&lt;h1&gt;&lt;strong&gt;Mycoplasma Genitalium Treatment in Bangkok, Pattaya, Phuket, Chiang Mai &amp;amp; Koh Samui (Thailand)&lt;/strong&gt;&lt;/h1&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Mycoplasma genitalium (MG) is a sexually transmitted bacterium that is difficult to culture. Detection relies on the use of PCR assays. MG causes urethritis in men. In women, MG can cause cervicitis and pelvic inflammatory disease. MG can also cause rectal infection.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h3 style=&quot;text-align: center;&quot;&gt;&lt;strong&gt;Book Your Appointment Today!&lt;/strong&gt;&lt;/h3&gt;
&lt;p style=&quot;text-align: center;&quot;&gt;&lt;a href=&quot;https://eu-health.org/booking&quot;&gt;&lt;img src=&quot;https://cms.eu-health.org/Files/Buttons/Booking-an-appointment-at-PULSE-CLINIC.png&quot; width=&quot;300&quot; height=&quot;33&quot; /&gt;&lt;/a&gt;&lt;/p&gt;
&lt;p style=&quot;text-align: center;&quot;&gt;&lt;strong&gt;For more information, please c&lt;/strong&gt;&lt;strong&gt;ontact us at&amp;nbsp;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;a href=&quot;mailto:info@eu-health.org&quot;&gt;info@eu-health.org&lt;/a&gt;&lt;/span&gt;,&lt;br /&gt;call +66994266982 or chat on your preferred platform:&lt;/strong&gt;&lt;/p&gt;
&lt;p style=&quot;text-align: center;&quot;&gt;&amp;nbsp;&lt;a href=&quot;https://line.me/ti/p/~@euwellness&quot;&gt;&lt;img src=&quot;https://cms.eu-health.org/Files/Charlie/LINE-icon.png&quot; width=&quot;55&quot; height=&quot;55&quot; /&gt;&lt;/a&gt;&amp;nbsp;&amp;nbsp;&amp;nbsp; &amp;nbsp; &lt;a href=&quot;https://api.whatsapp.com/send/?phone=%2B66994266982&amp;amp;text&amp;amp;type=phone_number&amp;amp;app_absent=0&quot;&gt;&lt;img src=&quot;https://cms.eu-health.org/Files/Charlie/whatsapp.png&quot; width=&quot;60&quot; height=&quot;60&quot; /&gt;&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;strong&gt;Causes and Transmission of Mycoplasma Genitalium&lt;/strong&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;MG is caused by the bacterium Mycoplasma genitalium. It can be transmitted through unprotected sex with someone who has MG, including oral sex, penetration, or even from touching the area of infection, as it can be passed through fluids. Sharing sex toys with someone who has MG can also put you at risk of infection.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;strong&gt;What Are the Symptoms of Mycoplasma Genitalium?&lt;/strong&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Most of the time, MG goes unnoticed as it usually doesn&amp;rsquo;t cause symptoms. In cases where symptoms do appear, they often overlap with other STDs like chlamydia, making MG difficult to notice. Some signs you might observe include:&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Discharge from the genitals&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Painful urination&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;a href=&quot;https://www.pulse-clinic.com/proctitis-proctocolitis-and-enteritis-treatment-guidelines&quot;&gt;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;strong&gt;Pain around and/or inside the anus&lt;/strong&gt;&lt;/span&gt;&lt;/a&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;If you have these symptoms, it is suggested that you get tested as soon as possible. Mycoplasma genitalium requires extra care in treatment. Due to its characteristics, you need to ensure that antibiotics can completely eradicate the bacteria, or they can remain in your system for a long time. If left untreated, MG could spread to other areas of the body and cause permanent damage, including infertility if the infection spreads to the reproductive organs.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;As Mycoplasma genitalium usually goes unnoticed due to its showing no symptoms, this results in MG not getting tested. You can still pass on your sexual partners mycoplasma genitalium despite being asymptomatic, and leaving it in your system for too long could lead to &lt;a href=&quot;https://www.pulse-clinic.com/std-complications-in-men&quot;&gt;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;strong&gt;complications&lt;/strong&gt;&lt;/span&gt;&lt;/a&gt; that cause permanent damage to your body.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Our &lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;strong&gt;&lt;a href=&quot;https://www.pulse-clinic.com/thailand-pcr-28-stds-promotion-std-test-bangkok-pattaya-phuket-hatyai-chiangmai&quot;&gt;PCR28 comprehensive STD test&lt;/a&gt;&lt;/strong&gt;&lt;/span&gt; includes the Mycoplasma genitalium test to help you make sure you&amp;rsquo;re free from any sexually-transmitted infections that could be hidden in your system. This test offers you an option for anyone who wants an all-in-one test that can help identify up to 28 pathogens that cause STDs. Contact us for more information about the test and make an appointment today!&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;strong&gt;Who Is at Risk of Mycoplasma Genitalium?&lt;/strong&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;&lt;a href=&quot;https://www.pulse-clinic.com.sg/mycoplasma-genitalium-m-gen&quot;&gt;Mycoplasma genitalium&lt;/a&gt; can be transmitted as easily as &lt;a href=&quot;https://www.pulse-clinic.com.sg/chlamydia&quot;&gt;chlamydia&lt;/a&gt;. Anyone sexually active is at risk of catching MG. This includes everyone who engages in vaginal sex, anal sex, and non-penetrative sex, regardless of sex and gender.&lt;/span&gt;&lt;/p&gt;

&lt;h2&gt;&amp;nbsp;&lt;/h2&gt;
&lt;h2&gt;&lt;strong&gt;Clinical Presentation&lt;/strong&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;em&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Mycoplasma genitalium &lt;/span&gt;&lt;/em&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;can cause urethritis, cervicitis, pelvic inflammatory disease, and rectal infection. Rectal infection is commonly asymptomatic. Asymptomatic rectal infection in men who have sex with men (MSM) is common. Studies are conflicting on the association between MG and proctitis. MG is associated with preterm delivery and spontaneous abortion and is a possible cause of tubal factor infertility. MG is uncommonly associated with sero-reactive arthritis.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;strong&gt;Clinical Indications for Testing&lt;/strong&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;ul&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Acute, persistent and recurrent non-gonococcal urethritis&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Cervicitis&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Pelvic inflammatory disease&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Post-coital bleeding&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Sexual contacts of MG. MSM require urine and anorectal swabs. Throat swabs are unnecessary as pharyngeal infection is rare (1%).&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Consider testing prior to termination of pregnancy&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Consider testing in proctitis&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Consider testing in epididymo-orchitis&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Consider testing in balanoposthitis&lt;/span&gt;&lt;/li&gt;
&lt;li style=&quot;font-weight: 400;&quot; aria-level=&quot;1&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Consider testing in sero-reactive arthritis&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Screening asymptomatic individuals, other than sexual contacts of MG positive index patient, for MG is currently not recommended.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;strong&gt;Diagnosis&lt;/strong&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;h3&gt;&lt;strong&gt;Males&lt;/strong&gt;&lt;/h3&gt;
&lt;table&gt;
&lt;tbody&gt;
&lt;tr&gt;
&lt;td&gt;
&lt;p&gt;&lt;strong&gt;Test&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td&gt;
&lt;p&gt;&lt;strong&gt;Site/ specimen&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td&gt;
&lt;p&gt;&lt;strong&gt;Comments&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;/tr&gt;
&lt;tr&gt;
&lt;td&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;NAAT&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Nucleic acid amplification test&lt;/span&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;First pass urine (FPU)&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Urethral swab&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Anorectal swab&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;/td&gt;
&lt;td&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Most labs offer NAAT testing for MG, and some NAATs also detect mutations conferring resistance to azithromycin to assist in individualising therapy.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;A FPU specimen is more sensitive than a urethral swab.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Throat swabs are unnecessary as pharyngeal infection is rare&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;/td&gt;
&lt;/tr&gt;
&lt;/tbody&gt;
&lt;/table&gt;
&lt;h3&gt;&amp;nbsp;&lt;/h3&gt;
&lt;h3&gt;&lt;strong&gt;Females&lt;/strong&gt;&lt;/h3&gt;
&lt;table&gt;
&lt;tbody&gt;
&lt;tr&gt;
&lt;td&gt;
&lt;p&gt;&lt;strong&gt;Test&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td&gt;
&lt;p&gt;&lt;strong&gt;Site/ specimen&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td&gt;
&lt;p&gt;&lt;strong&gt;Comments&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;/tr&gt;
&lt;tr&gt;
&lt;td&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;NAAT&lt;/span&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Vaginal swab&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Cervical swab&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;FPU&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;/td&gt;
&lt;td&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;A vaginal swab is the most sensitive specimen followed by cervical swab then urine&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Women who present with cervicitis, PID or post coital bleeding should be tested for MG.&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;/td&gt;
&lt;/tr&gt;
&lt;/tbody&gt;
&lt;/table&gt;
&lt;h2&gt;&amp;nbsp;&lt;/h2&gt;
&lt;h2&gt;&lt;strong&gt;Management&lt;/strong&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;h3&gt;&lt;strong&gt;Index patient&lt;/strong&gt;&lt;/h3&gt;
&lt;table&gt;
&lt;tbody&gt;
&lt;tr&gt;
&lt;td style=&quot;width: 126px;&quot;&gt;
&lt;p&gt;&lt;strong&gt;Condition&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td style=&quot;width: 298px;&quot;&gt;
&lt;p&gt;&lt;strong&gt;Recommended&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td style=&quot;width: 490px;&quot;&gt;
&lt;p&gt;&lt;strong&gt;Comments&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;/tr&gt;
&lt;tr&gt;
&lt;td style=&quot;width: 126px;&quot;&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Asymptomatic MG&lt;/span&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td style=&quot;width: 298px;&quot;&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;For MG known or suspected to be macrolide-susceptible:&lt;/span&gt;
&lt;ul&gt;
&lt;li&gt;&lt;strong&gt;Doxycycline 100mg PO, twice daily for 7 days,&lt;/strong&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;followed immediately by &lt;/span&gt;&lt;strong&gt;Azithromycin 1g PO, stat, then 500mg daily for another 3 days (2.5g total)&lt;/strong&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;For MG known or suspected to be macrolide resistant:&lt;/span&gt;
&lt;ul&gt;
&lt;li&gt;&lt;strong&gt;Doxycycline 100mg PO, twice daily for 7 days, &lt;/strong&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;followed immediately by &lt;/span&gt;&lt;strong&gt;Moxifloxacin 400mg PO daily for 7 days&lt;/strong&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;/li&gt;
&lt;/ul&gt;
&lt;/td&gt;
&lt;td style=&quot;width: 490px;&quot;&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Macrolide resistance mutations are detected in approximately 80% of MSM and 50% of heterosexual men and women infected with MG at Melbourne Sexual Health Centre (MSHC).&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Infections susceptible to azithromycin develop detectable de novo resistance in 12% of cases treated with azithromycin.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;To improve treatment efficacy and reduce selection of resistance MSHC developed a sequenced resistance-guided treatment strategy based on the macrolide-resistance profile of &lt;/span&gt;&lt;em&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;M. genitalium&lt;/span&gt;&lt;/em&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Moxifloxacin is not approved by the Therapeutic Goods Administration (TGA) for this infection and may cause significant side-effects including diarrhoea or tendonitis. We recommend discussing this with patients and assessing for contraindications and drug interactions. Pharmacies typically charge over $70 for five tablets. There are limited efficacy data and no data for treatment courses of less than 7 days.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;MG already treated with azithromycin on the same day as they were tested may be cured but confirm this with a test of cure 2-3 weeks later. If treatment fails, resistance is likely, particularly if reinfection is unlikely. Clinicians with no access to resistance testing can assume resistance in azithromycin treatment failures.&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;/td&gt;
&lt;/tr&gt;
&lt;tr&gt;
&lt;td style=&quot;width: 126px;&quot;&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;MG-associated pelvic inflammatory disease&lt;/span&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td style=&quot;width: 298px;&quot;&gt;
&lt;p&gt;&lt;strong&gt;Moxifloxacin 400mg [PO] daily for 14 days&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td style=&quot;width: 490px;&quot;&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Refer to &lt;/span&gt;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;strong&gt;&lt;a href=&quot;https://www.mshc.org.au/health-professionals/treatment-guidelines/pelvic-inflammatory-disease-treatment-guidelines&quot;&gt;PID treatment guidelines&lt;/a&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;/tr&gt;
&lt;tr&gt;
&lt;td style=&quot;width: 126px;&quot;&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;MG in pregnancy&lt;/span&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td style=&quot;width: 298px;&quot;&gt;
&lt;p&gt;&lt;strong&gt;Azithromycin 1g PO, stat, then 500mg daily for another 3 days (2.5g total)&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;OR&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Pristinamycin 1g PO, 4 times a day for 10 days&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td style=&quot;width: 490px;&quot;&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;/tr&gt;
&lt;tr&gt;
&lt;td style=&quot;width: 126px;&quot;&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Resistant MG which has failed moxifloxacin&lt;/span&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td style=&quot;width: 298px;&quot;&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;OR&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;1) Pristinamycin 1g PO, 3 times a day for 10 days &lt;/strong&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;combined with&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Doxycycline 100 mg PO, twice daily for 10 days&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;OR&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;2) Sitafloxacin 100 mg PO, twice daily for 7 days &lt;/strong&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;combined with&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Doxycycline 100 mg PO, twice daily for 7 days&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;OR&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;3) Minocycline 100 mg PO twice daily for 14 days&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td style=&quot;width: 490px;&quot;&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Resistance to moxifloxacin was detected in 15-20% of infections in Melbourne in 2016-18 and so moxifloxacin treatment-failures are not uncommon.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Minocycline cures 70% of macrolide-resistant infections. Minocycline is available on private script and is therefore a practical option for patients with macrolide-resistant MG who have failed moxifloxacin in the community.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Pristinamycin has been used at MSHC at a dose of 1g three times daily combined with doxycycline 100mg bd for 10 days and cures 75% of macrolide-resistant infections. Pristinamycin is available through hospital pharmacies, using the Special Access Scheme of the TGA and can be used in pregnancy. For patients with macrolide-resistant MG in whom doxycycline is contraindicated, prescribe pristinamycin 1g four times daily for ten days.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Sitafloxacin in combination with doxycycline has proven effective at MSHC and cures &amp;gt;90% of patients in a published series of patients with highly resistant MG. Access to this medication is limited and requires TGA approval (completion of a Category B TGA form). This option is limited to specialised services so consult with a sexual health physician if no other options are available. A test of cure 2- 3 weeks after completing therapy is essential.&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;/td&gt;
&lt;/tr&gt;
&lt;/tbody&gt;
&lt;/table&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;&lt;br /&gt;&lt;/span&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;To avoid the selection of macrolide resistance, STI symptoms such as urethritis, cervicitis, PID and proctitis should be treated with one week of doxycycline 100mg bd, instead of azithromycin. Patients with these symptoms should be tested for MG and recalled if positive. Other MG-infected patients should also pre-treated with doxycycline. Doxycycline lowers the bacterial load, increasing the likelihood of cure with a second antibiotic.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;strong&gt;Follow up&lt;/strong&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Test of cure is important in managing MG because of the risk of persisting, asymptomatic, resistant infection. Test of cure should be performed &lt;/span&gt;&lt;strong&gt;3-4 weeks after completing all antimicrobial therapy&lt;/strong&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;If symptoms have persisted or rebounded to similar intensity, treatment failure due to resistance is likely, but reinfection is also possible, so assess for risk of reinfection.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2&gt;&lt;strong&gt;Contact tracing &amp;amp; partner management&lt;/strong&gt;&lt;/h2&gt;
&lt;hr /&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Testing and treating infected partners is recommended, particularly in a continuing relationship.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Sexual partners should be pre-treated with doxycycline. Doxycycline lowers the bacterial load, increasing the likelihood of cure with a second antibiotic.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Given the high prevalence of macrolide resistance and the need for moxifloxacin in cases with resistance, discuss with patients both the benefits of treatment and the risk of uncommon but serious side effects.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;Infection rates in contacts are 40&amp;ndash;50% in women and MSM (mostly rectal infection) and 30% in heterosexual men.&lt;/span&gt;&lt;/p&gt;
&lt;h2 class=&quot;block-title&quot;&gt;&amp;nbsp;&lt;/h2&gt;
&lt;h3 style=&quot;text-align: center;&quot;&gt;&lt;strong&gt;Book Your Appointment Today!&lt;/strong&gt;&lt;/h3&gt;
&lt;p style=&quot;text-align: center;&quot;&gt;&lt;a href=&quot;https://eu-health.org/booking&quot;&gt;&lt;img src=&quot;https://cms.eu-health.org/Files/Buttons/Booking-an-appointment-at-PULSE-CLINIC.png&quot; width=&quot;300&quot; height=&quot;33&quot; /&gt;&lt;/a&gt;&lt;/p&gt;
&lt;p style=&quot;text-align: center;&quot;&gt;&lt;strong&gt;For more information, please c&lt;/strong&gt;&lt;strong&gt;ontact us at&amp;nbsp;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;a href=&quot;mailto:info@eu-health.org&quot;&gt;info@eu-health.org&lt;/a&gt;&lt;/span&gt;,&lt;br /&gt;call +66994266982 or chat on your preferred platform:&lt;/strong&gt;&lt;/p&gt;
&lt;p style=&quot;text-align: center;&quot;&gt;&amp;nbsp;&lt;a href=&quot;https://line.me/ti/p/~@euwellness&quot;&gt;&lt;img src=&quot;https://cms.eu-health.org/Files/Charlie/LINE-icon.png&quot; width=&quot;55&quot; height=&quot;55&quot; /&gt;&lt;/a&gt;&amp;nbsp;&amp;nbsp;&amp;nbsp; &amp;nbsp; &lt;a href=&quot;https://api.whatsapp.com/send/?phone=%2B66994266982&amp;amp;text&amp;amp;type=phone_number&amp;amp;app_absent=0&quot;&gt;&lt;img src=&quot;https://cms.eu-health.org/Files/Charlie/whatsapp.png&quot; width=&quot;60&quot; height=&quot;60&quot; /&gt;&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2 class=&quot;block-title&quot;&gt;&lt;strong&gt;Related treatment guidelines&lt;/strong&gt;&lt;/h2&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;strong&gt;&lt;a href=&quot;https://www.pulse-clinic.com/chlamydia-treatment-guidelines&quot;&gt;Chlamydia treatment guidelines&lt;/a&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;strong&gt;&lt;a href=&quot;https://www.pulse-clinic.com/enteric-infections-in-men-who-have-sex-with-men-msm--treatment-guidelines&quot;&gt;Enteric infections in MSM treatment guidelines&lt;/a&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;strong&gt;&lt;a href=&quot;https://www.pulse-clinic.com/gonorrhoea-treatment-guidelines&quot;&gt;Gonorrhoea treatment guidelines&lt;/a&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;strong&gt;&lt;a href=&quot;https://www.pulse-clinic.com/proctitis-proctocolitis-and-enteritis-treatment-guidelines&quot;&gt;Proctitis treatment guidelines&lt;/a&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;strong&gt;&lt;a href=&quot;https://www.pulse-clinic.com/lymphogranuloma-venereum-lgv-treatment-guidelines&quot;&gt;Lymphogranuloma venereum treatment guidelines&lt;/a&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;text-decoration: underline;&quot;&gt;&lt;strong&gt;&lt;a href=&quot;https://www.pulse-clinic.com/herpes-treatment-guidelines&quot;&gt;Herpes treatment guidelines&lt;/a&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;

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