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Time to manage Mycoplasma genitalium as an STI: but not with azithromycin 1 g!

Horner, Patricka,b; Blee, Karlab; Adams, Elisabetha,c

Current Opinion in Infectious Diseases: February 2014 - Volume 27 - Issue 1 - p 68–74
doi: 10.1097/QCO.0000000000000030

Purpose of review Mycoplasma genitalium is a sexually transmitted infection that causes significant morbidity in men and women and is a co-factor in HIV transmission. However, commercial diagnostic tests are not generally available for M. genitalium and sub-optimal treatment is often given. We review the literature on the burden of infection, how it may present in clinical practice and the effectiveness of current treatment regimens.

Recent findings In-vivo and in-vitro data strongly suggest that M. genitalium is an important cause of urethritis, cervicitis, pelvic inflammatory disease and potentially asymptomatic proctitis. Studies now consistently demonstrate suboptimal eradication rates with the current treatment regimens recommended first line for the treatment of nongonococcal urethritis. Concurrently, there has been a rapid emergence of antibiotic resistance in M. genitalium, with macrolide resistance now appearing to be endemic in some centres, and quinolone resistance is beginning to emerge.

Summary In the absence of specific M. genitalium diagnostic and antimicrobial resistance testing, azithromycin 1 g should not be used for the management of patients with symptomatic disease potentially caused by M. genitalium. This review offers an alternative evidence-based approach to managing such patients that should, theoretically, reduce the risk of the development of antimicrobial resistance.

aSchool of Social and Community Medicine, University of Bristol, UK

bBristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Tower Hill, Bristol

cAquarius Population Health, London, UK

Correspondence to Dr Patrick Horner, School of Social and Community Medicine, University of Bristol, 39 Whatley Rd, Bristol BS8 2PS, UK. Tel: +44 117 928 7387; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.