Epidemiology

 Mycoplasma genitalium (MG) is considered a new and emerging sexually transmitted pathogen (71), with an estimated global community prevalence of 1.3% (72). The prevalence of MG infection in HIV-positive individuals has not been systematically investigated in Australia, however a meta-analysis of observational studies worldwide suggested HIV-positive individuals bear a disproportionate burden of MG infection (73).  Like several other STIs, MG infection may increase the shedding of HIV-1 virus from the cervix (74), but the clinical implications of this finding have not been investigated.

Clinical presentation

 MG causes urethritis in men and cervicitis in women. It is associated with PID and is a possible cause of preterm delivery, spontaneous abortion and infertility in women (75). There is no evidence to suggest distinct clinical features are present or different management approaches are required in HIV-positive individuals.

Management

 The prevalence of macrolide resistance is high in Australia, especially among MSM (76). Doxycycline will only cure approximately one-third of MG infections, although Australian guidelines recommend a week of doxycycline 100mg po bd to reduce bacterial load, then resistance-guided therapy with either azithromycin 1g stat then 500mg daily for three days or, where macrolide resistance is confirmed or suspected, moxifloxacin 400mg po daily for 7 days (4).