{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:15:10Z","timestamp":1789845310502,"version":"4.0.1"},"reference-count":10,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,4,13]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      In Belgium, approximately a quarter of\n                      <jats:italic>Mycoplasma genitalium<\/jats:italic>\n                      infections are resistant to both macrolides and fluoroquinolones\u2014termed multidrug-resistant (MDR) infections. The optimal treatment approach for these MDR infections remains uncertain. Combination therapy has shown promise in treating other MDR pathogens by enhancing efficacy and reducing resistance development. We report the first five cases of MDR\n                      <jats:italic>M. genitalium<\/jats:italic>\n                      urethritis successfully treated with a novel combination therapy regimen consisting of minocycline, metronidazole, methenamine and pristinamycin (\u2018M3P\u2019).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We describe a case series of five individuals treated with M3P as salvage therapy for\n                      <jats:italic>M. genitalium<\/jats:italic>\n                      urethritis. Clinical data, laboratory findings, resistance profiles and treatment outcomes were reviewed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All five men with macrolide-resistant and fluoroquinolone-resistant\n                      <jats:italic>M. genitalium<\/jats:italic>\n                      urethritis received M3P for a minimum of 14 days. Two men received an extended 28-day M3P regimen, in which minocycline and methenamine were given for 28 days. All five patients experienced clinical and microbiological cure. Adverse effects were minimal and transient, with one patient reporting increased urinary frequency during treatment and another reporting mild dyspepsia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This case series demonstrates the potential efficacy of M3P as a novel salvage therapy for MDR\n                      <jats:italic>M. genitalium<\/jats:italic>\n                      urethritis, particularly where standard therapies have failed. The combination of pristinamycin, methenamine, and other agents may synergistically reduce bacterial load and increase efficacy. Further, in vitro and clinical studies are required to assess the optimal treatment strategies for MDR\n                      <jats:italic>M. genitalium<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056517","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T19:35:19Z","timestamp":1746646519000},"page":"43-46","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Combination therapy for multidrug-resistant\n                    <i>Mycoplasma genitalium<\/i>\n                    infections: a case series"],"prefix":"10.1136","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5541-6041","authenticated-orcid":false,"given":"Thibaut","family":"Vanbaelen","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Huis in \u2018t Veld","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J","family":"Visser","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1804-252X","authenticated-orcid":false,"given":"Irith","family":"De Baetselier","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7125-7001","authenticated-orcid":false,"given":"Jens Tomas","family":"Van Praet","sequence":"additional","affiliation":[{"name":"Nephrology and Infectious Diseases, AZ Sint-Jan AV, Brugge, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8421-5137","authenticated-orcid":false,"given":"Sheeba Santhini","family":"Manoharan-Basil","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorien","family":"Van den Bossche","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2557-8998","authenticated-orcid":false,"given":"Chris","family":"Kenyon","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium"},{"name":"University of Cape Town, Rondebosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"2026081704400947000_102.1.43.1","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2024.29.7.2300318","article-title":"Estimation of antimicrobial resistance of Mycoplasma genitalium, Belgium, 2022","volume":"29","author":"De Baetselier","year":"2024","journal-title":"Euro Surveill"},{"key":"2026081704400947000_102.1.43.2","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1111\/jdv.17972","article-title":"2021 European guideline on the management of Mycoplasma genitalium infections","volume":"36","author":"Jensen","year":"2022","journal-title":"Acad Dermatol Venereol"},{"key":"2026081704400947000_102.1.43.3","doi-asserted-by":"crossref","DOI":"10.1128\/aac.00006-23","article-title":"In Vitro Susceptibility and Resistance of Mycoplasma genitalium to Nitroimidazoles","volume":"67","author":"Wood","year":"2023","journal-title":"Antimicrob Agents Chemother"},{"key":"2026081704400947000_102.1.43.4","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofad427","article-title":"Efficacy of Minocycline for the Treatment of Mycoplasma genitalium","volume":"10","author":"Clarke","year":"2023","journal-title":"Open Forum Infect Dis"},{"key":"2026081704400947000_102.1.43.5","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofad590","article-title":"Efficacy of Sitafloxacin for Mycoplasma genitalium in an Era of Increasing Antimicrobial Resistance","volume":"10","author":"Samra","year":"2023","journal-title":"Open Forum Infect Dis"},{"key":"2026081704400947000_102.1.43.6","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2895"},{"key":"2026081704400947000_102.1.43.7","doi-asserted-by":"publisher","DOI":"10.3310\/AAFO2475"},{"key":"2026081704400947000_102.1.43.8","unstructured":"Petri W . Sulfonamides, trimethoprim, sulfamethoxazole, quinolones, and agents for urinary tract infections. In: Goodman & gilman\u2019s the pharmacological basis of therapeutics. New York (NY): McGraw Hill, 2006: 1111\u201325."},{"key":"2026081704400947000_102.1.43.9","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2180-9-1"},{"key":"2026081704400947000_102.1.43.10","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkac281"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056517","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:40:44Z","timestamp":1786966844000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056517"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,7]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,16]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/sextrans-2025-056517"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056517","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,7]]}}}