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Macrolide-Resistant M. genitalium — SCE Infectious Diseases MCQ

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ModerateSTIsMacrolide-Resistant M. genitaliumSCE Infectious Diseases

A 30-year-old woman presents with Mycoplasma genitalium urethritis. Macrolide resistance testing shows the mprA mutation conferring Azithromycin resistance. What is the resistance-guided treatment?

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Correct answer: D — Moxifloxacin 400 mg daily for 7 days — the recommended treatment for macrolide-resistant M. genitalium

BASHH 2018 M. genitalium guidelines recommend resistance-guided therapy: macrolide-susceptible → Azithromycin (1 g stat then 500 mg days 2–4); macrolide-RESISTANT → Moxifloxacin 400 mg daily for 7 days (or 14 days for PID). Doxycycline has poor M. genitalium cure rates (~30%) as monotherapy but is used as a pre-treatment 'debulking' step (7 days) before Azithromycin to improve cure rates. Moxifloxacin resistance is emerging (~5–15%) and is a growing concern. Test of cure at 3–5 weeks is mandatory.

Reference: BASHH 2018 – M. genitalium; NICE CKS 2024