ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Mycoplasma genitalium - is this the new chlamydia?
M. genitalium was isolated 30 years ago.
The organism is difficult to culture, and NAAT is difficult to access.
Commercial NAAT point of care testing is around the corner, so diagnosis is about to become much more accessible.
It has taken longer to establish its role as a pathogen because it is more commonly asymptomatic.
No evidence to support screening, just test those who are symptomatic.
Prevalence is about 1-3% of men and women.
Has similar clinical features to chlamydia.
Increases the risk of tubal abort and PID 2-fold.
No cell wall so not sensitive to penicillin-like antibiotics.
There has been widespread use of azithromycin for NSU symptoms, so macrolide (azithromycin) resistance increasing and is now at 50%, however it remains the first-line recommendation.
Moxifloxacin looked promising but resistance to this is now at 15-25% and increasing, currently for second-line treatment.
Guidelines concentrate on urogenital infection and don’t cover rectal infection.
Pristinamycin currently is our only other option, reserved for third-line treatment.