[Question #3987] Mycoplasma genitalium treatment FAILURE

85 months ago

Hi Doctor

this is follow up for my initial question # 3818.

Im right now on day 9 of the treatment for mycoplasma genitalium using moxifloxacin 400mg, by day 4 5 &6 discharge went away but sorethroat is still there day 7 8 & 9 discharge came back but in very small amount .

my Question is :

1-Should I continue taking the Moxifloxacin 400 till day 14 or I should stop now. ( i feel of strong side effect )

2- What is my choices of treatment ? I read about good medicine (Pristinamycin ) as third line treatment but its not available where I live and I think I need one month to have it ? What is your opinion on that.

3-Minocycline 100mg orally twice daily for 14 days as alternative ? And its available in hospital here . What is your opinion on that?

H. Hunter Handsfield, MD

85 months ago

Welcome back to the forum. I'll be answering this question, but I reviewed your recent discussion with Dr. Hook.

I agree with all Dr. Hook said. I would add that your symptoms are not necessarily due to Mycoplasma genitalium, even with the positive test result. Many (maybe most) M genitalium infections cause no symptoms, and your symptoms -- with sore throat as well as urethritis, plus non-response to initial antibiotic therapy -- were most consistent with a non-STD viral infection. In particular, the cold virus named adenovirus can be acquired by oral sex and a common cause of problems like yours.

Don't get me wrong: it was reasonable to test you for M genitalium, and to give treatment for the positive result. Still, moxifloxacin usually is effective against it, and continuing symptoms supports the idea that something other than M genitalium is the cause. It is NOT possible to conclude treatment failure for M genitalium based only on symptoms, only if it is found again on repeat testing. To your specific questions:

1) You should contact the doctor or clinic who prescribed the moxifloxacin and follow their advice. You don't say what "strong side effect" you are having -- but this also should be discussed with the prescribing doctor.

2) If your doctor retests you for M genitalium, and if a repeat test is positive, that doctor can best decide the next steps. Perhaps pristinamycin would be a consideration, but another option would be to not give additional treatment, but to continue to follow up to see if it persists. Other time, most M genitalium infections are believed to clear up on their own.

3) Most M genitalium strains are resistant to all tetracyclines (tetracycline itself, doxycycline, and minocycline). Minocycline is not likely to help. For sure do not treat yourself; discuss with your doctor.

Finally, have you been tested for trichomonas or treat for it (metronidazole or tinidazole)? This also is something to discuss with your doctor or clinic.

I'll be interested in hearing what your doctors advise. In the meantime, I hope these comments are helpful.

HHH, MD

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85 months ago

Hi Doctor,

Thank you for the details reply,

Can this be cured by it self (adenovirus ) ?

Next week I will go vacation after that I will test trichomonas and re test the MG

for now I will try to forget the problem and hope it will be solved by its self

I hope that you can leave the discussion open till that time , I will reply with the test result in mid of September.

H. Hunter Handsfield, MD

85 months ago

That's probably an OK plan, but doesn't address trichomonas. If you have not yet been tested or treated for trich, that would make sense, with no need to wait. If not yet done, I suggest you discuss this with your doctor. The normal approach in NGU that doesn't respond to standard therapies is to treat for possible trichomonas (e.g. metronidazole 500 mg twice daily for a week) -- preferably preceded by a PCR test for trich. (Of course disregard this if trichomonas has already been addressed.)

Adenovirus urethritis resolves entirely on its own, usually over 2-3 weeks. There is never a long term or persistent infection.

Threads normally are closed after 4 weeks of no activity. There is no need or apparent benefit to posting anything further if follow-up testing is negative for M genitalum and your symptoms have cleared up. And if still positive or with symptoms, it will require more than a brief response. you'll need to ask a new question at that time.

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85 months ago

Actually i found that i treated for Trich already by Flagy 400 & cipropay 500 for 5 days so i think we should take it off from the list do you agree or you think i should test for it since i did not test or that ?

for Adenovirus urethritis i have the symptoms 5 month now so i think we can ignore it . do you agree with that ?

and i think its bacteria infliction coz its response with antibiotic ( i saw improvement when i toke Unidox ( doxycycline) at the first time , but 2nd time i didnot see any improvement , and now i see the improvement again with moxifloxacin 400mg .

Please note that yesterday i finished the treatment with moxifloxacin 400mg for 10days can i re test the MG tomm or i should wait 1 month and then re test?

H. Hunter Handsfield, MD

85 months ago

It's good to hear your symptoms are improving. If that continues, and if they clear up entirely, I don't think anything more need be done: no need for any further diagnostic tests or treatment. I wouldn't retest you for M genitalium. But if you feel you need a retest or your doctor recommends it, then 1 month is about the right time.

As for trichomonas, if the metronidazole (Flagyl) dose was 400 mg twice daily for 5 days, it should have been effective and no more testing or treatment is necessary. (The normal dose is 500 mg twice daily, but perhaps 400 mg is used in some countries.) Ciprofloxacin (Cipropay) has no effect at all on trich and is never used for its treatment. (I have to question the STD knowledge of any doctor who uses such treatment.)

I didn't realize your symptoms had gone on so long. Adenovirus always clears up within 2-3 weeks. I agree this can now be ignored.

That concludes the two follow-up comments and replies included with each question and so concludes this thread. I hope the discussion has been helpful.

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