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&lt;h1 id=&quot;cc-m-header-16739461125&quot; class=&quot;&quot;&gt;&lt;strong&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;Mycoplasma genitalium: Challenges in Diagnosis and Treatment&lt;/span&gt;&lt;/strong&gt;&lt;/h1&gt;
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&lt;h2 id=&quot;cc-m-16739461525&quot; class=&quot;j-module n j-header &quot;&gt;&lt;strong&gt;&lt;span style=&quot;font-size: 14px; color: #ff99cc;&quot;&gt;What is Mycoplasma Genitalium?&lt;/span&gt;&lt;/strong&gt;&lt;/h2&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;In 2015, the Centers for Disease Control and Prevention (CDC) classified Mycoplasma genitalium infection as an &quot;emerging issue&quot; in its Sexually Transmitted Diseases Treatment Guidelines. First identified in the 1980s, M. genitalium is increasingly acknowledged as a significant contributor to various sexually transmitted infections (STIs), including urethritis in men and cervicitis in women. Notably, M. genitalium is responsible for more STIs than Neisseria gonorrhoeae and ranks as the second most common STI after Chlamydia trachomatis. Despite its prevalence, diagnosing and treating M. genitalium infections can be challenging.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Infectious Disease Advisor spoke with Dr. Oluwatosin Jaiyeoba Goje from the Ob/Gyn &amp;amp; Women&#39;s Health Institute at Cleveland Clinic in Ohio, and Dr. Amesh Adalja, spokesperson for the Infectious Diseases Society of America and Senior Associate at Johns Hopkins Center for Health Security in Baltimore, Maryland, about the difficulties in diagnosing and managing M. genitalium infections.&lt;/span&gt;&lt;/p&gt;
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&lt;h2 class=&quot;_1mf _1mj&quot; data-offset-key=&quot;6aee8-0-0&quot;&gt;&lt;strong&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;An Emerging STI&lt;/span&gt;&lt;/strong&gt;&lt;/h2&gt;
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&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;M. genitalium infection is a widespread cause of STIs globally, with prevalence rates ranging from 0.4% among young adults in the United States to 4.5% in the Netherlands. In Sweden, up to 6.3% of patients at a sexually transmitted diseases (STD) clinic were found to have M. genitalium. Despite variations in prevalence between countries, M. genitalium remains the most common STI, second only to Chlamydia trachomatis.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&amp;ldquo;The prevalence of M. genitalium is particularly alarming because most infected individuals are unaware of their condition,&amp;rdquo; Dr. Goje noted. &amp;ldquo;Symptoms can be vague or absent, and if left untreated, M. genitalium can lead to serious health issues, including urethritis, cervicitis, and pelvic inflammatory disease.&amp;rdquo;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Even when patients do exhibit symptoms, healthcare providers may not consider M. genitalium as a potential cause. &amp;ldquo;Clinicians are generally less familiar with M. genitalium than with other more commonly treated STIs that they learned about in medical school,&amp;rdquo; Dr. Adalja explained. &amp;ldquo;However, M. genitalium is prevalent enough in certain situations that it shouldn&#39;t be overlooked.&amp;rdquo;&lt;/span&gt;&lt;/p&gt;
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&lt;h2 class=&quot;_1mf _1mj&quot; data-offset-key=&quot;d3hmg-0-0&quot;&gt;&lt;strong&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;Diagnostic Techniques and Challenges&lt;/span&gt;&lt;/strong&gt;&lt;/h2&gt;
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&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Dr. Adalja emphasizes that M. genitalium infection should be considered in men displaying symptoms of urethritis, which are similar to those of chlamydia and gonorrhea. &amp;ldquo;M. genitalium is the second most common cause of urethritis, and it has been thoroughly studied in men. Testing is particularly important for those who do not improve after their first course of antibiotics, as M. genitalium often shows resistance to commonly used STI treatments,&amp;rdquo; he explained.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Dr. Goje also recommends testing for M. genitalium in women experiencing persistent cervicitis symptoms, especially in those who have not responded to empirical antibiotic treatment for chlamydia and gonorrhea and who have tested negative for these pathogens.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;However, testing for M. genitalium can be challenging and time-consuming due to the slow growth of the organism. &amp;ldquo;Isolating and culturing M. genitalium is impractical when immediate antimicrobial treatment is necessary,&amp;rdquo; Dr. Goje noted.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&amp;ldquo;Although there is no FDA-approved test for M. genitalium, the nucleic acid amplification test (NAAT) is the preferred method,&amp;rdquo; Dr. Goje stated. NAAT employs polymerase chain reaction (PCR) and can be conducted on various sample types, including urethral, vaginal, and cervical swabs, as well as urine and endometrial biopsies.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;However, NAAT for M. genitalium is based on assays developed for research purposes, meaning it is typically only available in reference labs, usually at large university hospitals. &amp;ldquo;If you&amp;rsquo;re at a smaller hospital, it&amp;rsquo;s crucial to know where testing can be done and which facilities are conducting it in research contexts,&amp;rdquo; Dr. Adalja explained. &amp;ldquo;It&amp;rsquo;s not a test that is readily accessible.&amp;rdquo;&lt;/span&gt;&lt;/p&gt;
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&lt;h2 class=&quot;_1mf _1mj&quot; data-offset-key=&quot;cffig-0-0&quot;&gt;&lt;strong&gt;&lt;span style=&quot;color: #ff99cc;&quot;&gt;Management and Antimicrobial Resistance&lt;/span&gt;&lt;/strong&gt;&lt;/h2&gt;
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&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Significant antimicrobial resistance poses a major challenge in treating M. genitalium infections. Since M. genitalium lacks a cell wall, antibiotics that target cell wall biosynthesis, such as beta-lactams (e.g., penicillins and cephalosporins), are ineffective against this organism, Dr. Goje explained.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Dr. Adalja noted that patients with urethritis often receive an empirical course of doxycycline, which is effective against C. trachomatis but has high treatment failure rates for M. genitalium infections. &amp;ldquo;More than half of patients with M. genitalium treated with doxycycline may experience microbiological failure,&amp;rdquo; he said.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Dr. Goje added that patients who do not respond to an initial course of doxycycline typically need a second round of antibiotics, usually consisting of azithromycin for at least five days. However, resistance to azithromycin occurs in up to 50% of M. genitalium cases. In instances where azithromycin fails, the preferred regimen is moxifloxacin 400 mg daily for 7 to 14 days. &amp;ldquo;Initial reports indicate cure rates with moxifloxacin are 100%, although more research is needed,&amp;rdquo; Dr. Goje stated.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;To mitigate further development of antimicrobial resistance in M. genitalium, Dr. Adalja emphasized the importance of avoiding inappropriate initial antibiotic treatments, such as doxycycline. &amp;ldquo;Increasing awareness among clinicians that M. genitalium could be responsible for their patient&#39;s STI symptoms is crucial. Many clinicians outside the infectious diseases or STI specialties may not be familiar with M. genitalium and its role in STIs, leading them to prescribe incorrect antibiotics inadvertently.&amp;rdquo;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Dr. Goje pointed out that the challenges in diagnosing M. genitalium infections are significant barriers to effective treatment. &amp;ldquo;We cannot treat what we cannot diagnose,&amp;rdquo; she said. &amp;ldquo;Sometimes, we have no choice but to treat empirically based on signs and symptoms and to rule out other known causes of urethritis and cervicitis.&amp;rdquo;&lt;/span&gt;&lt;/p&gt;
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