Clinical presentations and treatment outcomes of Mycoplasma genitalium infections at a large New York City healthcare system

Abstract

Abstract Background Mycoplasma genitalium (MG) is an emerging sexually transmitted infection. Treatment of MG is complicated by increasing resistance to primary treatment regimens, including macrolides and fluoroquinolones. Understanding the various clinical presentations and relative effectiveness of treatments for MG is crucial to optimizing care. Methods Patients with a positive MG Nucleic Acid Amplification Test (NAAT) between July 1, 2019 and June 30, 2021 at a large health system in New York City were included in a retrospective cohort. Demographics, clinical presentations, coinfections, treatment, and follow-up microbiologic tests were obtained from the electronic medical record. Associations with microbiologic cure were evaluated in bivariate and multivariable logistic regression models. Results Five-hundred and two unique patients had a positive MG NAAT during the study period. Males presented predominantly with urethritis (117/187, 63%) and females with vaginal symptoms (142/315, 45%). Among patients with follow-up testing who received a single antibiotic at the time of treatment, 43% (90/210) had persistent infection and 57% (120/210) had microbiologic cure. Eighty-two percent of patients treated with moxifloxacin had microbiologic cure compared to 41% of patients receiving azithromycin regimens (p < 0.001). In multivariable analysis, treatment with moxifloxacin was associated with four times the odds of microbiologic cure relative to low-dose azithromycin (aOR 4.18, 95% CI 1.73-10.13, p < 0.01). Conclusions Clinical presentations of MG vary, with urethritis or vaginal symptoms in most cases. Among patients who received a single antibiotic, only treatment with moxifloxacin was significantly associated with microbiologic cure relative to low-dose azithromycin.