Treatment of Mycoplasma genitalium and Mycoplasma hominis Infections

First-Line Treatment Recommendations

The Centers for Disease Control and Prevention recommends azithromycin 500 mg on day 1, followed by 250 mg daily on days 2-5, for Mycoplasma genitalium urinary tract infections, achieving 93-99% cure rates while minimizing macrolide resistance development 1
The Centers for Disease Control and Prevention recommends doxycycline 100 mg orally twice daily for 7 days as the preferred treatment for Mycoplasma hominis, due to its natural resistance to macrolides 2, 3

For Mycoplasma genitalium, the initial therapy with azithromycin 500 mg orally on day 1, then 250 mg daily on days 2-5, is superior to the single 1g dose, which has declining efficacy 1, 4
For Mycoplasma hominis, doxycycline 100 mg orally twice daily for 7 days is the first-line therapy, and alternative regimens include ofloxacin 300 mg orally twice daily for 7 days and levofloxacin 500 mg orally once daily for 7 days 2, 3

Doxycycline monotherapy achieves only 30-40% cure rates for Mycoplasma genitalium 1
Patients must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of multi-day regimens, and all sexual partners within the preceding 60 days require evaluation and treatment to prevent reinfection 1, 2, 3
Test for co-infections including gonorrhea, chlamydia, syphilis, and HIV, and return for evaluation only if symptoms persist or recur after treatment completion 2, 5