Mycoplasma Genitalium is a bacterium that can cause urethritis
and cervicitis. It is also believed that Mycoplasma Genitalium can cause pelvic
inflammatory disease in women and prostatitis and epididymitis in men. The
evidence for mycoplasma genitalium as a sexually transmitted infection is well
documented, as is the pathogenicity following studies of the polymorphonuclear
leucocytes in male urethral swabs, which shows a high inflammatory potential.
Diagnosis is through PCR as the bacteria grow very slowly and do not culture
The question is how to treat Mycoplasma
Genitalium once it is diagnosed? The traditional treatment has been a single
dose of 1 g Azithromycin but this treatment fails on an unacceptably high
number of occasions and resistance is then often observed. It is our view that 1 g single dose Azithromycin should never be used for this infection. Our
preference is for a 5 day course of Azithromycin with 500 mg on day one and
then 250 mg on the following 4 days. We have had success with Doxycycline,
although there is growing evidence of resistance. A final choice would be
Moxifloxacin for 10 days if other treatments have been shown to fail.