Treating infections that caused by Mycoplasma genitalium

 Treating infections caused by Mycoplasma genitalium poses a challenge in healthcare due to its increasing prevalence and antimicrobial resistance. M. genitalium is a sexually transmitted bacterium associated with urethritis in men and cervicitis, pelvic inflammatory disease (PID), and infertility in women. The bacterium's small genome and lack of a cell wall contribute to its resistance to many antibiotics commonly used to treat bacterial infections.

The primary treatment for M. genitalium infections is macrolide antibiotics such as azithromycin or erythromycin. However, resistance to macrolides, particularly azithromycin, has been steadily increasing worldwide. Resistance mechanisms include mutations in the 23S rRNA gene, which reduces the binding affinity of macrolides to their target site, and mutations in genes encoding ribosomal proteins, leading to decreased drug uptake or increased efflux.

In cases of macrolide-resistant M. genitalium infections, alternative antibiotics such as tetracyclines (e.g., doxycycline) or fluoroquinolones (e.g., moxifloxacin) may be considered. However, resistance to these antibiotics has also been reported, albeit less frequently than with macrolides. Tetracycline resistance in M. genitalium is associated with mutations in the 16S rRNA gene, while fluoroquinolone resistance is attributed to mutations in the quinolone resistance-determining regions of the gyrA and parC genes.

For persistent or recurrent M. genitalium infections despite appropriate antibiotic therapy, combination regimens involving two or more antibiotics with different mechanisms of action may be considered. Examples include the combination of azithromycin and moxifloxacin or the use of sequential therapy with azithromycin followed by moxifloxacin in cases of macrolide-resistant strains.

The management of M. genitalium infections also involves partner notification and treatment to prevent reinfection and transmission. Additionally, screening and management of other sexually transmitted infections (STIs) are recommended, as coinfection with other pathogens such as Chlamydia trachomatis or Neisseria gonorrhoeae is common.

Prevention of M. genitalium infections relies on safe sexual practices, including consistent and correct condom use, reducing the number of sexual partners, and regular STI screening for individuals at risk. Vaccines targeting M. genitalium are currently under development but are not yet available for clinical use.

In conclusion, treating infections caused by Mycoplasma genitalium requires a tailored approach that considers antimicrobial resistance patterns, patient factors, and the possibility of coinfections with other STIs. Continued surveillance of antimicrobial resistance and research into new treatment modalities are essential for addressing the evolving threat of M. genitalium infections.

References:

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3. Read TRH, Fairley CK, Murray GL, et al. Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation. Clin Infect Dis. 2019;68(4):554-560.
4. Getman D, Jiang A, O'Donnell M, Cohen S. Mycoplasma genitalium prevalence, coinfection, and macrolide antibiotic resistance frequency in a multicenter clinical study cohort in the United States. J Clin Microbiol. 2016;54(9):2278-2283