Trainee pharmacy technician Kellie has come to pharmacist Parveen with a query about a STI she has been reading about...

“I’m doing a training module on sexual health,” says Kellie. “It’s really interesting so I did a bit of reading around and came across a condition called mycoplasma genitalium. Have you heard of it? Apparently it can cause infertility and could be the next superbug...”

ANSWER

Mycoplasma genitalium (MG) hit the headlines recently when the British Association of Sexual Health and HIV (BASHH) launched draft guidance on its diagnosis and management for the first time, expressing concerns that if this littleknown STI was not diagnosed and treated, it could become resistant to antibiotics and hence difficult to manage.

Like many other STIs, MG is mainly transmitted through unprotected sex, and is commoner in smokers, younger people, those with a larger number of sexual partners, people of non-white ethnicity and older men. It is often asymptomatic, but symptoms in women can include vaginal discharge, pelvic pain, and bleeding after intercourse and between periods, whereas men are likely to complain of dysuria, urethral discharge and penile irritation and pain.

Infection in women has been linked to pelvic inflammatory disease (and subsequent fertility problems), premature birth, miscarriage and stillbirth, while men have been known to experience epididymitis as a complication. Reactive arthritis has been reported in both genders.

The reason for mounting fears that MG could become a superbug is that global resistance to macrolide treatment – the usual management option – stands at 30-100 per cent. In the UK, it is thought to be around 40 per cent, but BASHH says that the majority of cases will respond to azithromycin. Moxifloxacin has excellent efficacy (although resistance in the Asia-Pacific region is growing) but it is not recommended first-line due to concerns that it will limit future therapeutic options.

The bigger picture

Despite the asymptomatic nature of MG, BASHH says only individuals with symptoms plus their sexual partners (not those who have another STI diagnosed) should undergo testing as its management uses antibiotics that are prescribed for other STIs anyway.

First choice antibiotic is doxycycline 100mg bd for seven days followed by azithromycin 1g stat then 500mg od for two days. If macrolide-resistance is known or the above has failed, moxifloxacin 400mg od for 10 days should be given, extended to a 14-day course if the infection is complicated.

Patients should be retested between three to five weeks after starting treatment to see if the infection has cleared and to help identify any emerging resistance.

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