[Question #7435] MGEN treatment regimen

5 months ago
Hi Doc,
This is a new question since my follow ups were past 2 already.


After a month several doctors and tests I finally found out I had MGEN. When I first had symptoms of NGU I was treated with 1g of Azithromycin and Rocephin for Chlamydia and Gonorrhea. About a week later the discharge was still there so another doc decided to give me Doxy 200mg/day for 10 days. That almost completely eliminated the discharge but then about 5 days later I woke up with discharge again. I then decided to see another doc who put me on doxy once again but at the same time decided to test me for MGEN which about 6 days later came back positive. I was already in day 6 of my second doxy therapy when he decided to prescribe me Moxifloxacin 400mg for 10 days and to stop the doxy. I am wondering then now how effective is the moxi by itself for 10 days? I read online that moxi is last course treatment and first course can be 7day doxy followed by 2.5g of Azithromycin and only if that fails do you go to the moxi. I hadn’t received that first line treatment at all due to my original doc not knowing to test me for MGen. So if Moxi fails can I go back to the first line treatment or will the moxi be enough? I don’t believe I have one of the strains that is Azithromycin resistant because I never took enough of it to see if it would cure based on what I read and the fact that the doxy did eliminate my symptoms for a short time. I’m just hoping I can cured of this as I have heard people who have a hard time getting rid of it. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Greetings and welcome back -- although sorry you found it necessary. I'll be taking your question this time but I reviewed your recent discussion with Dr. Hook.

It's too soon to speculate about other treatments for M. genitalium if doxycycline followed by moxifloxacin isn't effective. You can cross that bridge if or when you come to it. As Dr. Hook said, the doxy+moxi sequence usually is highly effective. Further, that you had substantial (if incomplete) response to doxy alone makes is especially likely that the combination will be effective. If your symptoms do not clear up entirely or if they relapse in the next couple weeks after that, discuss retesting for M gen with your doctor. However, I would not recommend retesting unless you have continuing or recurrent symptoms. If you have continued symptoms and another posiitve test and your doctors don't seem to be on top of the treatment options, I'll be happy to advise you further at that time.

I hope this helps. Best wishes and stay safe.

HHH, MD
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5 months ago
Hi Doc, I have about 3 days remaining in my moxi treatment. Yesterday I feel like my symptoms got worse. I don’t see any new discharge but my upper urethra hurts when I’m sitting down. If I slightly press on the underside of my penis near the tip it feels sore. The one thing that’s odd is I have zero pain when urinating but when I’m sitting in a chair it just feels like penis is sore like I got hit there but nothing excruciating just sore. I’m wondering if the medicine is working or if I’m regressing?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
I cannot evaluate the likelihood you do or do not have persisting infection based only on these symptoms. I'm inclined to doubt it, but this is something that can only be evaluated only in person by the doctor or clinic treating you. Probably best to wait until at least a week after completing the moxifloxacin -- but check with his or her office about timing. If s/he suggests retesting you, that probably should not be done until at least a week after completing treatment.---
5 months ago
Hi Doc,

So I finished my 10 days of moxi on Saturday and I am now wondering when I can go get a test of cure? My doc did say I can come in for a urine test if I’d like but he did say If I had no symptoms there was no reason to test.

 I’ve read some articles that say at least 2 weeks and others that say within a week(especially if it’s determined the strain was resistant to the meds) you’d want to begin treatment again sooner than later.  I also have heard there is a possibility of false negatives due to low viral loads especially coming right off meds. I honestly still feel like I may have symptoms so I’m worried the moxi didn’t work and I have very minimal options left. I guess my last question would be is if there is growing evidence to suggest MGEN is a lifelong chronic disease or if people do eventually get over it it just may take some time? I know I’m premature in thinking this until I at least get a TOC. Thanks in advance 
5 months ago
Just another note Doc, I still see urine sediment(white strands) in my urine. I’ve read that this is a sign that the infection is still there. Is there any truth to that?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
All I can do is repeat the advice to keep working with your doctor. Mucus strands ("threads") in urine indeed can be a sign of urethral inflammation, but this alone doesn't establish a diagnosis of urethritis and most likely your M. genitalium infection is gone. However, retesting is the only way to know. There are no data to inform the best timing for such retesting, but longer is probably better than shorter -- i.e. I would recommend 2 weeks (rather than only 1 week) after completing treatment. I don't know how to interpret "I may have symptoms", but discuss these, the urine threads, and repeat testing with your doctor.

Is M. genitalium infection a "lifelong chronic disease"? Probably not, but the potential for long term carriage of the organism hasn't been studied. If it happens, probably it is harmless. M gen has been broadly known for only 10-15 years; for all of medical history until then, it was causing 10-20% of NGU cases, and undoubtedly explained many cases of persistent or recurrent NGU, and we now know that such infections usually were treated in ways that would not clear M genitalium. However, persistent or recurrent NGU, or asymptomatic M gen infection, have not been connected to any long term complications in either males or females. Such patients, who were very common in all STD clinics for decades, apparently never show up later with infertility, urethral stricture, epididymitis, PID, or other complications. 

All this suggests that chronic, untreated M genitalium probably doesn't occur (the immune system probably eventually clears most infections); or that if true long term carriage occurs, it usually is not harmful to either infected persons or their partners.

So have the follow-up test, which probably will be negative.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.
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