Mycoplasma Genitalium

Aka: Mycoplasma Genitalium

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II. Epidemiology

  1. Mycoplasma Genitalium is the second most common Bacterial STI (Chlamydia is the first) as of 2022 in U.S.

III. Pathophysiology

  1. Gram Negative Bacteria found in genitourinary tract as a Sexually Transmitted Infection
  2. Mycoplasma Genitalium causes Non-Gonococcal Urethritis
    1. Responsible for 25% of non-chlamydia Urethritis and 30% of recurrent Urethritis

IV. Associated Conditions

  1. Non-Gonococcal Urethritis
  2. Cervicitis
  3. Pelvic Inflammatory Disease

V. Labs

  1. Screening Indications
    1. Symptomatic patients with Urethritis or Cervicitis
    2. Pelvic Inflammatory Disease (consider)
    3. Persistent Epididymitis
    4. Avoid testing in isolated Vaginal Discharge
  2. Mycoplasma Genitalium PCR (NAAT)
    1. Obtain sample from first void urine sample, vulvovaginal swab or rectal swab
    2. Reflex Macrolide resistance testing is available from some labs

VI. Management

  1. Macrolide Resistance (or unknown, testing unavailable)
    1. First: Doxycycline 100 mg orally twice daily for 7 days
    2. Next: Moxifloxacin (Avelox) 400 mg orally daily for 7 days
  2. Macrolide Sensitive
    1. First: Doxycycline 100 mg orally twice daily for 7 days
    2. Next: Azithromycin 1000 mg on Day 1, then 500 mg daily on days 2, 3 and 4

VII. References

  1. Manhart (2011) Clin Infect Dis 53 Suppl 3(Suppl 3):S129-42 +PMID: 22080266 [PubMed]
  2. Workowski (2021) MMWR Recomm Rep 70(4): 1-187 [PubMed]

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