Mycoplasma genitalium (MG) has developed resistance to macrolides that currently exceeds 50% in most nations and quinolone-resistance, particularly in the Western Pacific region is increasingly being reported. Widespread use of azithromycin in the management of STI syndromes, chlamydia and gonorrhoea has contributed to the emergence and spread of macrolide-resistant MG globally. Diagnostic assays that incorporate macrolide resistance markers have recently been developed and provide an opportunity to reduce the use of azithromycin and individualise therapy. This talk will focus on the impact of the first generation of diagnostic resistance assays for MG on microbial cure and de novo resistance. It will review their utility in clinical algorithms in an STI setting and their impact on practice and policy. Macrolide resistance mutations are well described and result in high level resistance and failure of azithromycin making them highly suitable candidates for resistance assays. However markers of quinolone resistance, needed for the development of the next generation of resistance assays, have been harder to define and correlate with treatment outcomes.

Disclosure No significant relationships.