**2.5** *Mycoplasma genitalium*

This infection in women may be symptomatic or asymptomatic. In women infected with these bacteria, there have been such findings as cervicitis, pelvic inflammatory disease (PID), preterm delivery, spontaneous abortion, and infertility, with an approximately two-fold increase in the risk for these outcomes in such women [36]. The prevalence of MG in developed countries with higher Human Development Index (HDI) was 1.3–1.6% but the prevalence in developing countries with lower HDI was 3.9–5.2% [37]. The figures show that the prevalence is lower in developed countries compared to developing countries. Despite this obvious trend, the availability of facilities and personnel for testing, treatment, and prevention of these diseases is limited in developing countries.

This organism grows slowly in the culture medium in the laboratory. It can take up to 6 months to culture this organism and this is mostly limited to research for now. The Food and Drug Administration (FDA) in the USA has approved the use of NAAT for detection of the *MG* from urine, urethral, penile meatal, endocervical, and vaginal swab samples. The needed molecular tests for quinolone and macrolide-resistant testing are not available commercially. Men with recurrent nongonococcal urethritis (NGU) should be tested for MG using an FDA-cleared NAAT. If resistance testing is available, it should be performed, and the results used to guide therapy. Women with recurrent cervicitis should be tested for MG, and testing should be considered among women with pelvic inflammatory disease (PID) [1]. Testing should be accompanied by resistance testing, if available. Screening of asymptomatic MG infection among women and men or extragenital testing for MG is not recommended. In clinical practice, if testing is unavailable, MG should be suspected in cases of persistent or recurrent urethritis or cervicitis and considered for PID [1]. The laboratory confirmation of this organism is tedious and also not available for most patients in developing countries for the same reasons already adduced above.

Treatment: Based on CDC recommendations, if the organism is macrolide sensitive: oral Doxycycline 100 mg twice daily for 7 days, followed by oral Azithromycin 1 g initial dose, followed by 500 mg once daily for 3 additional days (2.5 g total). If macrolide-resistant oral Doxycycline 100 mg daily for 7 days followed by oral moxifloxacin 400 mg once daily for 7 days should be administered.
