{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:41:08Z","timestamp":1780544468088,"version":"3.54.1"},"reference-count":42,"publisher":"PAGEPress Publications","issue":"1","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Introduction: Mycoplasma genitalium and Mycoplasma hominis are urogenital mycoplasmas associated with urethritis, prostatitis, epididymitis, and pelvic inflammatory disease. In the last decade, acquired resistance to macrolides and fluoroquinolones in M. genitalium, together with intrinsic and acquired resistance to tetracyclines in M. hominis, have emerged as growing challenges in urology and sexual medicine.Material and methods: A systematic review was conducted following the PRISMA guideline, searching PubMed, Scopus, and Web of Science (2015-2025). Clinical, epidemiological, and molecular studies describing genetic resistance mechanisms, as well as meta-analyses and clinical guidelines, were included. After applying inclusion and exclusion criteria, 42 articles were selected.Results: In M. genitalium, macrolide resistance is associated with mutations in 23S rRNA (A2058G, A2059G), while fluoroquinolone resistance is linked to variants in parC and gyrA (S83I, D87N). In M. hominis, intrinsic macrolide resistance is complemented by the presence of tet(M), which contributes to doxycycline treatment failures. Globally, macrolide resistance in M. genitalium reaches 30-50% in Europe and the Americas, and over 60% in Asia; dual macrolide-fluoroquinolone resistance is emerging, with epidemic foci in Japan and China. In M. hominis, tetracycline resistance ranges from 10-30%, with regional variability.Conclusions: Antimicrobial resistance in M. genitalium and M. hominis limits the effectiveness of traditional empirical therapies and requires the implementation of molecular detection and resistance testing. Resistance-guided treatment and epidemiological surveillance are essential to optimize clinical management and curb the spread of multidrug-resistant strains.\n\u00a0<\/jats:p>","DOI":"10.4081\/aiua.2026.14694","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T08:08:53Z","timestamp":1770365333000},"source":"Crossref","is-referenced-by-count":1,"title":["Antimicrobial resistance in &lt;i&gt;Mycoplasma genitalium&lt;\/i&gt; and &lt;i&gt;Mycoplasma hominis&lt;\/i&gt;: a systematic review in urology"],"prefix":"10.4081","volume":"98","author":[{"given":"Jorge","family":"Llaca-D\u00edaz","sequence":"first","affiliation":[{"name":"Department of Clinical Pathology, University Hospital \u201cDr. Jos\u00e9 Eleuterio Gonz\u00e1lez\u201d, Universidad Aut\u00f3noma de Nuevo Le\u00f3n, Monterrey, Nuevo Le\u00f3n"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nestor","family":"Casillas-Vega","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, University Hospital \u201cDr. Jos\u00e9 Eleuterio Gonz\u00e1lez\u201d, Universidad Aut\u00f3noma de Nuevo Le\u00f3n, Monterrey, Nuevo Le\u00f3n"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"213461","doi-asserted-by":"crossref","unstructured":"1. 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Tetracycline resistance mediated by tet(M) has variable integrative conjugative element composition in Mycoplasma hominis strains isolated in the United Kingdom from 2005 to 2015. Antimicrob Agents Chemother 2021;65:e02513-20.","DOI":"10.1128\/AAC.02513-20"},{"key":"213469","unstructured":"9. Pereyre S, et al. Emerging resistance in Mycoplasma hominis: clinical significance. J Antimicrob Chemother 2017; 72:1627-34."},{"key":"213470","doi-asserted-by":"crossref","unstructured":"10. Page MJ, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:n71.","DOI":"10.1136\/bmj.n71"},{"key":"213471","doi-asserted-by":"crossref","unstructured":"11. Pi\u00f1eiro L, et al. Increases in macrolide resistance in Mycoplasma genitalium. Antibiotics (Basel) 2022; 11:923.","DOI":"10.3390\/antibiotics11111492"},{"key":"213472","unstructured":"12. Katsuta T, et al. A2059G mutation conferring MLSB phenotype in Mycoplasma hominis. 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Clin Infect Dis 2015; 61:S802-17.","DOI":"10.1093\/cid\/civ785"},{"key":"213477","doi-asserted-by":"crossref","unstructured":"17. Ahmadi MH. Resistance to tetracyclines among clinical isolates of Mycoplasma hominis and Ureaplasma species: a systematic review and meta-analysis. J Antimicrob Chemother 2021; 76:865-75.","DOI":"10.1093\/jac\/dkaa538"},{"key":"213478","doi-asserted-by":"crossref","unstructured":"18. Machalek DA, Tao Y, Shilling H, et al. Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis. Lancet Infect Dis 2020; 20:1302-14.","DOI":"10.1016\/S1473-3099(20)30154-7"},{"key":"213479","doi-asserted-by":"crossref","unstructured":"19. Murray GL, Bradshaw CS, Bissessor M, et al. Increasing macrolide and fluoroquinolone resistance in Mycoplasma genitalium. Emerg Infect Dis 2017; 23:809-12.","DOI":"10.3201\/eid2305.161745"},{"key":"213480","doi-asserted-by":"crossref","unstructured":"20. Le Roy C, H\u00e9nin N, Pereyre S, et al. Fluoroquinolone-resistant Mycoplasma genitalium, Southwestern France. Emerg Infect Dis 2016; 22:1677-9.","DOI":"10.3201\/eid2209.160446"},{"key":"213481","doi-asserted-by":"crossref","unstructured":"21. Deguchi T, Ito S, Yasuda M, et al. Surveillance of the prevalence of macrolide and\/or fluoroquinolone resistance-associated mutations in Mycoplasma genitalium in Japan. J Infect Chemother 2018;24:861-7.","DOI":"10.1016\/j.jiac.2018.08.009"},{"key":"213482","doi-asserted-by":"crossref","unstructured":"22. Li L, Huang J, Zhang J, et al. Emerging multidrug resistance contributes to treatment failure in Mycoplasma genitalium-infected patients in China. Diagn Microbiol Infect Dis 2023; 105:115854.","DOI":"10.1016\/j.diagmicrobio.2022.115854"},{"key":"213483","doi-asserted-by":"crossref","unstructured":"23. 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Clin Infect Dis 2020; 71:1461-8.","DOI":"10.1093\/cid\/ciz1031"},{"key":"213486","doi-asserted-by":"crossref","unstructured":"26. Trinchieri A, Abdelrahman KM, Bhatti KH, et al. Spectrum of causative pathogens and resistance rates to antibacterial agents in bacterial prostatitis. Diagnostics (Basel) 2021; 11:1333.","DOI":"10.3390\/diagnostics11081333"},{"key":"213487","unstructured":"27. Hini\u00b4c V, Mouttet F, Wu\u0308thrich D, et al. Unexpected Mycoplasma hominis infection in two renal transplant recipients, discovered accidentally in the bacterial workup. Transpl Infect Dis 2021; 23:e13481."},{"key":"213488","doi-asserted-by":"crossref","unstructured":"28. Ahmadi MH, Mirsalehian A, Sadighi Gilani MA, et al. Asymptomatic infection with Mycoplasma hominis negatively affects semen parameters and leads to male infertility as confirmed by improved semen parameters after antibiotic treatment. Urology 2017;100:97-102.","DOI":"10.1016\/j.urology.2016.11.018"},{"key":"213489","unstructured":"29. Horner PJ, Donders G, Cusini M, et al. Should we be testing for urogenital Mycoplasma genitalium? Evidence-based review and recommendations. Clin Microbiol Infect 2018; 24:521-9."},{"key":"213490","doi-asserted-by":"crossref","unstructured":"30. Waites KB, Crabb DM, Duffy LB, et al. Comparative in vitro susceptibilities of human mycoplasmas and ureaplasmas to a new investigational antimicrobial, AZD0914, a novel DNA gyrase inhibitor. Antimicrob Agents Chemother 2016; 60:1919-24.","DOI":"10.1128\/AAC.01734-16"},{"key":"213491","doi-asserted-by":"crossref","unstructured":"31. Clarke EJ, Cherny KE, Fairley CK, et al. Efficacy of minocycline for the treatment of Mycoplasma genitalium. Open Forum Infect Dis 2023; 10:ofad427.","DOI":"10.1093\/ofid\/ofad427"},{"key":"213492","doi-asserted-by":"crossref","unstructured":"32. Jensen JS, Hansen HT, Unemo M, et al. 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BMC Infect Dis 2020; 20:950.","DOI":"10.1186\/s12879-020-05659-3"},{"key":"213495","doi-asserted-by":"crossref","unstructured":"35. Chua TP, Vodstrcil LA, Murray GL, et al. Evolving patterns of macrolide and fluoroquinolone resistance in Mycoplasma genitalium: an updated systematic review and meta-analysis. Lancet Microbe 2025; 6:101047.","DOI":"10.1016\/j.lanmic.2024.101047"},{"key":"213496","unstructured":"36. UK Health Security Agency. Mycoplasma genitalium antimicrobial resistance surveillance (MARS) report: 2023. UKHSA; 2024. Available from: https:\/\/www.gov.uk\/government\/publications\/mycoplasma-genitalium-antimicrobial-resistance-surveillance-mars\/mycoplasma-genitalium-antimicrobial-resistancemars-report-2023"},{"key":"213497","doi-asserted-by":"crossref","unstructured":"37. Muller EE, Mahlangu MP, Lewis DA, et al. Macrolide and fluoroquinolone resistance-associated mutations in Mycoplasma genitalium in Johannesburg, South Africa, 2007-2014. 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J Appl Microbiol 2025;136:lxae308.","DOI":"10.1093\/jambio\/lxae308"},{"key":"213501","doi-asserted-by":"crossref","unstructured":"41. Boujemaa S, Mlik B, Mardassi H, et al. Clonal spread of tetracycline resistance among Mycoplasma hominis clinical strains, Tunisia. Infect Drug Resist 2020;13:2093-7.","DOI":"10.2147\/IDR.S249630"},{"key":"213502","doi-asserted-by":"crossref","unstructured":"42. Wen X, Nobakht MS, Yang Y, et al. Tetracyclines resistance in Mycoplasma and Ureaplasma urogenital isolates derived from humans: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob 2023; 22:83.","DOI":"10.1186\/s12941-023-00628-5"}],"container-title":["Archivio Italiano di Urologia e Andrologia"],"original-title":[],"link":[{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/download\/14694\/13699","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/download\/14694\/13699","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:01:39Z","timestamp":1775001699000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/view\/14694"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,6]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3,31]]}},"URL":"https:\/\/doi.org\/10.4081\/aiua.2026.14694","relation":{},"ISSN":["2282-4197","1124-3562"],"issn-type":[{"value":"2282-4197","type":"electronic"},{"value":"1124-3562","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2,6]]}}}