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- Jensen, J. S.Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark (author)
2021 European guideline on the management of Mycoplasma genitalium infections
- Article/chapterEnglish2022
Publisher, publication year, extent ...
- 2022-02-19
- Wiley-Blackwell Publishing Inc.2022
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- LIBRIS-ID:oai:DiVA.org:oru-97588
- https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-97588URI
- https://doi.org/10.1111/jdv.17972DOI
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- Language:English
- Summary in:English
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- Mycoplasma genitalium infection contributes to 10-35% of non-chlamydial non-gonococcal urethritis in men. In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID) in 10-25%. Transmission of M. genitalium occurs through direct mucosal contact.CLINICAL FEATURES AND DIAGNOSTIC TESTS: Asymptomatic infections are frequent. In men, urethritis, dysuria and discharge predominate. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. Symptoms are the main indication for diagnostic testing. Diagnosis is achievable only through nucleic acid amplification testing and must include investigation for macrolide resistance mutations.THERAPY: Therapy for M .genitalium is indicated if M. genitalium is detected. Doxycycline has a cure rate of 30-40%, but resistance is not increasing. Azithromycin has a cure rate of 85-95% in macrolide-susceptible infections. An extended course of azithromycin appears to have a higher cure rate, and pre-treatment with doxycycline may decrease organism load and the risk of macrolide resistance selection. Moxifloxacin can be used as second-line therapy but resistance is increasing.RECOMMENDED TREATMENT: Uncomplicated M. genitalium infection without macrolide resistance mutations or resistance testing: Azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral). Second-line treatment and treatment for uncomplicated macrolide-resistant M. genitalium infection: Moxifloxacin 400 mg od for 7 days (oral). Third-line treatment for persistent M. genitalium infection after azithromycin and moxifloxacin: Doxycycline or minocycline 100 mg bid for 14 days (oral) may cure 40-70%. Pristinamycin 1 g qid for 10 days (oral) has a cure rate of around 75%. Complicated M. genitalium infection (PID, epididymitis): Moxifloxacin 400 mg od for 14 days. MAIN CHANGES FROM THE 2016 EUROPEAN M.GENITALIUM GUIDELINE: Due to increasing antimicrobial resistance and warnings against moxifloxacin use, indications for testing and treatment have been narrowed to primarily involve symptomatic patients. The importance of macrolide resistance-guided therapy is emphasised.
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- Cusini, M.Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (author)
- Gomberg, M.Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia (author)
- Moi, H.Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway (author)
- Wilson, J.Genitourinary Medicine and HIV, Leeds Teaching Hospitals NHS Trust, Leeds, UK (author)
- Unemo, Magnus,1970-Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine(Swepub:oru)muo (author)
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, DenmarkFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (creator_code:org_t)
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- In:Journal of the European Academy of Dermatology and Venereology: Wiley-Blackwell Publishing Inc.36:5, s. 641-6500926-99591468-3083
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