Driven by alarming macrolide resistance (>60% in Australia), Mycoplasma genitalium (M. gen.) management requires resistance-guided sequential therapy. This episode deconstructs the ASHM guidelines for OSCE success. Learn why routine asymptomatic screening is contraindicated and why Doxycycline (100mg BD for 7 days) must precede targeted treatment—either Azithromycin for susceptible strains or Moxifloxacin for resistant infections. We cover 14-day Moxifloxacin PID protocols, pregnancy safety traps, contact tracing for ongoing partners, and timing the mandatory 14–21 day Test of Cure.
Pro Tip: In your OSCE, never prescribe single-dose Azithromycin or immediate Moxifloxacin alone! High-scoring candidates demonstrate safety by explicitly using resistance-guided sequential therapy: initiating Doxycycline 100mg BD for 7 days to reduce bacterial load before stepping up to Azithromycin (if susceptible) or Moxifloxacin 400mg daily (if resistant). Highlight key exam traps: routine asymptomatic screening is NOT recommended, Moxifloxacin is Category B3 and avoided in pregnancy (requiring specialist input/Pristinamycin), and a Test of Cure (TOC) by NAAT must be delayed until 14–21 days post-treatment to avoid false positives!
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