{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:49:23Z","timestamp":1791838163182,"version":"4.3.4"},"reference-count":11,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2024,7,17]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>British guidelines advise treatment of<jats:italic>Mycoplasma genitalium<\/jats:italic>(<jats:italic>Mgen<\/jats:italic>) infection using the results of macrolide resistance-associated mutation (MRAM) assays. Limited data informs management when patients fail MRAM-guided treatment. This study evaluates current management strategies employed for cases of<jats:italic>Mgen<\/jats:italic>infection with MRAM-guided treatment failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This retrospective analysis reviewed laboratory and clinical data pertaining to all positive<jats:italic>Mgen<\/jats:italic>results between 28 May 2020 and 05 November 2022 across three London sexual health clinics. Treatment failure was defined as microbiological or clinical failure, despite appropriate MRAM-guided treatment with full compliance and no re-infection risk. Where MRAM status was unable to be determined, samples were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>340 samples were included from mostly male (74.4%) patients with a mean age of 30 years. The majority of tests were sent for urethritis (63.8%), and most infections were present without concurrent STIs (83.5%). 183 (53.8%) samples were MRAM positive; 157 (46.1%) were wild type. 152\/183 (83.1%) received MRAM-guided treatment. 49\/152 (32.2%) cases of MRAM-guided treatment failure were identified. 32\/49 (65.3%) achieved either microbiological or clinical cure through a variety of treatment regimens. 66.6% of nine patients who received pristinamycin achieved microbiological cure; two patients were cured by minocycline. Many patients received multiple courses of moxifloxacin despite previous failures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Whilst high compliance with recommended MRAM-guided therapy was identified, there were also high rates of quinolone therapy failure (32.2%). Barriers to appropriate treatment include a lack of quinolone resistance assays and the non-availability of sitafloxacin in Europe, along with the limited availability of pristinamycin and minocycline in the UK during the study dates. We recommend developing a standardised management pathway for treatment resistant cases.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2023-056093","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T17:22:42Z","timestamp":1722532962000},"page":"5-9","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["<i>Mycoplasma genitalium<\/i>treatment outcomes among a cohort failing macrolide resistance-guided treatment across three London sexual health clinics"],"prefix":"10.1136","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3656-2648","authenticated-orcid":false,"given":"Kate","family":"Johnson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ella","family":"Buluwela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"McDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0763-6170","authenticated-orcid":false,"given":"John","family":"Golden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Dickinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolo","family":"Girometti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurmit","family":"Jagjitsingh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2434-0101","authenticated-orcid":false,"given":"Michael","family":"Rayment","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"2025012910100555000_101.1.5.1","doi-asserted-by":"publisher","DOI":"10.1177\/0956462419825948"},{"key":"2025012910100555000_101.1.5.2","doi-asserted-by":"publisher","DOI":"10.1099\/mic.0.000830"},{"key":"2025012910100555000_101.1.5.3","doi-asserted-by":"publisher","DOI":"10.1177\/0956462419890737"},{"key":"2025012910100555000_101.1.5.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30154-7"},{"key":"2025012910100555000_101.1.5.5","first-page":"248","article-title":"Mycoplasma genitalium: enhanced management using expanded resistance-guided treatment strategies","volume":"19","author":"Sweeney","year":"2022","journal-title":"Sex Health"},{"key":"2025012910100555000_101.1.5.6","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy477"},{"key":"2025012910100555000_101.1.5.7","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad057"},{"key":"2025012910100555000_101.1.5.8","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.17972"},{"key":"2025012910100555000_101.1.5.9","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2022-055621"},{"key":"2025012910100555000_101.1.5.10","doi-asserted-by":"crossref","unstructured":"Chua T-P , Vodstrcil LA , Murray GL , et al . Evolving patterns of macrolide and fluoroquinolone resistance in Mycoplasma genitalium: an updated global systematic review and meta-analysis. SSRN [Preprint] 2024. doi:10.2139\/ssrn.4764790","DOI":"10.2139\/ssrn.4764790"},{"key":"2025012910100555000_101.1.5.11","doi-asserted-by":"publisher","DOI":"10.1177\/09564624241254949"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2023-056093","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T18:14:32Z","timestamp":1738174472000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2023-056093"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,29]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/sextrans-2023-056093"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2023-056093","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}