Test of Cure for Mycoplasma: Methods and Best Practices

By Dr. Zubair Khalid, DVM, MS, PhD ·

Test of Cure for Mycoplasma: Methods and Best Practices

Introduction to Mycoplasma and Test of Cure

What is Mycoplasma?

Mycoplasmas are the smallest self-replicating prokaryotes, lacking a peptidoglycan cell wall. This absence of a cell wall makes them intrinsically resistant to β-lactam antibiotics such as penicillin and cephalosporins, which target cell wall synthesis. Mycoplasmas belong to the class Mollicutes and are characterized by their small genome (580 kb to 1,350 kb) and their dependence on host-derived nutrients, particularly sterols, which they cannot synthesize de novo. In cell culture, the most common contaminants are Mycoplasma arginini, M. hyorhinis, M. orale, and Acholeplasma laidlawii, while in human infections, M. pneumoniae, M. genitalium, and Ureaplasma urealyticum are clinically significant.

Because mycoplasmas lack a cell wall, they are not visible under standard light microscopy, and they can pass through 0.22-µm filters used for sterilizing media. In cell culture, contamination is often insidious: infected cultures show no turbidity, and the mycoplasma load can reach 10⁶ to 10⁸ colony-forming units (CFU) per milliliter without overtly killing the cells. Instead, contaminated cultures may exhibit reduced growth rates, altered metabolism, or chromosomal aberrations—effects that can silently invalidate experimental results.

Why Test of Cure Matters

A test of cure (TOC) is a diagnostic procedure performed after a course of treatment to confirm that the pathogen has been eliminated. In the context of mycoplasma, TOC serves two distinct but equally critical purposes. In clinical medicine, TOC confirms that an antibiotic regimen has eradicated the infection, particularly in cases where the organism is known for persistence or where treatment failure is common. In cell culture and bioprocessing, TOC verifies that a contaminated culture has been successfully cleared by antibiotic treatment or that a clean culture remains free of contamination.

The importance of TOC cannot be overstated. Mycoplasma infections can persist asymptomatically, and clinical symptoms may resolve even when viable organisms remain. Similarly, in cell culture, a contaminated culture may appear healthy while harboring mycoplasma at high titers. Without a definitive TOC, you cannot distinguish between true eradication and apparent recovery. This distinction is essential for patient management, for the integrity of research data, and for regulatory compliance in biopharmaceutical manufacturing.

Clinical Test of Cure for Mycoplasma Infections

Indications for Test of Cure

In clinical practice, TOC for mycoplasma is not universally recommended for every infection. The decision to perform a TOC depends on the species, the clinical context, and the treatment regimen used.

For M. genitalium, a sexually transmitted pathogen associated with urethritis and cervicitis, TOC is strongly recommended. This organism has a high rate of macrolide resistance, with prevalence exceeding 40% in some populations, and treatment failure rates with azithromycin can approach 30%. The 2021 European guideline on M. genitalium infections recommends a TOC at 3 to 4 weeks after completion of therapy for all patients, regardless of symptom resolution. This is because asymptomatic persistence is common, and untreated infection can lead to pelvic inflammatory disease or epididymitis.

For M. pneumoniae, the causative agent of atypical pneumonia, TOC is generally not recommended in uncomplicated cases. The infection is typically self-limiting, and the organism can be shed for weeks after clinical recovery. However, TOC may be indicated in immunocompromised patients, in cases of macrolide-resistant infection, or in outbreak settings where confirming eradication is epidemiologically important.

For Ureaplasma species, TOC is indicated in cases of persistent urethritis or in pregnant women with threatened preterm labor, where eradication of the organism is the therapeutic goal.

Sample Types and Collection

The choice of sample for TOC depends on the site of infection. For M. genitalium, a first-void urine sample (the first 10–20 mL of urine) is the specimen of choice in men, as it captures urethral exudate. In women, a vaginal swab (collected by a clinician or self-collected) has the highest sensitivity, followed by cervical swabs. Urethral swabs are more invasive and are reserved for cases where urine testing is negative but clinical suspicion remains high.

For M. pneumoniae, respiratory specimens are required. These include throat swabs, nasopharyngeal aspirates, sputum, or bronchoalveolar lavage fluid. The timing of collection is critical: the organism is most abundant in the first week of illness, and nucleic acid amplification tests (NAATs) can remain positive for up to 7 weeks after infection, even after successful treatment. This prolonged positivity complicates TOC interpretation, as a positive result may reflect dead DNA rather than viable organisms.

For Ureaplasma, first-void urine or urethral swabs are used in men, and vaginal or endocervical swabs in women. In neonatal infections, tracheal aspirates or nasopharyngeal swabs are appropriate.

Sample handling is critical. Mycoplasmas are fastidious and fragile; specimens should be transported in appropriate transport media (e.g., 2SP medium containing sucrose-phosphate buffer with fetal bovine serum) and processed within 24 hours if culture is intended. For NAATs, samples can be stored at 4°C for up to 72 hours or frozen at −20°C or −80°C for longer periods, provided that repeated freeze-thaw cycles are avoided.

Laboratory Methods for Mycoplasma Detection

Culture-Based Methods

Culture is the historical gold standard for mycoplasma detection, but it is slow, technically demanding, and has low sensitivity for some species. Mycoplasmas require enriched media containing sterols (e.g., 20% horse serum), yeast extract, and antibiotics to suppress contaminating bacteria. The classic media include Friis medium for M. hyorhinis, SP-4 medium for M. pneumoniae and M. genitalium, and A8 or U9 medium for ureaplasmas.

The culture process involves inoculating the specimen onto agar plates and into broth. Plates are incubated at 37°C in an atmosphere of 5% CO₂ and 95% nitrogen (or in a microaerophilic environment) for up to 14 days for M. pneumoniae and up to 8 weeks for M. genitalium. Colonies are typically 10–100 µm in diameter and have a characteristic "fried egg" appearance due to dense central growth penetrating the agar and a thinner peripheral zone on the surface. Ureaplasmas produce smaller colonies (15–30 µm) and require urea for growth; they are identified by the development of a pink color in U9 broth due to ammonia production from urea hydrolysis.

Culture has several limitations for TOC. First, the long incubation times delay clinical decisions. Second, prior antibiotic exposure can suppress growth even when viable organisms remain, leading to false-negative results. Third, some species, particularly M. genitalium, are extremely fastidious and may not grow in culture even when present in high numbers. For these reasons, culture is now rarely used for TOC in clinical settings, though it remains valuable for antimicrobial susceptibility testing and for confirming viability in research contexts.

Nucleic Acid Amplification Tests (NAATs)

NAATs, particularly real-time polymerase chain reaction (PCR), are the current standard for mycoplasma detection and TOC. These assays target conserved genes such as the 16S rRNA gene, the gap gene (encoding glyceraldehyde-3-phosphate dehydrogenase), or species-specific genes such as MgPa (the major adhesin gene of M. genitalium) and the P1 adhesin gene of M. pneumoniae.

Real-time PCR offers several advantages for TOC. It is rapid (results in 2–4 hours), highly sensitive (detecting as few as 10–100 copies of target DNA), and specific. Quantitative PCR (qPCR) can provide a measure of organism load, which is useful for monitoring response to therapy. A typical qPCR reaction for mycoplasma detection uses 5 µL of extracted DNA in a 20–25 µL reaction volume, with primers at 200–400 nM, probes at 100–200 nM, and cycling conditions of 95°C for 10 minutes (initial denaturation), followed by 40–45 cycles of 95°C for 15 seconds and 60°C for 60 seconds.

For TOC specifically, NAATs have a critical limitation: they detect DNA, not viable organisms. After successful treatment, dead organisms release DNA that can persist in the urogenital tract or respiratory tract for weeks. This is particularly problematic for M. genitalium, where DNA can be detected for up to 3 months after treatment in some patients. To address this limitation, some laboratories use messenger RNA (mRNA) detection as a viability marker, since mRNA is rapidly degraded in dead cells. However, mRNA-based assays are not yet widely available or standardized.

An alternative approach is the use of transcription-mediated amplification (TMA), which targets ribosomal RNA (rRNA). Since rRNA is more abundant than DNA (up to 10⁴ copies per cell), TMA offers higher analytical sensitivity. However, rRNA also persists in dead cells, so the viability issue remains.

Serological Testing

Serological tests detect antibodies against mycoplasma, rather than the organism itself. These are of limited value for TOC for several reasons. First, antibody responses are delayed: IgM appears 7–10 days after primary infection, and IgG peaks at 4–6 weeks. Second, antibodies persist for months to years after infection, so a positive serology cannot distinguish between past and current infection. Third, immunocompromised patients may not mount a detectable antibody response.

For M. pneumoniae, serology is still used for diagnosis, with a four-fold rise in IgG titers between acute and convalescent sera (collected 2–3 weeks apart) being considered diagnostic. However, serology is not recommended for TOC because antibody titers do not correlate with organism clearance. For M. genitalium, serology is not clinically useful due to cross-reactivity with other mycoplasma species and poor sensitivity.

In the context of cell culture, serological methods are irrelevant, as the goal is to detect the organism, not the host response. For culture monitoring, the ELISA Test can be adapted to detect mycoplasma antigens in culture supernatants, but this approach has largely been superseded by PCR-based methods.

Timing of Test of Cure: Why It Matters

Early vs. Late Testing

The timing of TOC is a critical determinant of result accuracy. Testing too early can produce false negatives because residual antibiotics may suppress organism growth or because the organism load has not yet rebounded to detectable levels. Testing too late can produce false positives because dead DNA persists, or it can delay necessary clinical decisions.

For M. genitalium, the recommended TOC window is 3 to 4 weeks after completion of antibiotic therapy. This timing balances two considerations. First, it allows sufficient time for the antibiotic to be fully eliminated, avoiding the suppressive effect of residual drug on culture-based assays. Second, it minimizes the likelihood of detecting residual DNA from dead organisms. However, even at 3–4 weeks, a positive NAAT result does not necessarily indicate viable infection; it may reflect persistent DNA. In such cases, a repeat test at 6–8 weeks may be warranted, or an mRNA-based assay may be used if available.

For M. pneumoniae, TOC is rarely performed, but when indicated, it should be done at least 2–3 weeks after symptom resolution. This is because the organism can be shed for up to 7 weeks after infection, and a positive PCR during this period does not indicate treatment failure.

For cell culture, the timing of TOC depends on the treatment protocol. If a contaminated culture is treated with antibiotics (e.g., a combination of 10 µg/mL ciprofloxacin and 10 µg/mL BM-Cyclin), the TOC should be performed at least 2 weeks after the final antibiotic dose. This allows the culture to undergo several passages in antibiotic-free medium, which dilutes out residual drug and any remaining mycoplasma.

Factors Affecting Timing

Several factors influence the optimal TOC timing:

Antibiotic half-life. Macrolides such as azithromycin have a long tissue half-life (up to 68 hours), and residual drug can persist for weeks. Doxycycline has a half-life of 18–24 hours, while moxifloxacin has a half-life of 12–15 hours. TOC should be scheduled after at least five half-lives of the antibiotic have elapsed to ensure that residual drug does not suppress growth in culture-based assays.

Organism load. Patients with high baseline organism loads may take longer to clear mycoplasma DNA. In such cases, a single negative TOC may be insufficient; a second confirmatory test 2–4 weeks later is recommended.

Immune status. Immunocompromised patients may clear the organism more slowly, and TOC may need to be delayed or repeated.

Sample type. Urine samples may have lower organism loads than swab samples, and the sensitivity of NAATs can vary by sample type. For M. genitalium, vaginal swabs have a sensitivity of approximately 95%, while urine has a sensitivity of approximately 80% in women.

Interpreting Test of Cure Results

Positive Results

A positive TOC result indicates the presence of mycoplasma DNA or viable organisms in the sample. In the clinical context, this is interpreted as treatment failure, and a change in antibiotic regimen is warranted. For M. genitalium, a positive TOC at 3–4 weeks post-treatment should prompt antimicrobial susceptibility testing if possible, or empirical therapy with a different antibiotic class (e.g., moxifloxacin if the initial treatment was azithromycin).

However, a positive NAAT result does not necessarily mean viable infection. As discussed, DNA from dead organisms can persist for weeks. To distinguish between viable and non-viable organisms, you can:

  1. Perform a culture-based assay to confirm viability (though this is slow and insensitive).
  2. Use an mRNA-based assay targeting a housekeeping gene such as gap or rpoB.
  3. Repeat the NAAT after 2–4 weeks; if the result becomes negative, the initial positive was likely due to residual DNA.

In cell culture, a positive TOC after antibiotic treatment indicates that the clearance protocol failed. The culture should be discarded, and a fresh culture should be initiated from a verified mycoplasma-free source. Attempting to re-treat the same culture is generally not recommended, as repeated antibiotic exposure can select for resistant mycoplasma strains.

Negative Results

A negative TOC result indicates that mycoplasma was not detected in the sample. In the clinical context, this is interpreted as successful eradication, and no further testing is required unless symptoms recur. However, a negative result is only as reliable as the sensitivity of the assay and the adequacy of the sample. A negative result from a poorly collected sample or an assay with low sensitivity may be a false negative.

In cell culture, a negative TOC is the desired outcome, but it should be interpreted with caution. A single negative test does not guarantee that the culture is mycoplasma-free, particularly if the test was performed too soon after treatment or if the sample size was inadequate. Regulatory guidelines, such as those from the European Pharmacopoeia, recommend testing at least 10⁶ cells or 1 mL of supernatant, and performing the test in duplicate.

Indeterminate Results

Indeterminate results occur when the assay signal falls near the detection threshold, or when there is evidence of PCR inhibition. In qPCR, an indeterminate result may be flagged when the cycle threshold (Ct) value is high (e.g., >38) or when the internal control (e.g., a spiked plasmid or a housekeeping gene such as human β-actin) fails to amplify.

For indeterminate results, the appropriate action is to repeat the test, ideally with a fresh sample. If the repeat test is also indeterminate, consider:

  1. Testing a different sample type (e.g., a swab instead of urine).
  2. Diluting the sample to reduce PCR inhibitors (e.g., 1:10 dilution in nuclease-free water).
  3. Re-extracting DNA using a different method (e.g., silica column-based extraction instead of phenol-chloroform).

In cell culture, an indeterminate result should be treated as a potential positive until proven otherwise. The culture should be quarantined, and testing should be repeated on a fresh sample.

Test of Cure in Cell Culture and Bioprocessing

Routine Mycoplasma Testing

In cell culture, mycoplasma testing is not just a TOC procedure; it is a routine quality control measure. Regulatory bodies, including the FDA and the European Medicines Agency, require that all cell banks and production cell lines be tested for mycoplasma. The standard methods include:

  1. Culture-based method: Inoculating the test sample into broth and agar media, incubating for 28 days, and examining for colony formation. This is the compendial method described in the European Pharmacopoeia (EP) and the US Pharmacopeia (USP).
  1. PCR-based method: Using a broad-range PCR targeting the 16S rRNA gene, followed by gel electrophoresis or real-time detection. This method is faster (results in 1 day) but is considered a "rapid alternative" and must be validated against the compendial method.
  1. Indicator cell culture method: Co-cultivating the test sample with a sensitive indicator cell line (e.g., Vero cells) and then staining with a DNA-binding fluorochrome such as Hoechst 33258 or DAPI. Mycoplasma contamination appears as extranuclear fluorescent dots or filaments.

For routine monitoring, the frequency of testing depends on the use of the culture. For actively growing cultures, testing every 2–4 weeks is recommended. For cell banks, testing is performed at the time of cryopreservation and again after thawing.

Clearance Validation

In bioprocessing, TOC is used to validate that downstream purification steps effectively remove or inactivate mycoplasma. This is a regulatory requirement for biologics manufacturing. The clearance validation study involves spiking a representative mycoplasma species (e.g., M. orale or A. laidlawii) into the process intermediate and demonstrating that the purification step (e.g., viral inactivation at low pH, chromatography, or nanofiltration) reduces the mycoplasma load by a defined log reduction factor (LRF).

The LRF is calculated as:

LRF = log₁₀(initial load) − log₁₀(final load)

A typical clearance validation requires an LRF of ≥ 6 logs for mycoplasma. The TOC in this context is the measurement of the final load after the purification step, using a validated assay with a known limit of detection. For example, if the assay has a limit of detection of 10 CFU/mL and the initial spike was 10⁶ CFU/mL, a negative result at the final step demonstrates an LRF of ≥ 6.

It is important to note that clearance validation is performed once, during process development, and is not repeated for every batch. However, routine batch testing for mycoplasma is still required, and a TOC is performed on the final product before release.

Common Pitfalls and Mistakes in Test of Cure

Testing Too Early

The most common mistake in TOC is testing before the antibiotic has been fully eliminated or before the organism has had a chance to rebound. For M. genitalium, testing at 1 week post-treatment will produce a high rate of false negatives because residual azithromycin (which has a tissue half-life of 68 hours) suppresses organism growth. For cell culture, testing immediately after antibiotic treatment will similarly produce false negatives because residual drug in the medium inhibits mycoplasma growth.

Best practice: Adhere to the recommended TOC windows. For clinical TOC, wait at least 3 weeks after the last antibiotic dose. For cell culture, maintain the culture in antibiotic-free medium for at least 2 weeks and perform at least two passages before testing.

Contamination Risks

Contamination can occur at any step of the TOC process, from sample collection to DNA extraction to PCR setup. In clinical settings, contamination of urine samples with skin flora or environmental mycoplasma can produce false positives. In the laboratory, amplicon contamination from previous PCR reactions is a well-documented cause of false positives.

Best practice: Use separate rooms or hoods for pre-PCR and post-PCR steps. Use filter tips for all pipetting. Include negative controls (nuclease-free water) in every PCR run. For clinical samples, use sterile collection devices and transport media. For cell culture, test the medium, serum, and trypsin used in the culture, as these are common sources of contamination.

Misinterpretation of Molecular Results

A positive NAAT result does not necessarily mean viable infection, and a negative result does not necessarily mean the organism is absent. The persistence of DNA after successful treatment is a well-documented phenomenon, and interpreting a positive PCR as treatment failure can lead to unnecessary antibiotic exposure.

Best practice: Understand the limitations of the assay. If a positive NAAT result is obtained at the recommended TOC time, consider repeating the test after 2–4 weeks or using a viability-based assay. If a negative result is obtained but clinical suspicion remains high, consider testing a different sample type or using a more sensitive assay.

Inadequate Sample Volume

For cell culture TOC, the sample volume is critical. The European Pharmacopoeia requires a minimum of 10⁶ cells or 1 mL of supernatant for mycoplasma testing. Using a smaller sample can produce false negatives simply because the mycoplasma concentration is below the assay's limit of detection.

Best practice: Always test the recommended sample volume. For cell culture, collect both cells and supernatant, as mycoplasma can be cell-associated or free-floating.

Using the Wrong Detection Method

Not all detection methods are suitable for TOC. Serology is not useful for TOC because antibodies persist after infection. Culture is insensitive for fastidious species such as M. genitalium. PCR is the method of choice, but the target gene and primer design must be validated for the specific species of interest.

Best practice: Use a validated NAAT for TOC. For clinical TOC, use a species-specific assay (e.g., targeting MgPa for M. genitalium). For cell culture, use a broad-range assay targeting the 16S rRNA gene, followed by sequencing or species-specific PCR to identify the contaminant.

Practical Summary and Recommendations

Key Takeaways

  • Test of cure for mycoplasma is essential in both clinical and cell culture contexts to confirm eradication after treatment.
  • The optimal TOC timing is 3–4 weeks after completion of antibiotic therapy for M. genitalium, and at least 2 weeks after antibiotic removal for cell culture.
  • NAATs (PCR) are the preferred detection method for TOC due to their speed, sensitivity, and specificity.
  • A positive NAAT result may reflect dead DNA, not viable infection; confirm with a repeat test or a viability-based assay.
  • Culture-based methods are slow and insensitive but are still required for regulatory compliance in biopharmaceutical manufacturing.
  • Serology is not useful for TOC because antibodies persist after infection.
  • Common pitfalls include testing too early, contamination, inadequate sample volume, and misinterpretation of molecular results.

Checklist for Test of Cure

  1. Confirm the indication for TOC (clinical vs. cell culture).
  2. Select the appropriate sample type (urine, swab, supernatant, cells).
  3. Collect the sample at the correct time (≥3 weeks post-treatment for clinical; ≥2 weeks after antibiotic removal for cell culture).
  4. Use a validated NAAT with appropriate controls.
  5. Include negative and positive controls in every run.
  6. Interpret results in the context of the assay's limitations (DNA persistence, sensitivity).
  7. Repeat the test if the result is indeterminate or if clinical suspicion remains high.
  8. For cell culture, quarantine the culture until a negative TOC is confirmed.
  9. Document all results and actions taken.

Frequently Asked Questions

What is a test of cure for mycoplasma?

A test of cure (TOC) is a diagnostic procedure performed after a course of treatment to confirm that the mycoplasma infection has been eradicated. It involves detecting the organism (or its nucleic acid) in a clinical sample or cell culture sample after a defined interval has elapsed since the completion of therapy. A negative TOC indicates successful eradication, while a positive TOC indicates treatment failure or persistent infection.

When should a test of cure be done for mycoplasma?

For M. genitalium, TOC should be performed at 3–4 weeks after completion of antibiotic therapy. For M. pneumoniae, TOC is generally not recommended in uncomplicated cases, but if performed, it should be done at least 2–3 weeks after symptom resolution. For cell culture, TOC should be performed at least 2 weeks after the removal of antibiotics from the culture medium, and after at least two passages in antibiotic-free medium.

How is a test of cure for mycoplasma performed?

A TOC is performed by collecting an appropriate sample (e.g., first-void urine, vaginal swab, or cell culture supernatant) and testing it using a nucleic acid amplification test (NAAT), typically real-time PCR. The sample is processed to extract DNA, and the DNA is amplified using primers specific to the mycoplasma species of interest. A positive result indicates the presence of mycoplasma DNA, while a negative result indicates that mycoplasma DNA was not detected at the assay's limit of detection.

Can a test of cure be false positive?

Yes. A false positive can occur due to contamination of the sample during collection or processing, or due to the detection of DNA from dead organisms that persist after successful treatment. Amplicon contamination from previous PCR reactions is a common cause of false positives in the laboratory. To minimize false positives, use separate areas for pre- and post-PCR steps, include negative controls, and interpret positive results in the context of the clinical or experimental situation.

What does a negative test of cure mean?

A negative TOC means that mycoplasma was not detected in the sample at the assay's limit of detection. In the clinical context, this is interpreted as successful eradication of the infection. In cell culture, a negative TOC indicates that the culture is free of detectable mycoplasma. However, a negative result does not guarantee absolute absence of the organism, particularly if the sample was inadequate or the assay has low sensitivity.

Why is test of cure important in cell culture?

Test of cure is important in cell culture because mycoplasma contamination can silently compromise experimental results without causing visible changes in the culture. A TOC confirms that a contaminated culture has been successfully cleared by antibiotic treatment, or that a clean culture remains free of contamination. This is essential for the integrity of research data and for regulatory compliance in biopharmaceutical manufacturing.

What are the common mistakes in test of cure?

Common mistakes include testing too early (before residual antibiotics are eliminated), using an inappropriate detection method (e.g., serology), collecting an inadequate sample volume, contamination during sample processing or PCR setup, and misinterpreting a positive NAAT result as viable infection when it may reflect dead DNA. To avoid these errors, adhere to recommended TOC timing, use validated NAATs, include appropriate controls, and interpret results with an understanding of the assay's limitations.

Key Takeaways

  • Test of cure for mycoplasma is essential in both clinical and cell culture contexts to confirm eradication after treatment.
  • The optimal TOC timing is 3–4 weeks after completion of antibiotic therapy for M. genitalium, and at least 2 weeks after antibiotic removal for cell culture.
  • NAATs (PCR) are the preferred detection method for TOC due to their speed, sensitivity, and specificity.
  • A positive NAAT result may reflect dead DNA, not viable infection; confirm with a repeat test or a viability-based assay.
  • Culture-based methods are slow and insensitive but are still required for regulatory compliance in biopharmaceutical manufacturing.
  • Serology is not useful for TOC because antibodies persist after infection.
  • Common pitfalls include testing too early, contamination, inadequate sample volume, and misinterpretation of molecular results.

Further Reading

  • Toh E et al. Evaluation of Clinical, Gram Stain, and Microbiological Cure Outcomes in Men Receiving Azithromycin for Acute Nongonococcal Urethritis: Discordant Cures Are Associated With Mycoplasma genitalium Infection. Sexually transmitted diseases. 2022. PubMed 34618416
  • Vodstrcil LA et al. Combination Therapy for Mycoplasma genitalium, and New Insights Into the Utility of parC Mutant Detection to Improve Cure. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2022. PubMed 34984438
  • Chromy D et al. High cure rates of Mycoplasma genitalium following empiric treatment with azithromycin alongside frequent detection of macrolide resistance in Austria. Infection. 2024. PubMed 38649669
  • Ong JJ et al. Clinical Characteristics of Anorectal Mycoplasma genitalium Infection and Microbial Cure in Men Who Have Sex With Men. Sexually transmitted diseases. 2018. PubMed 29465653
  • Gundevia Z et al. Positivity at test of cure following first-line treatment for genital Mycoplasma genitalium: follow-up of a clinical cohort. Sexually transmitted infections. 2015. PubMed 25096921
  • Jernberg E, Moghaddam A, Moi H. Azithromycin and moxifloxacin for microbiological cure of Mycoplasma genitalium infection: an open study. International journal of STD & AIDS. 2008. PubMed 18824619

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