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Volume 28, Number 8—August 2022
CME ACTIVITY - Online Report

Weighing Potential Benefits and Harms of Mycoplasma genitalium Testing and Treatment Approaches

Lisa E. ManhartComments to Author , William M. Geisler, Catriona S. Bradshaw, Jørgen S. Jensen, and David H. Martin
Author affiliations: University of Washington, Seattle, Washington, USA (L.E. Manhart); University of Alabama at Birmingham, Birmingham, Alabama, USA (W.M. Geisler); Monash University and University of Melbourne, Melbourne, Victoria, Australia (C.S. Bradshaw); Statens Serum Institut, Copenhagen, Denmark (J.S. Jensen); Tulane University, New Orleans, Louisiana, USA (D.H. Martin)

Main Article

Table

Key questions for the 2021 CDC Sexually Transmitted Infections Treatment Guidelines Review for Mycoplasma genitalium*

Category Questions
New evidence 1. What new evidence has emerged on associations between M. genitalium and reproductive tract disease syndromes?
2. What is the prevalence of asymptomatic M. genitalium infection in various risk groups (e.g., general population, high-risk cisgender women, high-risk men, MSM)?
3. What is the current efficacy of currently recommended syndromic therapies for NGU, epididymitis, cervicitis, and PID against M. genitalium? Does this differ by sex or by sex of sex partners?
4. What is the current efficacy of moxifloxacin (400 mg × 7–14 d) against M. genitalium? Does this differ by sex or by sex of sex partners?
5. What is the prevalence of antimicrobial resistance-associated gene mutations among M. genitalium strains? Does this differ by sex or by sex of sex partners?
6. What antimicrobials other than azithromycin and moxifloxacin have been studied, either in vitro, or in patients with persisting M. genitalium infections and what is their efficacy?
7. What new M. genitalium diagnostic assays are on the horizon and what is the expected timeline for FDA approval of additional assays?
8. What is the time to M. genitalium nucleic acid clearance after therapy?
Discussion 1. Who should be tested for M. genitalium (e.g., general population, high-risk cisgender women, high-risk men, MSM)?
2. Should the recommended empiric therapies for NGU, persistent/recurrent NGU, cervicitis, and/or PID be altered in recognition of the role played by M. genitalium? If so, how?
3. What is the preferred therapy for M. genitalium after detection by an FDA approved test? Does this differ by sex or by sex of sex partners?
4. What is the recommended approach in cases where M. genitalium infection persists after treatment with a) doxycycline, b) azithromycin, and c) moxifloxacin?
5. What is the recommended approach to partner management? Does this differ by sex or by sex of sex partner?
6. Should a test of cure be recommended after antibiotic therapy for a proven M. genitalium infection? Does this differ for symptomatic and asymptomatic persons?
7. Should antimicrobial resistance in M. genitalium be monitored in the United States?

*The summary of the primary evidence that informed the responses to these questions can be accessed in the Tables of Evidence posted on the CDC website: https://www.cdc.gov/std/treatment-guidelines/evidence.htm. CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; MSM, men who have sex with men; NGU, nongonococcal urethritis; PID, pelvic inflammatory disease.

Main Article

Page created: June 09, 2022
Page updated: July 20, 2022
Page reviewed: July 20, 2022
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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