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Mycoplasma genitalium | Questions & Answers | 2015 STD Treatment Guidelines

Question: Is there a commercially available diagnostic test for M. genitalium in the United States?

No FDA-approved diagnostic test for M. genitalium is currently available in the United States. However, Hologic, Inc. (formerly Gen-Probe) has recently made analyte specific reagents (ASR) targeting M. genitalium commercially available for use with their Aptima TMA assay. Any laboratory that performs an in-house validation of the assay can use it to perform M. genitalium testing, and results can be used to guide clinical care. Laboratories interested in purchasing the M. genitalium ASR from Hologic can contact either the local sales representative or Hologic Customer Service.

Question: Are fluoroquinolones, other than moxifloxacin, recommended for the treatment of M. genitalium?

Fluoroquinolones other than moxifloxacin are not recommended for the treatment of M. genitalium. Microbiologic treatment failure (persistent detection of the organism) after levofloxacin ranges from 30%–67%, and after ofloxacin was 66% in the only study evaluating it. In contrast, cure rates for moxifloxacin range from 70%–100%. Several fourth-generation quinolones (i.e. gatifloxacin and sitafloxacin) have somewhat better efficacy against M. genitalium than levofloxacin and ofloxacin, but these are not available in the United States. However, treatment failures have been reported for both the seven-day and the ten-day moxifloxacin regimens, with few studies evaluating longer duration of treatment. The CDC 2015 STD Treatment Guidelines recommends moxifloxacin  to treat men and women with previous treatment failure.

Question: Is testing and treatment of sex partners of patients with M. genitalium recommended?

Testing and treatment of asymptomatic sex partners of patients with M. genitalium is not currently recommended, primarily due to the limited availability of diagnostic testing for the organism. In areas without validated tests, symptomatic sex partners should be managed syndromically according to the guidelines for treating nongonococcal urethritis (NGU), cervicitis, and PID; asymptomatic partners should not be routinely treated for M. genitalium. In areas where diagnostic testing is available, providers may choose to test and treat asymptomatic partners based on clinical judgment.