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

@article{Horner2014TimeTM,
  title={Time to manage Mycoplasma genitalium as an STI: but not with azithromycin 1 g!},
  author={Patrick J Horner and Karla Blee and Elisabeth J. Adams},
  journal={Current Opinion in Infectious Diseases},
  year={2014},
  volume={27},
  pages={68–74}
}
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… 
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Mycoplasma genitalium infection: current treatment options, therapeutic failure, and resistance-associated mutations
TLDR
A strong and consistent association exists between presence of 23S rRNA gene mutations and azithromycin treatment failure and an upward trend in the prevalence of macrolide-resistant M. genitalium infections is indicated.
Management of Mycoplasma genitalium infections – can we hit a moving target?
TLDR
There is a critical need for trials of combinations of existing registered drugs and new antimicrobial compounds, implementation of diagnostic testing combined with molecular detection of resistance, and antimicrobial surveillance.
Mycoplasma genitalium infections: current treatment options and resistance issues
TLDR
There is currently a need to formulate diagnostic algorithms and etiology-based treatment regimens rather than the syndromic approach, preferably using combination therapy instead of a monotherapy, for the early detection and management of MDR M. genitalium infections.
Efficacy of Antimicrobial Therapy for Mycoplasma genitalium Infections.
TLDR
Treatment failures after extended doses of azithromycin similarly increased, and circulating macrolide resistance was present in high levels in several areas, but moxifloxacin remains the most effective therapy, but treatment failures and quinolone resistance are emerging.
Diagnosis and antimicrobial treatment of Mycoplasma genitalium infection: sobering thoughts
TLDR
In the short to medium term, combination therapy and/or the advent of a new antibiotic might abate the spread of resistance, but in the long term, there is potential for increasing prevalence of untreatable M. genitalium disease.
Mycoplasma genitalium: An Overlooked Sexually Transmitted Pathogen in Women?
TLDR
Prospective studies on the prevalence, pathophysiology, and long-term reproductive consequences of M. genitalium infection in the general population are needed to determine if screening protocols are necessary.
Antimicrobial-resistant sexually transmitted infections: gonorrhoea and Mycoplasma genitalium
TLDR
Clinicians need to be aware of the current guidelines on diagnostic procedures, recommended treatment regimens, as well as therapeutic options for multidrug-resistant bacteria, and elucidate how AMRs compromise treatment effectiveness, guiding research for effective future therapies.
Macrolide resistance in Mycoplasma genitalium in Catalonia, Spain: a 1 year prospective study.
TLDR
The results support the contribution of the previous use of macrolides in resistant strains, and given the difficulties in performing TOC in all patients, the inclusion ofmacrolide resistance in the detection test should be mandatory.
Molecular Basis of Antibiotic Resistance in Mycoplasma genitalium.
The Efficacy of Azithromycin for the Treatment of Genital Mycoplasma genitalium: A Systematic Review and Meta-analysis.
  • A. Lau, C. Bradshaw, J. Hocking
  • Medicine
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2015
TLDR
The efficacy of a single dose of 1 gram of azithromycin for the treatment of urogenital MG has decreased to approach 60%, and most of the available evidence is based on observational studies that have considerable variability in sample size and timing of microbial cure.
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References

SHOWING 1-10 OF 70 REFERENCES
Mycoplasma genitalium: should we treat and how?
TLDR
Existing data on infection in women are limited and inconsistent but suggest that M. genitalium is associated with urethritis, cervicitis, pelvic inflammatory disease, and possibly female infertility, and available data suggest that azithromycin is superior to doxycycline in treating M. genitalsium infection.
Fluoroquinolone and Macrolide Resistance-Associated Mutations in Mycoplasma genitalium
TLDR
The results indicate that further surveillance is needed, and testing and treatment protocols for M. genitalium infections may need to be reviewed, as well as support anecdotal clinical reports of azithromycin and moxifloxacin treatment failures in Sydney.
Azithromycin antimicrobial resistance and genital Chlamydia trachomatis infection: duration of therapy may be the key to improving efficacy
  • P. Horner
  • Medicine, Biology
    Sexually Transmitted Infections
  • 2012
TLDR
The evidence for treatment failure is reviewed, whether the authors need to modify current treatment regimes and suggests possible topics for future research are considered.
Azithromycin and moxifloxacin for microbiological cure of Mycoplasma genitalium infection: an open study
TLDR
Azithromycin 1 g as a single dose seems to be the best choice of treatment for M. genitalium, with moxifloxacin 400 mg × 1 for seven days if treatment fails.
Detection of macrolide resistance in Mycoplasma genitalium in France.
TLDR
For the first time, macrolide resistance for M. genitalium is described in France and its detection has increased since 2006, with figures ranging from 10% to 15.4% of patients per year.
Transmission and Selection of Macrolide Resistant Mycoplasma genitalium Infections Detected by Rapid High Resolution Melt Analysis
TLDR
A rapid high resolution melt analysis assay targeting resistance mutations in the MG 23S rRNA gene was developed and validated by examining pre- and post-treatment archived samples from MG-infected patients, and was able to detect all mutational changes determined in this study by DNA sequencing.
Mycoplasma genitalium: An Emerging Cause of Sexually Transmitted Disease in Women
TLDR
Collectively, M. genitalium is highly prevalent in high- and low-risk populations, and should be considered an etiologic agent of select reproductive tract disease syndromes in women.
Treatment of Mycoplasma genitalium. Observations from a Swedish STD Clinic
TLDR
Although azithromycin 1 g was not significantly less efficient than extended dosage, it was associated with selection of macrolide resistant M. genitalium strains and should not be used as first line therapy for M. female genitalium.
O19.1 Azithromycin and Doxycycline Resistance Profiles of Mycoplasma Genitalium and Association with Treatment Outcomes
TLDR
Approximately 60% of MG strains were resistant to azithromycin at baseline; azithroitcin treatment failures occurred in 90–100% of men who received azithromcin; development of new antimicrobial therapies for MG is essential.
Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial.
  • J. Schwebke, A. Rompalo, J. Y. Lee
  • Medicine, Biology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2011
TLDR
Addition of tinidazole to the treatment regimen did not result in higher cure rates but effectively eradicated trichomonas, and doxycycline had significantly better efficacy against Chlamydia, whereas azithromycin was superior to doxy cycline for the treatment of M. genitalium.
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