Mycoplasma genitalium: Key Information for the Primary Care Clinician

Med Clin North Am. 2024 Mar;108(2):297-310. doi: 10.1016/j.mcna.2023.07.004. Epub 2023 Sep 14.

Abstract

Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, which appears to be a cause of urethritis and cervicitis and has been associated with pelvic inflammatory disease (PID), epididymitis, proctitis, infertility, complications during pregnancy, and human immunodeficiency virus (HIV) transmission. Three Food and Drug Administration (FDA) approved tests are available. Testing should be focused to avoid inappropriate antibiotic use. The Center of Disease Control and Prevention (CDC) guidelines recommend testing for persistent male urethritis, cervicitis, and proctitis and state that testing should be considered in cases of PID. Testing is also recommended for sexual contacts of patients with MG. Testing is not recommended in asymptomatic patients, including pregnant patients, who do not have a history of MG exposure. Although resistance-guided therapy is recommended, there are currently no FDA approved tests for MG macrolide resistance, and tests are not widely available in the United States. The CDC recommends 2-step treatment with doxycycline followed by azithromycin or moxifloxacin. Moxifloxacin is recommended if resistance testing is unavailable or testing demonstrates macrolide resistance..

Keywords: Antimicrobial resistance; Cervicitis; Fluoroquinolone; Macrolide; Mycoplasma genitalium; Nucleic acid amplification test; Urethritis.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Macrolides / therapeutic use
  • Male
  • Moxifloxacin / therapeutic use
  • Mycoplasma Infections* / complications
  • Mycoplasma Infections* / diagnosis
  • Mycoplasma Infections* / drug therapy
  • Mycoplasma genitalium*
  • Pelvic Inflammatory Disease* / complications
  • Pelvic Inflammatory Disease* / diagnosis
  • Pelvic Inflammatory Disease* / drug therapy
  • Pregnancy
  • Primary Health Care
  • Proctitis* / complications
  • Proctitis* / drug therapy
  • Urethritis* / complications
  • Urethritis* / diagnosis
  • Urethritis* / drug therapy
  • Uterine Cervicitis* / complications
  • Uterine Cervicitis* / drug therapy

Substances

  • Anti-Bacterial Agents
  • Moxifloxacin
  • Macrolides