Overview
Mycoplasma genitalium is a sexually transmitted pathogen that can cause urethritis in men 2. It is a significant contributor to non-chlamydial, non-gonococcal urethritis 2.
Diagnosis
Diagnosis is indicated by symptoms such as urethritis, dysuria, and discharge in men 2.
Asymptomatic infections are frequent 2.
Diagnosis is achievable only through nucleic acid amplification testing (NAAT) 2.
NAAT must include investigation for macrolide resistance mutations 2.
Clinical characteristics alone cannot reliably differentiate between causative pathogens of urethritis 1.Management
Therapy for M. genitalium* is indicated if the pathogen is detected 2.
First-line treatment (macrolide-susceptible): Azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral) 2.
Alternative first-line (if doxycycline contraindicated): Azithromycin is reserved for cases where doxycycline is contraindicated in empirical treatment of urethritis 1.
Pre-treatment: Pre-treatment with doxycycline may decrease organism load and the risk of macrolide resistance selection 2.
Second-line treatment (macrolide-resistant or second-line indication): Moxifloxacin can be used 2.
Doxycycline has a cure rate of 30-40% and resistance is not increasing 2.Key Recommendations
Diagnosis of Mycoplasma genitalium should be confirmed by nucleic acid amplification testing, which must include testing for macrolide resistance mutations 2. (Evidence: Moderate)
For 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) is recommended 2. (Evidence: Moderate)
Moxifloxacin is recommended as second-line therapy or for uncomplicated macrolide-resistant M. genitalium infection 2. (Evidence: Moderate)References
1 Werner RN, Vader I, Abunijela S, Bickel M, Biel A, Boesecke C et al.. German evidence- and consensus-based guideline on the management of penile urethritis. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2025. link
2 Jensen JS, Cusini M, Gomberg M, Moi H, Wilson J, Unemo M. 2021 European guideline on the management of Mycoplasma genitalium infections. Journal of the European Academy of Dermatology and Venereology : JEADV 2022. link