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Antibiotic treatment of symptomatic Mycoplasma genitalium infection in Scandinavia: a controlled clinical trial

E Björnelius¹, C Anagrius², G Bojs³, H Carlberg⁴, G Johannisson⁵, E Johansson⁴, H Moi⁶, J S Jensen⁷ and P Lidbrink¹

¹ Department of Dermatovenereology, Karolinska University Hospital Huddinge, Stockholm, Sweden
² STI Clinic, Central Hospital, Falun, Sweden
³ Department of Dermatology, Central Hospital, Kristianstad, Sweden
⁴ Department of Dermatology and Venereology, South Hospital, Stockholm, Sweden
⁵ Department of Dermatology and Venereology, Sahlgrenska University Hospital, Gothenburg, Sweden
⁶ Olafiaklinikken, Ullevaal Hospital, Oslo, Norway
⁷ Mycoplasma Laboratory, Statens Serum Institut, Copenhagen, Denmark

Correspondence to:
E Björnelius, Karolinska University Hospital, Huddinge, S-141 86 Stockholm, Sweden; eva.bjornelius{at}karolinska.se

Objectives: To evaluate the microbiological cure rate after treatment with tetracyclines or azithromycin in patients infected with M genitalium.

Methods: One hundred and fifty-two men and 60 women positive for M genitalium were recruited. Patients treated either with doxycyline for 9 days or with azithromycin 1 g stat. were compared. Those still positive for M genitalium after primary doxycycline treatment received an extended course of azithromycin 500 mg on day 1 followed by 250 mg daily for the following 4 days, whereas those with treatment failure after azithromycin received doxycycline 100 mg twice daily for 15 days.

Results: The eradication rate after azithromycin 1 g stat. was 85% (95% CI 69 to 94) in men (n = 39) and 88% (95% CI 64 to 99) in women (n = 17) and after doxycycline 17% (95% CI 9 to 27) in men (n = 76) and 37% (95% CI 19 to 58) in women (n = 27). Extended azithromycin eradicated M genitalium from 96% (95% CI 85 to 99) of the men (n = 47) and from all six women who failed on doxycycline. Extended doxycycline treatment was insufficient. Persistent urethral inflammation was seen in a substantial portion of the men after eradication of M genitalium regardless of the antibiotic drug, indicating a poor predictive value of urethral smears in evaluation of persistent or recurrent infection.

Conclusions: Azithromycin was more effective than doxycycline in treating patients infected with M genitalium. The extended course of azithromycin was highly effective but was given after the initial treatment with doxycycline. Randomised clinical trials are needed to compare the different dosages of azithromycin.

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