Jensen J S, Cusini M, Gomberg M, Moi H, Wilson J, Unemo M
Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
J Eur Acad Dermatol Venereol. 2022 May;36(5):641-650. doi: 10.1111/jdv.17972. Epub 2022 Feb 19.
Mycoplasma genitalium infection contributes to 10-35% of non-chlamydial non-gonococcal urethritis in men. In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID) in 10-25%. Transmission of M. genitalium occurs through direct mucosal contact.
Asymptomatic infections are frequent. In men, urethritis, dysuria and discharge predominate. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. Symptoms are the main indication for diagnostic testing. Diagnosis is achievable only through nucleic acid amplification testing and must include investigation for macrolide resistance mutations.
Therapy for M .genitalium is indicated if M. genitalium is detected. Doxycycline has a cure rate of 30-40%, but resistance is not increasing. Azithromycin has a cure rate of 85-95% in macrolide-susceptible infections. An extended course of azithromycin appears to have a higher cure rate, and pre-treatment with doxycycline may decrease organism load and the risk of macrolide resistance selection. Moxifloxacin can be used as second-line therapy but resistance is increasing.
Uncomplicated M. genitalium infection without macrolide resistance mutations or resistance testing: Azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral). Second-line treatment and treatment for uncomplicated macrolide-resistant M. genitalium infection: Moxifloxacin 400 mg od for 7 days (oral). Third-line treatment for persistent M. genitalium infection after azithromycin and moxifloxacin: Doxycycline or minocycline 100 mg bid for 14 days (oral) may cure 40-70%. Pristinamycin 1 g qid for 10 days (oral) has a cure rate of around 75%. Complicated M. genitalium infection (PID, epididymitis): Moxifloxacin 400 mg od for 14 days. MAIN CHANGES FROM THE 2016 EUROPEAN M.
Due to increasing antimicrobial resistance and warnings against moxifloxacin use, indications for testing and treatment have been narrowed to primarily involve symptomatic patients. The importance of macrolide resistance-guided therapy is emphasised.
生殖支原体感染在男性非衣原体非淋菌性尿道炎中占10% - 35%。在女性中，生殖支原体与10% - 25%的宫颈炎和盆腔炎（PID）相关。生殖支原体通过直接黏膜接触传播。
无症状感染很常见。男性以尿道炎、排尿困难和分泌物增多为主。女性的症状包括阴道分泌物增多、排尿困难或PID症状——腹痛和性交困难。症状是诊断测试的主要指征。仅通过核酸扩增测试才能实现诊断，且必须包括对大环内酯耐药突变的检测。
如果检测到生殖支原体，则需进行治疗。多西环素的治愈率为30% - 40%，但耐药性未增加。阿奇霉素在大环内酯敏感感染中的治愈率为85% - 95%。延长疗程的阿奇霉素似乎治愈率更高，用多西环素预处理可能会降低病原体载量和大环内酯耐药选择的风险。莫西沙星可作为二线治疗，但耐药性在增加。
无大环内酯耐药突变或未进行耐药性检测的单纯生殖支原体感染：第1天口服阿奇霉素500mg，然后在第2 - 5天每天口服250mg。二线治疗及单纯大环内酯耐药生殖支原体感染的治疗：莫西沙星400mg每日一次，共7天（口服）。阿奇霉素和莫西沙星治疗后持续性生殖支原体感染的三线治疗：多西环素或米诺环素100mg每日两次，共14天（口服），治愈率可达40% - 70%。普那霉素1g每日四次，共10天（口服），治愈率约为75%。复杂生殖支原体感染（PID、附睾炎）：莫西沙星400mg每日一次，共14天。2016年欧洲生殖支原体指南的主要变化：由于抗菌药物耐药性增加以及对莫西沙星使用的警告，检测和治疗指征已缩小，主要涉及有症状的患者。强调了大环内酯耐药性指导治疗方法的重要性。
