{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T06:18:06Z","timestamp":1775110686955,"version":"3.50.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The management of\n                      <jats:italic>Mycoplasma genitalium<\/jats:italic>\n                      (MG) infection is challenged by rising macrolide resistance, leading to high failure rates with azithromycin. Evidence on the long-term effectiveness of alternative initial regimens, particularly sequential therapy, and easily obtainable predictors for poor outcomes remains scarce.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study at a tertiary hospital in China (2018-2024). Sexually active adults with nucleic acid amplification test (NAAT)-confirmed MG infection and available treatment records were included. The primary outcomes were treatment failure (persistent infection at 8 weeks, ultimate failure) and recurrence. Multivariable logistic regression and Kaplan-Meier survival analyses were employed to assess the impact of initial antibiotic regimens (azithromycin, quinolones, doxycycline-quinolone sequential therapy), demographics, and co-infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1, 192 MG-positive patients, 474 completed follow-up. After adjustment, doxycycline-quinolone sequential therapy was associated with significantly lower odds of ultimate treatment failure (adjusted odds ratio [aOR]=0.36, 95%CI:0.21-0.61) and recurrence (aOR=0.37, 95%CI:0.18-0.75) compared to azithromycin. Survival analysis confirmed a faster median time to clearance with sequential therapy (7 vs. 10 weeks, p=0.001) and a marked \u201clong-tail\u201d effect in the azithromycin group (mean clearance time: 94.2 vs. 28.0 weeks). Co-infection with\n                      <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                      (CT) was the strongest independent predictor for all adverse outcomes (aOR for ultimate failure=3.21, 95%CI:1.88-5.48), followed by male sex.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this real-world cohort, doxycycline-quinolone sequential therapy demonstrated superior long-term effectiveness over azithromycin for MG infection. CT co-infection and male sex were key risk predictors. These findings advocate for a paradigm shift towards risk-stratified initial therapy, prioritizing sequential regimens for high-risk patients to improve cure rates while supporting antimicrobial stewardship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1787520","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T05:23:59Z","timestamp":1775107439000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Towards precision management of Mycoplasma genitalium: a real-world cohort study identifying key predictors for treatment failure and the superiority of sequential therapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Xinmin","family":"Qiu","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Hangzhou Third People\u2019s Hospital","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baobing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Hangzhou Third People\u2019s Hospital","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Hangzhou Third People\u2019s Hospital","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinzheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Hangzhou Third People\u2019s Hospital","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiyun","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Hangzhou Third People\u2019s Hospital","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s12941-023-00627-6","article-title":"Global analysis on the mutations associated with multidrug-resistant urogenital mycoplasmas and ureaplasmas infection: a systematic review and meta-analysis","volume":"22","author":"Abavisani","year":"2023","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"B2","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1136\/sti.77.1.33","article-title":"Incidence of recurrent diagnoses of Chlamydia trachomatis genital infections among male and female soldiers of the US Army","volume":"77","author":"Barnett","year":"2001","journal-title":"Sex Transm. Infect."},{"key":"B3","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1136\/sextrans-2017-053384","article-title":"Prevalence of Mycoplasma genitalium in different population groups: systematic review and meta-analysis","volume":"94","author":"Baumann","year":"2018","journal-title":"Sex Transm. Infect."},{"key":"B4","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1186\/s12879-021-06193-6","article-title":"Prevalence and risk factors of Mycoplasma genitalium infection in patients attending a sexually transmitted infection clinic in Reunion Island: a cross-sectional study (2017-2018)","volume":"21","author":"Begnis","year":"2021","journal-title":"BMC Infect. Dis."},{"key":"B5","doi-asserted-by":"publisher","first-page":"5884","DOI":"10.1128\/AEM.01763-14","article-title":"Dead or alive: molecular assessment of microbial viability","volume":"80","author":"Cangelosi","year":"2014","journal-title":"Appl. Environ. Microbiol."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268822001066","article-title":"Mycoplasma genitalium and Chlamydia trachomatis infection among women in Southwest China: a retrospective study","volume":"150","author":"Che","year":"2022","journal-title":"Epidemiol. Infect."},{"key":"B7","doi-asserted-by":"publisher","first-page":"201","DOI":"10.35541\/cjd.20230711","article-title":"Chinese expert consensus on the diagnosis and treatment of Mycoplasma genitalium infection (2024)] [J","volume":"57","year":"2024","journal-title":"Zhonghua Pi Fu Ke Za Zhi"},{"key":"B8","doi-asserted-by":"publisher","first-page":"S114","DOI":"10.1086\/652397","article-title":"Pathogenesis of genital tract disease due to Chlamydia trachomatis","volume":"201","author":"Darville","year":"2010","journal-title":"J. Infect. Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1093\/cid\/cix853","article-title":"High prevalence of multidrug-resistant Mycoplasma genitalium in human immunodeficiency virus-infected men who have sex with men in Alabama","volume":"66","author":"Dionne-Odom","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1099\/mic.0.000830","article-title":"Mycoplasma genitalium: a review","volume":"166","author":"Gnanadurai","year":"2020","journal-title":"Microbiol. (Reading)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.1111\/jdv.15146","article-title":"Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? - a position statement from the European STI Guidelines Editorial Board","volume":"32","author":"Horner","year":"2018","journal-title":"J. Eur. Acad. Dermatol. Venereol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"S396","DOI":"10.1093\/infdis\/jix145","article-title":"Mycoplasma genitalium infection in men","volume":"216","author":"Horner","year":"2017","journal-title":"J.\u00a0Infect. Dis."},{"key":"B13","doi-asserted-by":"publisher","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":"J. Eur. Acad. Dermatol. Venereol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1186\/s12879-020-05659-3","article-title":"Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at a STI clinic in Guangzhou, China, 2016-2018","volume":"20","author":"Ke","year":"2020","journal-title":"BMC Infect. Dis."},{"key":"B15","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1093\/cid\/ciz294","article-title":"Mycoplasma genitalium in symptomatic male urethritis: macrolide use is associated with increased resistance","volume":"70","author":"Li","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"B16","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1186\/s12879-018-3580-0","article-title":"Comparison of rRNA-based and DNA-based nucleic acid amplifications for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Ureaplasma urealyticum in urogenital swabs","volume":"18","author":"Liang","year":"2018","journal-title":"BMC Infect. Dis."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2025.108228","article-title":"Evaluation of Mycoplasma genitalium positivity and co-infection with Chlamydia trachomatis and\/or Neisseria gonorrhoeae at various care sites across the United States","volume":"162","author":"Lillis","year":"2026","journal-title":"Int. J. Infect. Dis."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1016\/S1473-3099(20)30154-7","article-title":"Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis","volume":"20","author":"Machalek","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1001324","article-title":"Mycoplasma genitalium: an emerging cause of sexually transmitted disease in women","volume":"7","author":"McGowin","year":"2011","journal-title":"PloS Pathog."},{"key":"B20","doi-asserted-by":"publisher","first-page":"3842","DOI":"10.1128\/IAI.00819-12","article-title":"Persistent Mycoplasma genitalium infection of human endocervical epithelial cells elicits chronic inflammatory cytokine secretion","volume":"80","author":"McGowin","year":"2012","journal-title":"Infect. Immun."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e35","DOI":"10.1097\/OLQ.0000000000000940","article-title":"Prevalence, macrolide resistance, and fluoroquinolone resistance in Mycoplasma genitalium in men who have sex with men attending an sexually transmitted disease clinic in Dublin, Ireland in 2017-2018","volume":"46","author":"Mulligan","year":"2019","journal-title":"Sex Transm. Dis."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1196","DOI":"10.1177\/09564624211030040","article-title":"Mycoplasma genitalium infection in women reporting dysuria: a pilot study and review of the literature","volume":"32","author":"Olson","year":"2021","journal-title":"Int. J. STD AIDS"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1071\/SH22134","article-title":"Australian sexually transmitted infection (STI) management guidelines for use in primary care 2022 update","volume":"20","author":"Ong","year":"2023","journal-title":"Sex Health"},{"key":"B24","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1136\/sextrans-2022-055678","article-title":"Multidrug-resistant Mycoplasma genitalium urethritis: successful eradication with sequential therapy","volume":"99","author":"Raccagni","year":"2023","journal-title":"Sex Transm. Infect."},{"key":"B25","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1136\/sextrans-2024-056338","article-title":"Lefamulin for Mycoplasma genitalium treatment failure in Australia and the USA: a case series and pilot open-label parallel arm randomised trial","volume":"101","author":"Ramchandani","year":"2025","journal-title":"Sex Transm. Infect."},{"key":"B26","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1136\/sextrans-2020-054529","article-title":"Mycoplasma genitalium coinfection in men with symptomatic gonococcal urethritis","volume":"97","author":"Richardson","year":"2021","journal-title":"Sex Transm. Infect."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2024.1417276","article-title":"Research progress on the relationship between chronic prostatitis\/chronic pelvic pain syndrome and the microbiota of the reproductive system","volume":"14","author":"Song","year":"2024","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1177\/0956462419825948","article-title":"British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium (2018)","volume":"30","author":"Soni","year":"2019","journal-title":"Int. J. STD AIDS"},{"key":"B29","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1128\/CMR.00006-11","article-title":"Mycoplasma genitalium: from chrysalis to multicolored butterfly","volume":"24","author":"Taylor-Robinson","year":"2011","journal-title":"Clin. Microbiol. Rev."},{"key":"B30","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1177\/09564624231160676","article-title":"Prevalence of Mycoplasma genitalium infection with antimicrobial resistance mutations among gay sex workers in China","volume":"34","author":"Wang","year":"2023","journal-title":"Int. J. STD AIDS"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab574","article-title":"Impact of an electronic medical record best practice alert on expedited partner therapy for Chlamydia infection and reinfection","volume":"9","author":"Willis","year":"2021","journal-title":"Open Forum Infect. Dis."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sexually transmitted infections treatment guidelines, 2021","volume":"70","author":"Workowski","year":"2021","journal-title":"MMWR Recomm Rep."},{"key":"B33","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1097\/OLQ.0000000000002105","article-title":"Efficacy of doxycycline-sitafloxacin sequential therapy for urogenital Mycoplasma genitalium infection in Nanjing, China","volume":"52","author":"Yuan","year":"2025","journal-title":"Sex Transm. Dis."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1080\/21505594.2022.2095741","article-title":"Pathogenicity and virulence of Mycoplasma genitalium: unraveling Ariadne's thread","volume":"13","author":"Yueyue","year":"2022","journal-title":"Virulence"},{"key":"B35","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1186\/s12879-021-06349-4","article-title":"Prevalence and correlates of Mycoplasma genitalium infection among patients attending a sexually transmitted infection clinic in Guangdong, China: a cross-sectional study","volume":"21","author":"Zhang","year":"2021","journal-title":"BMC Infect. Dis."},{"key":"B36","first-page":"4401","article-title":"Evaluation of real-time fluorescence isothermal nucleic acid amplification technology in detecting Neisseria gonorrhoeae","volume":"23","author":"Zhong","year":"2015","journal-title":"Zhongguo Wei Sheng Jian Yan Za Zhi"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1787520\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T05:24:00Z","timestamp":1775107440000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1787520\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":36,"alternative-id":["10.3389\/fcimb.2026.1787520"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1787520","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]},"article-number":"1787520"}}