Diagnostic Examination
Etiologic management is usually chosen over syndromic management in clinical care and requires accurate STD Diagnostic Tests. Given the time and difficulty of culturing, the best way is a Mycoplasma test; NAATs are the method.
Benefits of Diagnostic Exams
The incidents of Mycoplasma and Chlamydia infections are similar, yet antibiotics for syndromic treatment of urethritis and cervicitis have low efficacy against Mycoplasma. Exams when patients first seek care would enable folks to follow therapy with a more effective regimen against it rapidly. This kind of practice would reduce symptoms, likely reduce the risk for sequelae, reduce transmission to partners, and lead to fewer incidents with the system.
Harms of Diagnostic exams
Diagnostic exams to determine appropriate therapy might increase healthcare costs. Detecting MGen in Test results in extra treatment with expensive drugs that can have serious adverse effects. Even when symptoms resolve, a positive STD result might increase a patient’s stress, and the debate over sequelae in women has led some to believe infections are not of concern to warrant treatment. If infections do not warrant treatment, the cost might outweigh the benefits; however, this has not been studied. The 2021 CDC treatment rules recommend STD Panel screening only for persons with symptoms.
Checks of Cure
Exams are done to confirm a cure and stop infection. Australian rules recommend an exam of cure 14–21 days after treatment.
Benefits of Checkups of Cure
The primary benefit of STD Urine screening of cure is to confirm that it has been cured. Because Myco sometimes recrudesces after symptoms resolve, an exam of cure would identify the need for extra therapy earlier and, in turn, lower the risk of infecting sex partners, with strains not detected initially or selected during treatment.
Harms of Exams of Cure
A positive exam of cure indicates either treatment failure or reinfection. Cases of reinfection revealed in mycoplasma Lab tests are usually treated with the same antibiotic, whereas cases of treatment failure are cured with an alternative antibiotic. When the risk of long-term sequelae is high, the benefit of the harm is more pressure. When the risk for sequelae is low, the potential harm might outweigh the benefit of confirming a cure.
Given these questions, the benefit of exams of cure is currently unknown.
Azithromycin
The power of azithromycin is shown in Lab exams for MGen infection, and there has been a decline over time through 2015. More recent studies have found that cure rates are as low as 52%. Some studies (1.5 g given over 5 days) and a check suggested resistance with this regimen. However, an old study reported no difference in resistance between the 2.
Moxifloxacin
Although the efficacy of moxifloxacin for MGen was initially high (100%), it dropped to 89% in studies. Sitafloxacin, a more potent drug, has higher cure rates but is unavailable in many countries, including the United States.
PID Treatment
The recommended treatment in the 2015 CDC treatment rules consisted of antimicrobial drugs. Such drugs are for empiric treatment of gonorrhoea and chlamydia (cephalosporin and doxycycline). This regimen had limited effectiveness against MGen genitalium; cure rates were as low as 56%. One incorporates metronidazole, regardless of whether the regimen included azithromycin or moxifloxacin. Similarly, infections were significantly less common among patients receiving a PID regimen with metronidazole than those who did not. Metronidazole targets anaerobes and is thought to lack activity against Myco.
Alternative Antibiotics
To treat patients that tested positive for Mycoplasma when other MGen antibiotics have failed, doctors combine Minocycline (100 mg orally 2×/d for 14 days) and Pristinamycin (1g 3×/d for 10 days) with Doxycycline. In a sexual health clinic in Australia, minocycline cured 71% of patients, and pristinamycin cured ≈75% of patients. Minocycline is widely available, but pristinamycin is unavailable in many areas, including the United States.
Combination STD therapy using doxycycline and moxifloxacin for patients with positive results yielded microbiologic cure rates equivalent to those seen using sequential therapy, suggesting efficacy but no advantage over therapy. Combination therapy using doxycycline and sitafloxacin has been more effective.
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