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Mycoplasma genitalium (genital) diagnosis and management

Last updated: June 2013

Diagnosis

Current SA Health protocols advise testing in the following groups:

  • males with urethral symptoms
  • contacts of diagnosed cases
  • females with cervicitis or Pelvic Inflammatory Disease (PID)
  • males or females with proctitis.

Nucleic Acid Amplification Test

Note: NAAT refers to Nucleic Acid Amplification Test, such as PCR

Diagnosis is made on a positive sample from an infected site such as:

  • first catch urine or urethral swab in males
  • physician collected or self-collected vaginal swab
  • endocervical swab
  • in females without a cervix or in whom swabs cannot be taken, a first catch urine is tested.

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Treatment

Standard therapy

Azithromycin 500 mg orally stat, followed 24 hours later by 250 mg daily for 4 more doses (B1).

Previously treated

If patient previously treated (before result available) for urethritis with Azithromycin 1 g stat see treatment algorithm below.

In Pelvic Inflammatory Disease

Moxifloxacin 400 mg orally daily for 14 days (B3) in addition to standard PID treatment.

Epidemiologic treatment

Epidemiologic treatment is given to sexual partners, regardless of age or gender, of persons with mycoplasma genitalium.

All contacts should have appropriate investigations for mycoplasma genitalium before treatment is provided.

Standard therapy

Azithromycin 500 mg orally stat, followed 24 hours later by 250 mg daily for 4 more doses (B1).

Alternate therapy

Alternate therapy used in contacts of patients treated with Moxifloxacin 400 mg orally daily for 10 days (B3) in addition to standard PID treatment.

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Patient education

The following points should be covered:

  • Mycoplasma Genitalium is sexually transmitted
  • abstinence from sex (including oral sex) until 1 week after patient and partner treatment
  • advise on the side effects of medications
  • a test of cure is required at 6 weeks.

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Follow up

  • Test of cure is required at 6 weeks
  • assess medication compliance if single dose therapy not used
  • check if the patient experienced any reactions to the medication
  • evaluate symptoms and signs
  • enquire about further sexual activity since diagnosis, reinforce prevention and safe sex practices
  • confirm contact tracing
  • screen for HIV and syphilis at 3 months.

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Further information

For further information on the diagnosis and management of Mycoplasma genitalium contact Clinic 275.

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Disclaimer

These guidelines are based on review of current literature, current recommendations of the United States Centers for Disease Control and Prevention, World Health Organization, the British Association for Sexual Health and HIV and local expert opinion.

They are written primarily for use by Clinic 275 staff and some flexibility is required in applying them to certain private practice situations.

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Management algorithm

The management algorithm for mycoplsma genitalium

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