Nitroimidazole susceptibility and mechanisms of resistance in Mycoplasma genitalium

PROJECT SUMMARY Mycoplasma genitalium is a sexually transmitted bacterial pathogen that frequently causes genital tract syndromes including urethritis in men and cervicitis, pelvic inflammatory disease, and infertility in women. Sensitive diagnostic tests have been approved in the US since 2019, however, few treatment options for M.

genitalium are available. M. genitalium lacks a cell wall and has only a single membrane so antibiotics targeting peptidoglycan synthesis, or the bacterial outer membrane, are completely inactive. Doxycycline is only 30-40% effective in eradicating M. genitalium infections. The efficacy of azithromycin, the preferred

therapy, has decreased in recent years and now more than 50% of US strains are resistant. In high-risk populations in the US and worldwide azithromycin resistance reaches 100%. More than 10% of strains are resistant to moxifloxacin, the recommended second line therapy, and resistance to both macrolides and

fluoroquinolones is increasingly reported. No effective treatment options are approved in the US to treat these dually resistant infections. In addition, moxifloxacin is not approved for certain patient groups (e.g., pregnant women, adolescents