Treating Mycoplasma genitalium: Overcoming Antibiotic Resistance

Mycoplasma genitalium (MG) is now one of the most antibiotic-resistant STIs, with global treatment failure rates exceeding 40%. Successful eradication requires resistance-guided therapy and strict follow-up protocols.

🔬 Current Resistance Landscape (2024 Data)

*Although the drug resistance rate is low (<10%), the cure rate of single use is only 30%-40%.

⚠️ Critical Alert: Single-dose azithromycin is contraindicated – induces resistance!

Treatment of Mycoplasma Genitalium

Macrolide or fluoroquinolone antibiotics can be used to treat the infection of Mycoplasma genitalium.

The Growing Threat of Antibiotic Resistance in Mycoplasma genitalium

Research shows that 40% to 68.4% of Mgen strains are resistant to macrolides (e.g., azithromycin) and tetracyclines (e.g., doxycycline) [1,2]. Additionally, 4.5% to 20% exhibit resistance to fluoroquinolones (e.g., moxifloxacin) [1-5]. Alarmingly, around 8.6% of infections show dual resistance (to both macrolides and fluoroquinolones) [6].

The major challenge with Mgen is its rapidly increasing antibiotic resistance. Some patients receive antibiotic treatment but fail to fully eradicate highly resistant Mgen strains, leading to recurrent infections and further escalation of resistance. Researchers warn that rising resistance to azithromycin and doxycycline could lead to widespread untreatable Mgen infections [2].

The medical community attributes this crisis to suboptimal treatment, localized antibiotic misuse, and overuse of antibiotics [2-7].

References: 

[1] : Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at a STI Clinic in Guangzhou, China, 2016-2018. BMC Infect Dis 2020 Dec 11;20:950.

[2]  Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation.  Clinical Infectious Disease, 2019:68 (15 February)

[3] : Antibiotic Susceptibility Profiles of Mycoplasma Hominis and Ureaplasma Urealyticum Isolated During a Population-Based Study Concerning Women Infertility in Northeast Romania. Braz J Microbiol 2011 Jan-Mar;42(1):256–260.

[4] Li Y, Su X, Le W, et al. Mycoplasma genitalium in Symptomatic Male Urethritis: Macrolide Use Is Associated With Increased Resistance. Clin Infect Dis. 2020;70(5):805-810.

[5] Pond MJ, Nori AV, Witney AA et. al. High prevalence of antibiotic-resistant Mycoplasma genitalium in nongonococcal urethritis: the need for routine testing and the inadequacy of current treatment options. Clin Infect Dis. 2014;58(5):631-637. 

[6] Murray GL, Bradshaw CS, Bissessor M, et al. Increasing macrolide and fluoroquinolone resistance in Mycoplasma genitalium. Emerg Infect Dis 2017; 23:809–12

[7] Dorothy AM, Yusha Tao, Hannah Shilling et al. Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis. Lancet Infec Dis. 2020; 20(11):1302-1324)