Mycoplasma genitalium: update on diagnosis, treatment and resistance

Abstract

Mycoplasma genitalium is a sexually transmitted bacterium and a major causative agent of non-chlamydial non-gonococcal urethritis (NGU) with approximately 20–35% of NGU cases attributed to this infection. In women it has been associated with cervicitis, endometritis, and pelvic inflammatory disease. There are a limited number of commercial nucleic acid amplification assays available for its detection, however none are yet FDA approved and most laboratories are either using these commercial or in-house developed assays to provide diagnostic results. Mycoplasma genitalium infection is primarily treated with macrolide antibiotic azithromycin. However, it has been shown that use of azithromycin in the treatment of NGU and other infections has resulted in increased macrolide resistance, attributed to mutations on the 23S rRNA gene. The currently recommended second line treatment, moxifloxacin, is a fluoroquinolone antibiotic. Moxifloxacin is relatively expensive, can result in side effects and is not suitable in pregnant women, which limits its widespread usage. Resistance to moxifloxacin has also been reported with its increasing use. Detection, appropriate treatment and test of cure of M. genitalium are important in control of this infection.