Criteria & Principles
DUHS Adult and Adolescent (≥13 yrs) Management Guidance
- Benefits of treatment are not established for asymptomatic patients. We recommend against routine asymptomatic screening for M. genitalium.
- Guidelines support testing for M. genitalium in the following:
- Patients with persistent or recurrent symptoms of urethritis or cervicitis following completion of standard syndromic treatment
- May be considered in initial evaluation of cervicitis or PID.
- Observational studies suggest associations between M. genitalium and cervicitis (in 10-30% of cases) or PID (in 10% of cases) – however, the benefits of testing or treating for M. genitalium in PID remain unproven.
- Macrolide resistance is emerging in M. genitalium and thus a sequential treatment strategy is recommended, with limited evidence basis. Susceptibility testing would require referral lab testing.
Treatment
Severity
All Severity
Asymptomatic detection1: No treatment
Sex partner of known case (symptomatic or asymptomatic): May offer empiric treatment as below. Risk/benefit discussion with the patient is encouraged. This is an area without clear recommendations, therapy is long, and clinicians should weigh ADE risk.
Symptomatic cervicitis/urethritis2:
- Preferred: doxycycline 100 mg PO Q12h for 7 days followed by moxifloxacin 400 mg PO daily for 7 days
- Alternative (if moxifloxacin allergic): doxycycline 100 mg PO Q12h for 7 days followed by azithromycin 1 g on day 8, followed by azithromycin 500 mg PO daily for 3 days. Given risk of macrolide resistance, consider test of cure ≥21 days after completion of treatment if alternative regimen is used.
- Pregnancy: Do not treat if detected on asymptomatic screening. If risk/benefit discussion with the patient indicates need for treatment for persistent or recurrent cervicitis/urethritis: azithromycin 1g on day 1 followed by 500mg on days 2 through 4. Clearance with this regimen is not assured.
1Current USPSTF guidelines do not recommend including Mycoplasma genitalium in routine STI screening of asymptomatic individuals (including as part of prenatal screening).
2CDC guidelines offer different treatment options if macrolide resistance results are known; however send out test results will likely not be available at the time of clinical decision-making.
References
https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm