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Infections mycoplasma genitalium: new recommendations:
Discreet but problematic pathogen, Mycoplasma genitals poses major problems of antibiotic resistance. Nevertheless, Faced with this rise in resistance. Therefore, the limited therapeutic arsenal, the High Authority for Health (HAS) published in April 2025 a complete revision of its recommendations for curative care. Moreover, Focus on the main developments to know.
Strictly limited treatment indications – Infections mycoplasma genitalium: new recommendations
The first novelty of these recommendations is explicit limitation of treatment to symptomatic patients only. Therefore, Unlike the sometimes observed practices. Similarly, the treatment of asymptomatic carriers is no longer recommended, except in one case: that of the sexual partners of a symptomatic patient tested positive. Therefore, This restriction aims to brake the emergence of resistant strains, aggravated by a systematic prescription of antibiotics.
A turn in antibiotic strategies – Infections mycoplasma genitalium: new recommendations
As a general rule. Consequently, the treatment will only be started after receipt of the antibiogram
infections mycoplasma genitalium: new recommendations
➤ Abandonment of azithromycin in single dose
One of the strong messages concerns the abandonment of the single dose scheme of 1 g of azithromycin, historically used. Moreover, Now considered too ineffective. too much at risk of selecting resistances, this protocol is replaced by a dosage split over three days: Azithromycin 1 g on day 1, then 500 mg on days 2 and 3 (total: 2 g over 3 days).
This scheme is reserved for strains sensitive to macrolides.
➤ Moxifloxacine en 2th intention …. in 1era in complicated forms
In the event of a mutation of macrolide resistance, or failure of a treatment well led by azithromycin, moxifloxacin (400 mg/d for 7 days) becomes the molecule of choice. It is also used as a first interior in complicated infections. such as high genital infections (IGH) in women or orchi-epididymites (simultaneous infections of testicles and epididymis) in humans, with a prolonged duration of 10 infections mycoplasma genitalium: new recommendations to 14 days depending on the location.
Sequential treatment guided by resistance (TSGR): the recommended strategy – Infections mycoplasma genitalium: new recommendations
In the event of severe symptoms. need to treat quickly, experts recommend sequential treatment in two stages:
- Doxycycline 100 mg × 2/d for 7 days, in primer.
- Then adaptation of treatment according to the results of research resistance to macrolides:
- Azithromycin (if sensitive strain)
- Moxifloxacin (if resistant strain)
.
This approach reduces the initial bacterial load while effectively targeting the strain according to its resistance profile.
Alternatives in the event of multi-resistance
If the two main therapeutic lines (macrolides then fluoroquinolones) fails. the following options are offered:
- Doxycycline 14 days: modest efficiency (~ 40 %).
- Doxycycline 7 days followed by Pristinamycin 1 g × 4/d for 10 days: higher efficiency (75 %).
- Minocycline 100 mg × 2/d for 14 days: around 70 % healing.
infections mycoplasma genitalium: new recommendations
A specialized opinion in infectiology or IS Sexually transmitted infections. is recommended in these complex cases.
What treatments in specific situations?
- Pregnant women: Azithromycin remains usable. Doxycycline is possible at 1is quarter.
- Breastfeeding: only azithromycin can be used.
- Unusual locations (joint, eye): to be discussed on a case -by -case basis.
The healing test is not systematic
A post-processing control test is only indicated in the event of persistence of the symptoms. at least 3 weeks after the end of treatment. If the symptomatology disappears, no healing test is required.
Beyond antibiotic therapy, the essential measures
Management should not be limited to antibiotic therapy. She must include:
- Systematic screening of other STIs.
- Clear and reassuring information,
- A proposal to help the notification of partners,
- An orientation towards the PrEP Pre-exhibition infections mycoplasma genitalium: new recommendations prophylaxis. PREP is a strategy that allows a seronegative person exposed to HIV to eliminate the risk of infection. taking, continuously or “on demand”, anti-retroviral treatment based on Truvada®. or other prevention devices if necessary.
Key message for prescribers
The diagnosis of infection Mycoplasma genitals must be followed by reasoned treatment. guided by microbiological results and the resistance profile. The stake is twofold: effectively cure symptomatic patients. preserve the effectiveness of rare antibiotics active against this bacteria in strong progression.
In summary
| Situation | Recommended treatment |
| Uncomplicated, sensitive infection | Azithromycine 1 g J1 + 500 mg J2-J3 |
| Macrolide resistance | Moxifloxacine 400 mg/j pendant 7 j |
| Multi-resistance | Doxycycline + Pristinamycine ou Minocycline |
| Complicated forms (IGH, orchi-epididymitis) | Moxifloxacine 10 to 14 j |
| Urgent treatment without resistance test | TSGR: doxycycline 7 J then adaptation |
Further reading: babies and patients share an unexpected biological characteristic – DEENGE refers a disturbing appearance in Bangladesh – 06/24/2025 at 23:05 – Ischemic stroke: record time intervention – Methods of implementation of the infant and newborn immunization campaign against syncytial respiratory virus infections (VRS) – Lubumbashi: a malaria vaccination campaign soon launched for children from 3 to 59 months old.
