honoraria from Hologic, Inc., SpeeDx Pty. Ltd., Cepheid, Abbott, and GlaxoSmithKline and honoraria from Roche.

Top

References

  1. Bachmann  LH, Kirkcaldy  RD, Geisler  WM, Wiesenfeld  HC, Manhart  LE, Taylor  SN, et al.; MAGNUM Laboratory Working Group. Prevalence of Mycoplasma genitalium infection, antimicrobial resistance mutations and symptom resolution following treatment of urethritis. Clin Infect Dis. 2020;71:e62432. DOIPubMedGoogle Scholar
  2. Chambers  LC, Morgan  JL, Lowens  MS, Robinson  TS, Romano  SS, Leipertz  GL, et al. Cross-sectional study of urethral exposures at last sexual episode associated with non-gonococcal urethritis among STD clinic patients. Sex Transm Infect. 2019;95:2128. DOIPubMedGoogle Scholar
  3. Lis  R, Rowhani-Rahbar  A, Manhart  LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61:41826. DOIPubMedGoogle Scholar
  4. Svenstrup  HF, Fedder  J, Kristoffersen  SE, Trolle  B, Birkelund  S, Christiansen  G. Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility—a prospective study. Fertil Steril. 2008;90:51320. DOIPubMedGoogle Scholar
  5. Clausen  HF, Fedder  J, Drasbek  M, Nielsen  PK, Toft  B, Ingerslev  HJ, et al. Serological investigation of Mycoplasma genitalium in infertile women. Hum Reprod. 2001;16:186674. DOIPubMedGoogle Scholar
  6. Cina  M, Baumann  L, Egli-Gany  D, Halbeisen  FS, Ali  H, Scott  P, et al. Mycoplasma genitalium incidence, persistence, concordance between partners and progression: systematic review and meta-analysis. Sex Transm Infect. 2019;95:32835. DOIPubMedGoogle Scholar
  7. Jensen  JS, Bradshaw  C. Management of Mycoplasma genitalium infections—can we hit a moving target? BMC Infect Dis. 2015;15:343. DOIPubMedGoogle Scholar
  8. Lau  A, Bradshaw  CS, Lewis  D, Fairley  CK, Chen  MY, Kong  FY, et al. The efficacy of azithromycin for the treatment of genital Mycoplasma genitalium: a systematic review and meta-analysis. Clin Infect Dis. 2015;61:138999. DOIPubMedGoogle Scholar
  9. Li  Y, Le  WJ, Li  S, Cao  YP, Su  XH. Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection. Int J STD AIDS. 2017;28:110614. DOIPubMedGoogle Scholar
  10. Machalek  DA, Tao  Y, Shilling  H, Jensen  JS, Unemo  M, Murray  G, et al. Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis. Lancet Infect Dis. 2020;20:130214. DOIPubMedGoogle Scholar
  11. Li  Y, Su  X, Le  W, Li  S, Yang  Z, Chaisson  C, et al. Mycoplasma genitalium in symptomatic male urethritis: macrolide use is associated with increased resistance. Clin Infect Dis. 2020;70:80510. DOIPubMedGoogle Scholar
  12. Taylor-Robinson  D, Jensen  JS. Mycoplasma genitalium: from Chrysalis to multicolored butterfly. Clin Microbiol Rev. 2011;24:498514. DOIPubMedGoogle Scholar
  13. Eickhoff  JH, Frimodt-Møller  N, Walter  S, Frimodt-Møller  C. A double-blind, randomized, controlled multicentre study to compare the efficacy of ciprofloxacin with pivampicillin as oral therapy for epididymitis in men over 40 years of age. BJU Int. 1999;84:82734. DOIPubMedGoogle Scholar
  14. Ito  S, Tsuchiya  T, Yasuda  M, Yokoi  S, Nakano  M, Deguchi  T. Prevalence of genital mycoplasmas and ureaplasmas in men younger than 40 years-of-age with acute epididymitis. Int J Urol. 2012;19:2348. DOIPubMedGoogle Scholar
  15. Hamasuna  R. Acute epididymitis detected with Mycoplasma genitalium: a case report. Japanese Journal of Sexually Transmitted Diseases. 2008;19:8992.
  16. Kjaergaard  N, Kristensen  B, Hansen  ES, Farholt  S, Schønheyder  HC, Uldbjerg  N, et al. Microbiology of semen specimens from males attending a fertility clinic. APMIS. 1997;105:56670. DOIPubMedGoogle Scholar
  17. Abusarah  EA, Awwad  ZM, Charvalos  E, Shehabi  AA. Molecular detection of potential sexually transmitted pathogens in semen and urine specimens of infertile and fertile males. Diagn Microbiol Infect Dis. 2013;77:2836. DOIPubMedGoogle Scholar
  18. Gimenes  F, Medina  FS, Abreu  AL, Irie  MM, Esquiçati  IB, Malagutti  N, et al. Sensitive simultaneous detection of seven sexually transmitted agents in semen by multiplex-PCR and of HPV by single PCR. [Erratum in: PLoS One. 2014;9:e112864]. PLoS One. 2014;9:e98862. DOIPubMedGoogle Scholar
  19. Plecko  V, Zele-Starcevic  L, Tripkovic  V, Skerlev  M, Ljubojevic  S, Plesko  S, et al. Unusually low prevalence of Mycoplasma genitalium in urine samples from infertile men and healthy controls: a prevalence study. BMJ Open. 2014;4:e005372. DOIPubMedGoogle Scholar
  20. Latimer  RL, Shilling  HS, Vodstrcil  LA, Machalek  DA, Fairley  CK, Chow  EPF, et al. Prevalence of Mycoplasma genitalium by anatomical site in men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect. 2020;96:56370. DOIPubMedGoogle Scholar
  21. Francis  SC, Kent  CK, Klausner  JD, Rauch  L, Kohn  R, Hardick  A, et al. Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005-2006. Sex Transm Dis. 2008;35:797800. DOIPubMedGoogle Scholar
  22. Foschi  C, Gaspari  V, Sgubbi  P, Salvo  M, D’Antuono  A, Marangoni  A. Sexually transmitted rectal infections in a cohort of ‘men having sex with men’. J Med Microbiol. 2018;67:10507. DOIPubMedGoogle Scholar
  23. Read  TRH, Murray  GL, Danielewski  JA, Fairley  CK, Doyle  M, Worthington  K, et al. Symptoms, sites, and significance of Mycoplasma genitalium in men who have sex with men. Emerg Infect Dis. 2019;25:71927. DOIPubMedGoogle Scholar
  24. Chow  EPF, Lee  D, Bond  S, Fairley  CK, Maddaford  K, Wigan  R, et al. Nonclassical pathogens as causative agents of proctitis in men who have sex with men. Open Forum Infect Dis. 2021;8:ofab137.
  25. Lusk  MJ, Garden  FL, Rawlinson  WD, Naing  ZW, Cumming  RG, Konecny  P. Cervicitis aetiology and case definition: a study in Australian women attending sexually transmitted infection clinics. Sex Transm Infect. 2016;92:17581. DOIPubMedGoogle Scholar
  26. Latimer  RL, Vodstrcil  LA, Plummer  EL, Doyle  M, Murray  GL, Fairley  CK, et al. The clinical indications for testing women for Mycoplasma genitalium. Sex Transm Infect. 2022;98:27785.PubMedGoogle Scholar
  27. Lillis  RA, Martin  DH, Nsuami  MJ. Mycoplasma genitalium infections in women attending a sexually transmitted disease clinic in New Orleans. Clin Infect Dis. 2019;69:45965. DOIPubMedGoogle Scholar
  28. Balkus  JE, Manhart  LE, Jensen  JS, Anzala  O, Kimani  J, Schwebke  J, et al. Mycoplasma genitalium infection in Kenyan and US women. Sex Transm Dis. 2018;45:51421. DOIPubMedGoogle Scholar
  29. Taylor  BD, Zheng  X, O’Connell  CM, Wiesenfeld  HC, Hillier  SL, Darville  T. Risk factors for Mycoplasma genitalium endometritis and incident infection: a secondary data analysis of the T cell Response Against Chlamydia (TRAC) Study. Sex Transm Infect. 2018;94:41420. DOIPubMedGoogle Scholar
  30. Hay  PE, Kerry  SR, Normansell  R, Horner  PJ, Reid  F, Kerry  SM, et al. Which sexually active young female students are most at risk of pelvic inflammatory disease? A prospective study. Sex Transm Infect. 2016;92:636. DOIPubMedGoogle Scholar
  31. Oliphant  J, Azariah  S. Pelvic inflammatory disease associated with Chlamydia trachomatis but not Mycoplasma genitalium in New Zealand. Sex Health. 2016;13:438. DOIPubMedGoogle Scholar
  32. Baczynska  A, Funch  P, Fedder  J, Knudsen  HJ, Birkelund  S, Christiansen  G. Morphology of human Fallopian tubes after infection with Mycoplasma genitalium and Mycoplasma hominisin vitro organ culture study. Hum Reprod. 2007;22:96879. DOIPubMedGoogle Scholar
  33. Peipert  JF, Zhao  Q, Schreiber  CA, Teal  S, Turok  DK, Natavio  M, et al. Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study. Am J Obstet Gynecol. 2021;225:157.e19. DOIPubMedGoogle Scholar
  34. Idahl  A, Jurstrand  M, Olofsson  JI, Fredlund  H. Mycoplasma genitalium serum antibodies in infertile couples and fertile women. Sex Transm Infect. 2015;91:58991. DOIPubMedGoogle Scholar
  35. Rajkumari  N, Kaur  H, Roy  A, Gupta  N, Dhaliwal  LK, Sethi  S. Association of Mycoplasma genitalium with infertility in North Indian women. Indian J Sex Transm Dis AIDS. 2015;36:1448. DOIPubMedGoogle Scholar
  36. Alfarraj  DA, Somily  AM. Isolation of Mycoplasma genitalium from endocervical swabs of infertile women. Saudi Med J. 2017;38:54952. DOIPubMedGoogle Scholar
  37. Adesola Ajani  T, Oluwasola  TAO, Ajani  MA, Bakare  RA. The prevalence of, and risk factors for, Mycoplasma genitalium infection among infertile women in Ibadan: A cross-sectional study. Int J Reprod Biomed (Yazd). 2017;15:6138. DOIPubMedGoogle Scholar
  38. Jurstrand  M, Jensen  JS, Magnuson  A, Kamwendo  F, Fredlund  H. A serological study of the role of Mycoplasma genitalium in pelvic inflammatory disease and ectopic pregnancy. Sex Transm Infect. 2007;83:31923. DOIPubMedGoogle Scholar
  39. Ashshi  AM, Batwa  SA, Kutbi  SY, Malibary  FA, Batwa  M, Refaat  B. Prevalence of 7 sexually transmitted organisms by multiplex real-time PCR in Fallopian tube specimens collected from Saudi women with and without ectopic pregnancy. BMC Infect Dis. 2015;15:569. DOIPubMedGoogle Scholar
  40. Rowlands  S, Danielewski  JA, Tabrizi  SN, Walker  SP, Garland  SM. Microbial invasion of the amniotic cavity in midtrimester pregnancies using molecular microbiology. Am J Obstet Gynecol. 2017;217:71.e15. DOIPubMedGoogle Scholar
  41. Kayem  G, Doloy  A, Schmitz  T, Chitrit  Y, Bouhanna  P, Carbonne  B, et al. Antibiotics for amniotic-fluid colonization by Ureaplasma and/or Mycoplasma spp. to prevent preterm birth: A randomized trial. PLoS One. 2018;13:e0206290. DOIPubMedGoogle Scholar
  42. Payne  MS, Ireland  DJ, Watts  R, Nathan  EA, Furfaro  LL, Kemp  MW, et al. Ureaplasma parvum genotype, combined vaginal colonisation with Candida albicans, and spontaneous preterm birth in an Australian cohort of pregnant women. BMC Pregnancy Childbirth. 2016;16:312. DOIPubMedGoogle Scholar
  43. Averbach  SH, Hacker  MR, Yiu  T, Modest  AM, Dimitrakoff  J, Ricciotti  HA. Mycoplasma genitalium and preterm delivery at an urban community health center. Int J Gynaecol Obstet. 2013;123:547. DOIPubMedGoogle Scholar
  44. Ramazanzadeh  R, Khodabandehloo  M, Farhadifar  F, Rouhi  S, Ahmadi  A, Menbari  S, et al. A case-control study on the relationship between Mycoplasma genitalium infection in women with normal pregnancy and spontaneous abortion using polymerase chain reaction. Osong Public Health Res Perspect. 2016;7:3348. DOIPubMedGoogle Scholar
  45. Rahimkhani  M, Mordadi  A, Gilanpour  M. Detection of urinary Chlamydia trachomatis, Mycoplasma genitalium and human papilloma virus in the first trimester of pregnancy by PCR method. Ann Clin Microbiol Antimicrob. 2018;17:25. DOIPubMedGoogle Scholar
  46. Contini  C, Rotondo  JC, Magagnoli  F, Maritati  M, Seraceni  S, Graziano  A, et al. Investigation on silent bacterial infections in specimens from pregnant women affected by spontaneous miscarriage. J Cell Physiol. 2018;234:1007. DOIPubMedGoogle Scholar
  47. Luki  N, Lebel  P, Boucher  M, Doray  B, Turgeon  J, Brousseau  R. Comparison of polymerase chain reaction assay with culture for detection of genital mycoplasmas in perinatal infections. Eur J Clin Microbiol Infect Dis. 1998;17:25563. DOIPubMedGoogle Scholar
  48. Patel  KK, Salva  PS, Webley  WC. Colonization of paediatric lower respiratory tract with genital Mycoplasma species. Respirology. 2011;16:10817. DOIPubMedGoogle Scholar
  49. Justel  M, Alexandre  I, Martínez  P, Sanz  I, Rodriguez-Fernandez  A, Fernandez  I, et al. Vertical transmission of bacterial eye infections, Angola, 2011–2012. Emerg Infect Dis. 2015;21:4713. DOIPubMedGoogle Scholar
  50. Farley  TA, Cohen  DA, Elkins  W. Asymptomatic sexually transmitted diseases: the case for screening. Prev Med. 2003;36:5029. DOIPubMedGoogle Scholar
  51. Stamm  WE. Chlamydia trachomatis infections of the adult. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, et al., editors. Sexually transmitted diseases. 4th ed. New York: McGraw-Hill; 2008. p. 575–94.
  52. Dombrowski  JC, Wierzbicki  MR, Newman  LM, Powell  JA, Miller  A, Dithmer  D, et al. Doxycycline versus azithromycin for the treatment of rectal chlamydia in men who have sex with men: a randomized controlled trial. Clin Infect Dis. 2021;73:82431. DOIPubMedGoogle Scholar
  53. Lau  A, Kong  FYS, Fairley  CK, Templeton  DJ, Amin  J, Phillips  S, et al. Azithromycin or doxycycline for asymptomatic rectal Chlamydia trachomatis. N Engl J Med. 2021;384:241827. DOIPubMedGoogle Scholar
  54. Scholes  D, Stergachis  A, Heidrich  FE, Andrilla  H, Holmes  KK, Stamm  WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996;334:13626. DOIPubMedGoogle Scholar
  55. Wang  R, Trent  ME, Bream  JH, Nilles  TL, Gaydos  CA, Carson  KA, et al. Mycoplasma genitalium infection is not associated with genital tract inflammation among adolescent and young adult women in Baltimore, Maryland. Sex Transm Dis. 2022;49:13944. DOIPubMedGoogle Scholar
  56. Manhart  LE, Geisler  WM, Golden  MR, Leipertz  GL, McNeil  CJ, Pathela  P, et al. Mycoplasma genitalium: is it time for surveillance? Presented at: 2021 STI & HIV World Congress; July 1–17, 2021; Amsterdam, the Netherlands.
  57. Golden  MR, Workowski  KA, Bolan  G. Developing a public health response to Mycoplasma genitalium. J Infect Dis. 2017;216(suppl_2):S4206. DOIPubMedGoogle Scholar
  58. Ong  JJ, Ruan  L, Lim  AG, Bradshaw  CS, Taylor-Robinson  D, Unemo  M, et al. Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical model. EClinicalMedicine. 2021;33:100779. DOIPubMedGoogle Scholar
  59. Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2019. Atlanta: US Department of Health and Human Services; 2021.
  60. Kreisel  KM, Llata  E, Haderxhanaj  L, Pearson  WS, Tao  G, Wiesenfeld  HC, et al. The burden of and trends in pelvic inflammatory disease in the United States, 2006–2016. J Infect Dis. 2021;224(Suppl 2):S10312. DOIPubMedGoogle Scholar
  61. Pépin  J, Saheb  N, Coulombe  MA, Alary  ME, Corriveau  MP, Authier  S, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile–associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis. 2005;41:125460. DOIPubMedGoogle Scholar
  62. Workowski  KA, Bachmann  LH, Chan  PA, Johnston  CM, Muzny  CA, Park  I, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70:1187. DOIPubMedGoogle Scholar
  63. Wi  TE, Ndowa  FJ, Ferreyra  C, Kelly-Cirino  C, Taylor  MM, Toskin  I, et al. Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward. J Int AIDS Soc. 2019;22(Suppl 6):e25343. DOIPubMedGoogle Scholar
  64. Jensen  JS, Hansen  HT, Lind  K. Isolation of Mycoplasma genitalium strains from the male urethra. J Clin Microbiol. 1996;34:28691. DOIPubMedGoogle Scholar
  65. Van Der Pol  B, Waites  KB, Xiao  L, Taylor  SN, Rao  A, Nye  M, et al. Mycoplasma genitalium detection in urogenital specimens from symptomatic and asymptomatic men and women by use of the cobas TV/MG test. J Clin Microbiol. 2020;58:e0212419. DOIPubMedGoogle Scholar
  66. Wetmore  CM, Manhart  LE, Lowens  MS, Golden  MR, Whittington  WL, Xet-Mull  AM, et al. Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study. Sex Transm Dis. 2011;38:1806. DOIPubMedGoogle Scholar
  67. Schwebke  JR, Rompalo  A, Taylor  S, Seña  AC, Martin  DH, Lopez  LM, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens—a randomized clinical trial. Clin Infect Dis. 2011;52:16370. DOIPubMedGoogle Scholar
  68. Manhart  LE, Gillespie  CW, Lowens  MS, Khosropour  CM, Colombara  DV, Golden  MR, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis. 2013;56:93442. DOIPubMedGoogle Scholar
  69. Workowski  KA, Bolan  GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1137.PubMedGoogle Scholar
  70. Falk  L, Enger  M, Jensen  JS. Time to eradication of Mycoplasma genitalium after antibiotic treatment in men and women. J Antimicrob Chemother. 2015;70:313440. DOIPubMedGoogle Scholar
  71. Alliance  ASH. Australian STI management guidelines for use in primary care: Mycoplasma genitalium. 2020 [cited 2020 Jan 6]. http://www.sti.guidelines.org.au/sexually-transmissible-infections/mycoplasma-genitalium
  72. Mena  LA, Mroczkowski  TF, Nsuami  M, Martin  DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium–positive urethritis in men. Clin Infect Dis. 2009;48:164954. DOIPubMedGoogle Scholar
  73. Read  TR, Fairley  CK, Tabrizi  SN, Bissessor  M, Vodstrcil  L, Chow  EP, et al. Azithromycin 1.5g over 5 days compared to 1g single dose in urethral Mycoplasma genitalium: impact on treatment outcome and resistance. Clin Infect Dis. 2017;64:2506. DOIPubMedGoogle Scholar
  74. Anagrius  C, Loré  B, Jensen  JS. Treatment of Mycoplasma genitalium. Observations from a Swedish STD clinic. PLoS One. 2013;8:e61481. DOIPubMedGoogle Scholar
  75. Walker  J, Fairley  CK, Bradshaw  CS, Tabrizi  SN, Twin  J, Chen  MY, et al. Mycoplasma genitalium incidence, organism load, and treatment failure in a cohort of young Australian women. Clin Infect Dis. 2013;56:1094100. DOIPubMedGoogle Scholar
  76. Bissessor  M, Tabrizi  SN, Twin  J, Abdo  H, Fairley  CK, Chen  MY, et al. Macrolide resistance and azithromycin failure in a Mycoplasma genitalium–infected cohort and response of azithromycin failures to alternative antibiotic regimens. Clin Infect Dis. 2015;60:122836. DOIPubMedGoogle Scholar
  77. Jensen  JS, Cusini  M, Gomberg  M, Moi  H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2016;30:16506. DOIPubMedGoogle Scholar
  78. Horner  P, Ingle  SM, Garrett  F, Blee  K, Kong  F, Muir  P, et al. Which azithromycin regimen should be used for treating Mycoplasma genitalium? A meta-analysis. Sex Transm Infect. 2018;94:1420. DOIPubMedGoogle Scholar
  79. Murray  GL, Bodiyabadu  K, Danielewski  J, Garland  SM, Machalek  DA, Fairley  CK, et al. Moxifloxacin and sitafloxacin treatment failure in Mycoplasma genitalium infection: association with parC mutation G248T (S83I) and concurrent gyrA mutations. J Infect Dis. 2020;221:101724.PubMedGoogle Scholar
  80. Read  TRH, Fairley  CK, Murray  GL, Jensen  JS, Danielewski  J, Worthington  K, et al. Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation. Clin Infect Dis. 2019;68:55460. DOIPubMedGoogle Scholar
  81. Durukan  D, Read  TRH, Murray  G, Doyle  M, Chow  EPF, Vodstrcil  LA, et al. Resistance-guided antimicrobial therapy using doxycycline-moxifloxacin and doxycycline-2.5 g azithromycin for the treatment of Mycoplasma genitalium infection: efficacy and tolerability. Clin Infect Dis. 2020;71:14618. DOIPubMedGoogle Scholar
  82. Haggerty  CL, Totten  PA, Astete  SG, Lee  S, Hoferka  SL, Kelsey  SF, et al. Failure of cefoxitin and doxycycline to eradicate endometrial Mycoplasma genitalium and the consequence for clinical cure of pelvic inflammatory disease. Sex Transm Infect. 2008;84:33842. DOIPubMedGoogle Scholar
  83. Latimer  RL, Read  TRH, Vodstrcil  LA, Goller  JL, Ong  JJ, Fairley  CK, et al. Clinical features and therapeutic response in women meeting criteria for presumptive treatment for pelvic inflammatory disease associated with Mycoplasma genitalium. Sex Transm Dis. 2019;46:739. DOIPubMedGoogle Scholar
  84. Wiesenfeld  HC, Meyn  LA, Darville  T, Macio  IS, Hillier  SL. A randomized controlled trial of ceftriaxone and doxycycline, with or without metronidazole, for the treatment of acute pelvic inflammatory disease. Clin Infect Dis. 2021;72:11819. DOIPubMedGoogle Scholar
  85. Edwards  DI. Nitroimidazole drugs—action and resistance mechanisms. I. Mechanisms of action. J Antimicrob Chemother. 1993;31:920. DOIPubMedGoogle Scholar
  86. Doyle  M, Vodstrcil  LA, Plummer  EL, Aguirre  I, Fairley  CK, Bradshaw  CS. Nonquinolone options for the treatment of Mycoplasma genitalium in the era of increased resistance. Open Forum Infect Dis. 2020;7:ofaa291.
  87. Paukner  S, Gruss  A, Jensen  JS. In vitro activity of lefamulin against sexually transmitted bacterial pathogens. Antimicrob Agents Chemother. 2018;62:e0238017. DOIPubMedGoogle Scholar
  88. Jensen  JS, Nørgaard  C, Scangarella-Oman  N, Unemo  M. In vitro activity of the first-in-class triazaacenaphthylene gepotidacin alone and in combination with doxycycline against drug-resistant and -susceptible Mycoplasma genitalium. Emerg Microbes Infect. 2020;9:138892. DOIPubMedGoogle Scholar
  89. Gossé  M, Nordbø  SA, Pukstad  B. Evaluation of treatment with two weeks of doxycycline on macrolide-resistant strains of Mycoplasma genitalium: a retrospective observational study. BMC Infect Dis. 2021;21:1225. DOIPubMedGoogle Scholar
  90. Vodstrcil  LA, Plummer  EL, Doyle  M, Murray  GL, Bodiyabadu  K, Jensen  JS, et al. Combination therapy for Mycoplasma genitalium, and new insights into the utility of parC mutant detection to improve cure. Clin Infect Dis. 2022 Jan 4 [Epub ahead of print]. DOIPubMedGoogle Scholar
  91. Durukan  D, Doyle  M, Murray  G, Bodiyabadu  K, Vodstrcil  L, Chow  EPF, et al. Doxycycline and sitafloxacin combination therapy for treating highly resistant Mycoplasma genitalium. Emerg Infect Dis. 2020;26:18704. DOIPubMedGoogle Scholar
  92. Slifirski  JB, Vodstrcil  LA, Fairley  CK, Ong  JJ, Chow  EPF, Chen  MY, et al. Mycoplasma genitalium infection in adults reporting sexual contact with infected partners, Australia, 2008–2016. Emerg Infect Dis. 2017;23:182633. DOIPubMedGoogle Scholar
  93. Jensen  JS, Cusini  M, Gomberg  M, Moi  H, Wilson  J, Unemo  M. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2022;36:64150. DOIPubMedGoogle Scholar
  94. Soni  S, Horner  PJ. Launch of the BASHH guideline for the management of M. genitalium in adults. Sex Transm Infect. 2019;95:237. DOIPubMedGoogle Scholar
  95. Singh  AE, Labbé  AC, Auguste  U. Mycoplasma genitalium infection. CMAJ. 2019;191:E103. DOIPubMedGoogle Scholar

Top

Figure
Table

Top

Follow Up

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 75% passing score) and earn continuing medical education (CME) credit, please go to https://www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers.

You must be a registered user on http://www.medscape.org. If you are not registered on http://www.medscape.org, please click on the “Register” link on the right hand side of the website.

Only one answer is correct for each question. Once you successfully answer all post-test questions, you will be able to view and/or print your certificate. For questions regarding this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@medscape.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please go to https://www.ama-assn.org. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the AMA PRA CME credit certificate, and present it to your national medical association for review.

Article Title: 
Weighing Potential Benefits and Harms of Mycoplasma genitalium Testing and Treatment Approaches
CME Questions
  • Your patient is a 34-year-old female patient with pelvic inflammatory disease (PID). According to the updated systematic review by Manhart and colleagues, which of the following statements about associations of Mycoplasma genitalium with reproductive, urologic, and perinatal complications is correct?

    • The association of M. genitalium with PID is well-established

    • M. genitalium is a documented cause of male infertility and proctitis

    • The bulk of evidence supports a link between M. genitalium and obstetric outcomes

    • Gaps in our understanding of M. genitalium must be filled to optimize testing and treatment strategies

  • According to the updated systematic review by Manhart and colleagues, which of the following statements about indications for M. genitalium testing is correct?

    • Most diagnostic tests for M. genitalium include detection of antimicrobial resistance

    • Evidence to date allows weighing the benefits and harms of M. genitalium testing

    • Screening, diagnostic testing, and tests of cure each have different goals, and evidence to date for M. genitalium is insufficiently robust to inform clear recommendations

    • Culturing urine (for men) or vaginal swabs (for women) for M. genitalium is the preferred method of detection

  • According to the updated systematic review by Manhart and colleagues, which of the following statements about management of M. genitalium infections is correct?

    • Although treatment approaches for M. genitalium infections have been identified, antimicrobial resistance has emerged and spread at an alarming rate

    • To limit spread, testing and treatment for M. genitalium infections should include asymptomatic contacts of known cases

    • Single-dose azithromycin (1 g) is currently preferred for treatment for M. genitalium infections

    • 2021 CDC guidelines recommend treating infected partners with a different antibiotic from that provided to the index person

Top

Cite This Article

DOI: 10.3201/eid2808.220094

Original Publication Date: July 20, 2022

Related Links

Table of Contents – Volume 28, Number 8—August 2022

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Lisa E. Manhart, University of Washington Center for AIDS and STD, Box 359931, 325 9th Ave, Seattle, WA 98104, USA

Send To

10000 character(s) remaining.

Top

Page created: June 09, 2022
Page updated: July 20, 2022
Page reviewed: July 20, 2022
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external