Mycoplasma Genitalium: Should we look and how can we treat it?
Dr. Tim Read
Mycoplasma Genitalium (MG) is the bug that has all of a sudden made day-to-day testing and treatment in a sexual health service complicated. No longer can we just test the heterosexuals for chlamydia and everyone else for everything else - MG has raised questions and have had sexual health clinicians almost at logger-heads with what to do about it - who to test, asymptomatic or only symptomatic; what to do if found - straight treatment or reduce the bacterial load first and then treat specifically?
Dr Read showed information from Melbourne Sexual Health regarding the prevalence of infection in both asymptomatic and symptomatic men who have sex with men. He concluded that if we look we will find! But is is not clear how a MG in an asymptomatic man might affect that man or his partners.
It is known that MG causes the same spectrum of infection as Chlamydia and it is known that untreated CT is thought to be problematic in both men and women due to the inflammation it causes - leading to possible scaring, infertility and pelvic infection etc. But not enough is known about the long term sequelae of MG.
Treatment is complex and MSHS is using long course treatment (doxy/azithro or doxy/moxi) - However they have also utilised 'resistance-guided' therapy using a PCR test that not only detects MG but informs the clinician if that particular sample has macrolide resistance. (2/3 of samples in this research were macrolide resistance). Using this technique they had a 90% cure rate using doxy to lower the bacterial load.
The recommendation he gives for MG are as follows -
Treat NGU with doxy pending MG test
consider reducing the azithro when coinfection with MG likely
base therapy on known of likely macrolide resistance
do not screen asymptomatic people for MG
need more data on prevelence in heterosexuals.