Evaluation of treatment with two weeks of doxycycline on macrolide-resistant strains of Mycoplasma genitalium: a retrospective observational study

Abstract

Background Increasing macrolide resistance makes treatment of Mycoplasma genitalium infections challenging. The second-line treatment is moxifloxacin, an antibiotic drug best avoided due to the potential of severe side effects and interactions. This study evaluates the effects of treatment with doxycycline 100 mg twice daily for 2 weeks as an alternative to moxifloxacin. Methods This retrospective observational study examined the medical records of patients testing positive for macrolide resistant Mycoplasma genitalium from January 1st, 2016 to September 1st, 2019 in Trondheim, Norway. Information regarding symptoms as well as clinical and microbiological cure was collected. Results 263 infections from 259 patients (161 females/98 males) were examined. 155 (58.9%) had a negative test of cure following treatment. 34.7% of symptomatic patients not achieving microbiological cure experienced symptom relief or clearance. There was no statistical difference between bacterial loads in symptomatic versus asymptomatic patients. The mean difference was 1.6 × 105 copies/ml (95% CI − 1.4 × 105–4.8 × 105, p = 0.30) for women and 1.4 × 106 copies/ml (95% CI -4.0 × 105–3.2 × 106, p = 0.12) for men. Conclusions The cure rate of doxycycline in this study is higher than previously reported. This adds support to doxycycline’s role in treatment before initiating treatment with less favorable drugs such as moxifloxacin.

Defensins: defenders of human reproductive health

“…At present, antibiotic resistance is an important issue in treating reproductive tract infections ( Unemo and Jensen, 2017 ). Macrolide antibiotics and fluoroquinolones are used to treat common mycoplasma infections in the genital tract, and related mutations that are resistant to these two drugs cause treatment failure ( Li et al , 2020 ; Machalek et al , 2020 ; Gossé et al , 2021 ). In some low-income and middle-income countries, the increase in drug-resistant strains of AIDS is mainly due to poor antiretroviral therapy, incomplete adherence to treatment and poor viral load testing ( Hamers et al , 2018 ).…”

Retrospective Analysis of Ugandan Men with Urethritis Reveals Mycoplasma genitalium and Associated Macrolide Resistance

“…In our study, however, the majority of participants with M. genitalium , including those with other STI coinfections, reported resolution of symptoms after receiving treatment for UDS in accordance with the Ugandan treatment guidelines. All of the participants with an M. genitalium monoinfection received doxycycline treatment, which could have helped to alleviate symptoms by reducing bacterial burden ( 38 ). The longer-term durability of clinical cure and whether the M. genitalium infection was eradicated are not known.…”

Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis

“… 29 , 84 The use of an extended doxycycline regimen for 14 days has not been systematically evaluated but is also considered an option for third-line treatment. 85 …”