Editing Mycoplasma genitalium (section)

==Treatment==
The U.S. [[Centers for Disease Control and Prevention]] recommends a step-wise treatment approach for ''Mycoplasma genitalium'' with [[doxycycline]] for seven days followed immediately by a seven-day course of [[moxifloxacin]] as the preferred therapy due to high rates of macrolide resistance.<ref name="pmid38331481"/><ref name="JAMA Tuddenham">{{cite journal |last1=Tuddenham |first1=Susan |last2=Hamill |first2=Matthew M. |last3=Ghanem |first3=Khalil G. |title=Diagnosis and Treatment of Sexually Transmitted Infections: A Review |journal=JAMA |date=11 January 2022 |volume=327 |issue=2 |pages=161–172 |doi=10.1001/jama.2021.23487 |pmid=35015033|s2cid=245855151 }}</ref><ref name="CDC 2021 guidelines" /> If resistance assay testing is available, and the Mgen is sensitive to macrolides, the CDC recommends a seven-day course of doxycycline followed by a four-day course of [[azithromycin]].<ref name="pmid38331481">{{cite journal |vauthors=Obafemi OA, Rowan SE, Nishiyama M, Wendel KA |title=Mycoplasma genitalium: Key Information for the Primary Care Clinician |journal=Med Clin North Am |volume=108 |issue=2 |pages=297–310 |date=March 2024 |pmid=38331481 |doi=10.1016/j.mcna.2023.07.004}}</ref>  Although the majority of ''M. genitalium'' strains are sensitive to moxifloxacin, resistance has been reported, and potential for serious, adverse side effects should be considered with this regimen. <ref>{{Cite web |title=Food and Drug Administration |url=//www.fda.gov/news-events/press-announcements/fda-updates-warnings-fluoroquinolone-antibiotics-risks-mental-health-and-low-blood-sugar-adverse |website=FDA}}</ref> Floroquinolones, including moxifloxacin, have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together including:{{cn|date=January 2023}}
* Tendinitis and tendon rupture
* Peripheral Neuropathy
* Central nervous system effects

and other serious side effects detailed in the FDA black box warning. Moxifloxacin/Avelox should be reserved for use when patients have no other treatment options. <ref>{{Cite web |title=Access Data FDA |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/021085s063lbl.pdf}}</ref>

In settings without access to resistance testing, or if moxifloxacin cannot be used, the CDC recommends as an alternative regimen: seven days of doxycycline followed by the four-day course of azithromycin, with a test of cure 21 days after treatment being required due to the high rate of macrolide resistance.  [[Beta-lactam antibiotic|Beta lactam antibiotics]] are not effective against Mgen as the organism lacks a cell wall.<ref name="CDC 2021 guidelines">{{cite journal |last1=Workowski |first1=Kimberly A. |title=Sexually Transmitted Infections Treatment Guidelines, 2021 |journal=MMWR. Recommendations and Reports |date=2021 |volume=70 |issue=4 |pages=1–187 |doi=10.15585/mmwr.rr7004a1 |pmid=34292926 |pmc=8344968}}</ref>

In the UK the British Association for Sexual Health and HIV (BASHH) guidelines for treatment are:<ref>{{cite web|url=https://www.bashh.org/guidelines|title=BASHH Guidelines|date=13 March 2015 }}</ref>
* Doxycycline 100mg twice a day for seven days followed by azithromycin 1 gram orally as a single dose then 500mg orally once daily for 2 days where organism is known to be macrolide-sensitive or where resistance status is unknown.
* Moxifloxacin 400mg orally once daily for 10 days if organism known to be macrolide-resistant or where treatment with azithromycin has failed.

Treatment of ''Mycoplasma genitalium'' infections is becoming increasingly difficult due to rapidly growing [[antimicrobial resistance]].<ref>{{Cite web |url=https://www.who.int/yaws/2013_Yaws_seminar_Lancet.pdf?ua=1&ua=1 |title=Yaws |date=2013 |website=World Health Organization |access-date=8 December 2017 |archive-date=29 November 2021 |archive-url=https://web.archive.org/web/20211129193615/https://www.who.int/yaws/2013_Yaws_seminar_Lancet.pdf?ua=1&ua=1 |url-status=live }}</ref> Diagnosis and treatment is further hampered by the fact that ''Mycoplasma genitalium'' infections are not routinely tested.<ref>{{cite journal |last1=Suneta |first1=Soni |last2=Parkhouse |first2=Andy |last3=Gillian |first3=Dean |date=24 April 2017 |title=Macrolide and quinolone-resistant ''Mycoplasma genitalium'' in a man with persistent urethritis: the tip of the British iceberg? |journal=Sexually Transmitted Infections |volume=93 |issue=8 |doi=10.1136/sextrans-2016-053077 |pmid=28438948 |pages=sextrans–2016–053077 |s2cid=9178150}}</ref> Studies have demonstrated that a 5-day course of azithromycin has a superior cure rate compared to a single, larger dose. Further, a single dose of azithromycin can lead to the bacteria becoming resistant to azithromycin.<ref>{{cite journal |last1=Yew |first1=H. S. |last2=Anderson |first2=T. |last3=Coughlan |first3=E. |last4=Werno |first4=A. |title=Induced macrolide resistance in ''Mycoplasma genitalium'' isolates from patients with recurrent nongonococcal urethritis |journal=Journal of Clinical Microbiology |year=2011 |volume=49 |issue=4 |pages=1695–1696 |doi=10.1128/JCM.02475-10 |pmid=21346049 |pmc=3122813}}</ref> Among Swedish patients, doxycycline was shown to be relatively ineffective (with a cure rate of 48% for women and 38% for men); and treatment with a single dose of azithromycin is not prescribed due to it inducing antimicrobial resistance. The five-day treatment with azithromycin showed no development of antimicrobial resistance.<ref>{{cite journal |last1=Anagrius |first1=Carin |last2=Loré |first2=Britta |last3=Jensen |first3=Jørgen Skov |last4=Coenye |first4=Tom |title=Treatment of ''Mycoplasma genitalium''. Observations from a Swedish STD Clinic |journal=PLOS ONE |year=2013 |volume=8 |issue=4 |pages=e61481 |doi=10.1371/journal.pone.0061481 |pmid=23593483 |pmc=3620223 |bibcode=2013PLoSO...861481A |doi-access=free}}</ref> Based on these findings, UK doctors are moving to the 5-day azithromycin regimen. Doxycycline is also still used, and [[moxifloxacin]] is used as a second-line treatment in case doxycyline and azithromycin are not able to eradicate the infection.<ref name="Jorgen S 2016">{{cite journal |last1=Unemo |first1=Magnus |last2=Jensen |first2=Jorgen S. |date=10 January 2017 |title=Antimicrobial-resistant sexually transmitted infections: gonorrhoea and ''Mycoplasma genitalium'' |journal=Nature Reviews Urology |volume=14 |issue=3 |pages=139–125 |doi=10.1038/nrurol.2016.268 |pmid=28072403 |s2cid=205521926}}</ref><ref>{{cite web |url=http://www.theonlineclinic.co.uk/news/2012/12/20/MycoplasmaGenitaliumTreatmentChoices.aspx |title=Mycoplasma Genitalium Treatment Choices |website=www.theonlineclinic.co.uk |access-date=21 December 2012 |archive-date=24 June 2021 |archive-url=https://web.archive.org/web/20210624210015/https://www.theonlineclinic.co.uk/news/2012/12/20/MycoplasmaGenitaliumTreatmentChoices.aspx |url-status=live }}</ref>
In patients where doxycycline, azithromycin and moxifloxacin all failed, [[pristinamycin]] has been shown to still be able to eradicate the infection.<ref name="Jorgen S 2016"/>