Key points

Mgen infections are highly resistant to common antibiotics - treatment failure is common

Chris and Luke were cured of Mgen infection using Resistance Guided Therapy

Chris contracted a resistant form of Mgen. He was correctly diagnosed and successfully treated with Resistance Guided Therapy.

Luke had a resistant Mgen infection, was initially misdiagnosed, and incorrectly treated. He was able to be cured with the use of diagnostics that detect Mgen and the resistance status.

What is Mgen?

Mgen (Mycoplasma genitalium) is already a highly prevalent sexually transmitted infection affecting up to 2% of the population. It is reported up to 400,000 Australians could be carrying the disease. This is far higher than the prevalence of gonorrhoea.

Mgen is often asymptomatic but may cause the following consequences:

In women
▪ Pain and/or difficulty when urinating
▪ Post-coital bleeding
▪ Painful inter-menstrual bleeding
▪ Inflammation of the cervix
▪ Lower abdominal pain
▪ Pelvic inflammatory disease
▪ Infertility
▪ Pre-term delivery

In men
▪ Urethral discharge
▪ Pain and/or difficulty when urinating
▪ Penile irritation
▪ Urethral discomfort

Prof. David Lewis (Western Sydney Sexual Health Centre and University of Sydney) and Prof. Suzanne Garland (The Royal Women’s Hospital) discuss problems associated with Mgen in the video below.

Mgen is highly resistant to the first line treatment

The resistance rate to the front-line treatment called azithromycin is reported to be up to 50%, and treatment failure is common. If Mgen continues to be treated without knowledge of resistance status, it will become increasingly difficult to treat with current antibiotics. There have been many reports in the media describing how this pathogen may become the next superbug. (BBC, CNN, The Daily Telegraph)

Resistance Guided Therapy increases cure rate of Mgen

Resistance Guided Therapy (RGT) has proven to be highly effective in improving the cure rates of Mgen infection. Up to 93% achieved cure as opposed to 40% in the group treated without RGT. These diagnostics also expedite treatment of sexual contacts with the most effective treatment, which helps to reduce the spread of the disease. RGT minimises unnecessary use of antibiotics, which is an effective strategy to prevent Mgen becoming the next superbug.

Guidelines for treatment of Mgen with Resistance Guided Therapy

International, British, and Australian guidelines for Mgen infection management recommend Resistance Guided Therapy as best practice for treating the disease.

Summary of the BASHH guideline for treatment of Mgen. Refer to the full guideline for details.

Patients with non-gonococcal urethritis are to be screened for Mgen and the pathogen’s resistant status to azithromycin. Patients screened as positive for Mgen are given either oral azithromycin or moxifloxacin antibiotics depending on the resistance status.

Resistance Guided Therapy is already recommended in Mgen management guidelines for Europe, United Kingdom, and Australia. Collectively these guidelines encourage greater antimicrobial stewardship through a more effective use of the limited antibiotics available to treat Mgen.