What to do with Mycoplasma Genitalium this year?

A reporty back on David Lewis and Catriona Bradshaw's presentation Clinical Management and Therapeutics – MGEN Symposium.

After a morning of antimicrobial resistant gonorrhoea, it was time to turn our attention to antimicrobial resistant Mycoplasma genitalium (MG).  Prof. David Lewis set the scene by outlining the prevalence (about 1-2%) and clinical role of MG and perhaps it was more a case of what we don’t know than what we do.  While the association between MG and non-gonococcal urethritis in men is clear, it is less certain when it comes to proctitis, epididymitis and balanoposthitis. 


For women, MG is associated with cervicitis and a recent systematic review showed a two fold increase in PID, preterm delivery and spontaneous abortion with a non-significant association with infertility. However what is needed is further research into clinical presentations and MG. Dr Catriona Bradshaw moved to a discussion of diagnosing and treating macrolide and quinolone resistance (an increasing problem in the Western Pacific region).  Using doxycycline at initial presentation of NGU and then allowing resistance results to guide antibiotic therapy as adopted by the Australian STI Management Guidelines, provided cure rates of 95% for macrolide sensitive infections and 92% for macrolide resistant infections. Similar to antimicrobial resistant gonorrhoea – the take home messages were that we need increased surveillance (both nationally and internationally, point of care assays with resistance markers, new antimicrobials and strategies to protect the antimicrobials that we have. However, perhaps the most important take home message was reinforced during the panel discussion at the end of the session – “don’t test patients who aren’t symptomatic”!

Author bio: Sharon is the Clinical Nurse Consultant for HIV & Sexual Health at St George Hospital, Sydney, NSW.