Review article
https://doi.org/10.37797/ig.42.3.2
Mycoplasma genitalium: a complete overview with special reference to antimicrobial resistance and recent treatment protocols
Tian Košar
; Medicinski fakultet Sveučilišta u Zagrebu, Zagreb, Hrvatska
Sunčanica Ljubin-Sternak
orcid.org/0000-0002-6405-6922
; Nastavni zavod za javno zdravstvo „Dr. Andrija Štampar“, Zagreb, Hrvatska
*
* Corresponding author.
Abstract
The genus Mycoplasma encompasses a large number of species that live as commensals or pathogens on the mucous membranes of humans and animals. This group of bacteria distinguishes itself from other prokaryotes by the absence of a cell wall, rendering all its members intrinsically resistant to antibiotics that inhibit peptidoglycan synthesis.
Mycoplasma genitalium (M. genitalium) is an emerging pathogen and a recognized cause of sexually transmitted infections. Due to its reduced genome and significant metabolic restrictions, cultivating this bacterium is extremely challenging, and it directly relies on the host for survival. It possesses several virulence factors that enable it to adapt to a parasitic way of life, with the terminal organelle being the most important among them.
As a causative agent of sexually transmitted infections, M. genitalium spreads through direct contact between the mucous membranes of infected individuals. Increased infection rates are observed in specific high-risk groups, while its prevalence in the general population remains low. The most common syndromes associated with this mycoplasma are non-gonococcal urethritis, cervicitis, and pelvic inflammatory disease, with persistent infection potentially leading to infertility in both sexes. Molecular diagnostic methods revolutionized the detection of this bacterium, which was previously exceedingly challenging.
A single dose of azithromycin used as a syndromic treatment has led to the selection and rapid spread of macrolide-resistant strains, particularly among the high-risk populations, consequently increasing the use of moxifloxacin. However, the emergence of fluoroquinolone resistance genes has been recognised, and combined resistance to both antibiotics is increasingly being reported. Therefore, existing therapeutic options should be reevaluated and regular surveillance of resistant strains in the population should be implemented. Ultimately, this bacterium should be included in the diagnostic protocol for the management of sexually transmitted infections, along with the introduction of mandatory test of cure to assess treatment success to curb further resistance spread.
Keywords
sexually transmitted diseases; Mycoplasma genitalium; antimicrobial resistance; azithromycin; quinolones
Hrčak ID:
332738
URI
Publication date:
27.6.2025.
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