Mycoplasma Genitalium: Key information and resources

Key information and additional resources for Mycoplasma genitalium.

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Key information

Public health importance

M. genitalium is a sexually transmitted pathogen that is emerging as a significant cause of genital tract infections.

Screening

Routine screening for M. genitalium is not recommended. Testing for M. genitalium is recommended only when chlamydia and gonorrhea have been ruled out as a cause of persistent or recurrent urethritis, cervicitis or pelvic inflammatory disease (PID), following empiric treatment for gonorrhea and chlamydia, when pre-treatment NAAT tests or follow-up TOC are negative for chlamydia and gonorrhea).

Diagnostic testing

Nucleic acid amplification tests (NAAT) for M. genitalium may be done on urine, cervical, vaginal, urethral or meatal swabs and endometrial biopsies.

Treatment

Management and treatment of most infections will occur in the context of syndromic management of urethritis, cervicitis or PID. This is because screening is not routine and test availability is limited.

Limited information is available about M. genitalium antimicrobial resistance (AMR) patterns in Canada.

The recommended treatment for suspected or confirmed M. genitalium-associated cervicitis or urethritis (not previously treated with azithromycin) is azithromycin 500 mg PO on day one, followed by 250 mg PO on days two to five.

Azithromycin 1 g PO in a single dose may select for macrolide resistance in M. genitalium. People who have not responded to this regimen may not benefit from retreatment with the multi-day regimen. When cervicitis or urethritis has previously been treated with azithromycin, the recommended treatment is moxifloxacin 400 mg PO once daily for seven days.

The recommended treatment of suspected or confirmed macrolide-resistant M. genitalium-associated cervicitis or urethritis is moxifloxacin 400 mg PO once daily for seven days.

The recommended treatment for suspected or confirmed M. genitalium-associated PID is moxifloxacin 400 mg PO once daily for 14 days in addition to a standard treatment regimen for PID.

Follow-up

Test of cure (TOC) should be done at least three weeks after the completion of treatment for people who remain symptomatic or who reside in regions with documented high prevalence of antibiotic resistance.

Partner notification

Notification and treatment of current partners should be considered (regardless of symptoms) to prevent reinfection of the index case.

Resources

Additional Resources

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