Mycoplasma genitalium infections: current treatment options and resistance issues

Figures & data

Table 1 Signs, symptoms and complications of Mycoplasma genitalium infection

Signs and symptoms: females	Signs and symptoms: males
Asymptomatic: 40% – 75%	Asymptomatic: 70%
Increased or altered vaginal discharge (<50%)	Urethritis (acute, persistent and recurrent)
Dysuria or urgency (30%)	Dysuria
Occasionally inter-menstrual bleeding or post-coital bleeding	Urethral discharge
Cervicitis	Proctitis
Lower abdominal pain (<20%)	Balanoposthitis
Complications: females	Complications: males
Pelvic inflammatory disease (endometritis, salpingitis)	Sexually acquired reactive arthritis
Tubal factor infertility	Epididymitis
Sexually acquired reactive arthritis	Rarely conjunctivitis in adults
Adverse pregnancy outcome
Infertility (only indirect evidence)

Note: Data from references 50 to 56.

Table 2 Indications for laboratory testing for Mycoplasma genitalium as per the 2016 European guidelines

Signs and symptoms
Symptoms or signs of urethritis in men Mucopurulent cervicitis
Cervical or vaginal discharge with a risk factor for STIs Intermenstrual or post coital bleeding
Acute pelvic pain and/or PID
Acute epididymo-orchitis in a male aged <50 years
Risk factors
Any of the above symptoms in a regular sexual partner
Persons with high-risk sexual behavior (age <40 years and >3 new sexual contacts in last year)
Sexual contact with persons with an STI or PID, in particular
M. genitalium infected persons
Before termination of pregnancy or other procedures that breach the cervical barrier
Regular testing of MSM, including anal sampling

Note: Data adapted from Jensen et al.⁷⁰

Abbreviations: MSM, men who have sex with men; PID, pelvic inflammatory disease; STI, sexually transmitted disease.

Table 3 European guidelines for management of Mycoplasma genitalium infection

Type of infection	Macrolide resistance	First-line antibiotics	Second-line antibiotics	Third-line antibiotics
Uncomplicated infection	No	Azithromycin or josamycin	Moxifloxacin	Doxycycline or pristinamycin
	Yes	Moxifloxacin
Complicated infection (pelvic inflammatory disease, epididymitis)	Moxifloxacin 400 mg once a day for 14 days

Note: Data from Jensen et al.⁷⁰

JensenJSCusiniMGombergMMoiH2016 European guideline on Mycoplasma genitalium infectionsJ Eur Acad Dermatol Venereol201630101650165627505296

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