Mycoplasma genitalium: an unknown agent.

My focus today was on Mycoplasma Genitalium as it has been a topic of many discussions recently. 

Several presenters discussed this topic

Dr Catriona Bradshaw, Melbourne Sexual Health

Dr Jorgen Jensen, Statens Serum Institute, Copenhagen

Prof. Charlotte Gaydos, John  Hopkins Centre

Dr Lisa Manhart, University of Washington 

Mycoplasma Genitalium (MG) causes symptoms similar to C. Trachomatis & N. Gonorrhoea 

Sequelae in women include pelvic inflammatory disease, spontaneous abortion, preterm birth and infertility. 

Diagnosis is limited to NAAT as culture lacks sensitivity and takes a long time. It is however recommended that NAAT testing should include resistance assay.

First line treatment regimes have included azithromycin and doxycycline, individually or in varying combinations, but doxycycline has a low efficacy rate and macrolide resistance has developed after 20 years use of azithromycin for other STI's. 

Moxifloxacin has been used as second line treatment but the past 10 years has seen emerging failure rates in some countries with rates as high as 15% in Asia-Pacific regions. Recent warnings from FDA and Europe, high cost and side effects make this option unpopular.

Funding for testing and trials of new classes of antmicrobials include

* solithromycin

* lefamulin

* diafloxacin

* zoliflodacin

* gepotidasin

The emergence of dual class resistance to both macrolides and  quinolones means there is no highly effective class of antimicrobials currently available to treat  MG. 

Prof. Basil Donovan from the Kirby Institute Sydney in his discussion of treatment of chlamydia, advocates for alternatives to azithromycin. This concerns me, as my experience in a sexual health clinic is that poor compliance is a major factor for using single dose treatments. I hope that new antimicrobial treatments will include single dose.