Mycoplasma Genitalium
Treatment Guide

Instructions

You have stated that you wish to obtain treatment with Doxycycline and Moxifloxacin for treatment of Mycoplasma genitalium. This medication regimen is Doxycycline Hyclate 100mg tablets which you are to take one tablet by mouth twice daily for 7 days FOLLOWED by Moxifloxacin 400 mg taken once daily for 7 days. Ensure to finish all your treatment. This treatment will control the infection of this bacteria which can transmit during sexual activity with a colonized partner. These organisms are a normal part of the genital and urinary flora but can cause symptoms with overgrowth. Researchers are still determining whether partners can spread Mgen through oral sex. These organisms are a normal part of the urogenital system, but can cause symptoms with overgrowth. Mgen can be detected among 10-30% of patients assigned female at birth with clinical cervicitis (irritation of the cervix), 40% of patients assigned male at birth causing recurrent urethritis (irritation of the urethra), and up to 26% rectally in patients assigned male at birth compared to 3% rectally in patients assigned female at birth. Mgen can oftentimes have no symptoms, but if symptoms do occur you can experience abnormal genital discharge, burning with urination, and rectal pain and discharge. Untreated Mgen can result in pelvic inflammatory disease in patients assigned female at birth which can cause complications with fertility in the future. Ensure to abstain from intercourse 7 days AFTER completing treatment AND when your symptoms are gone to prevent transmission to another partner and reinfection to yourself.

This medication, and all quinolone antibiotics, have a boxed warning from the FDA for the risk of tendinopathy and tendon rupture, and peripheral neuropathy. Please ensure your medical history is up to date to ensure your safety of proceeding with this dosing regimen.

Please inform all of your sexual partners about your exposure so they can seek treatment. They can create an account with us to access care.

Allergies/Contraindications

These medicines, like all medications, may cause an allergic reaction if you are allergic to similar medicines or components. If you are allergic to any of the following please do not take the medicine and call or message us or see your doctor in person.

Doxycycline

• Tetracyclines (Minocycline, Tetracycline)

Moxifloxacin

• Quinolones (Ciprofloxacin, Levofloxacin)
  
  

Conditions

We have evaluated your health history and the specific health information you provided us, however if anything changes and you develop one of these conditions, please stop taking this medicine and call or message us immediately.

Doxycycline

• Pregnancy
• Myasthenia Gravis
• Oesophagitis (inflammation of your esophagus)

Moxifloxacin

• Myasthenia Gravis
• Prolonged QTc syndrome
• History of heart issues including irregular heartbeats and aortic aneurysms
• Ehlers-Danlos syndrome
• History of liver problems or disease
• History of kidney problems or disease
• Caution: High blood pressure and vascular diseases- increased risk for tendon rupture
• Caution: Diabetes- can alter glucose regulation
• Caution: Rheumatoid arthritis- increased risk for tendon rupture
• Caution: Older adults- increased risk for tendon rupture and cardiac issues
  
  

Pregnancy and Breastfeeding

Doxycycline

• Based on available data, Doxycycline is not considered acceptable or safe for use in pregnancy.
• Examination of current literature indicates there is no likely harm in short term use of Doxycycline with breastfeeding as milk levels are low and absorption by the infant is inhibited by the calcium in breastmilk. As a precautionary measure prolonged (more than 21 days) or repeat courses while breastfeeding should be avoided.

Moxifloxacin

• Moxifloxacin crosses the placenta and has shown adverse effects on animal studies. Potential benefits may warrant use of this medication in certain scenarios. This medication is considered pregnancy class C.
• Recent studies indicate little risk with Moxifloxacin and breastfeeding. Moxicloxacin is acceptable in nursing mothers. Monitor the infant for possible effects on the gastrointestinal flora such as diarrhea or candidiasis (thrush, diaper rash).
  
  

Medications, Supplements and Foods

We have evaluated the specific health information you provided us, however if you are taking any of the medicines, foods, or supplements listed below call or message us before you take the medicine. Some of these can cause dangerous interactions with the medicine we are prescribing you and we will help you evaluate that risk and decide on an appropriate treatment plan. Please ensure your chart is up to date with your current medications, allergies, and medical conditions so your provider can safely treat you as this list may not be all inclusive.

Doxycycline

• Dairy (should avoid for 2 hours after treatment)
• Antacids (should avoid for 2 hours after treatment)
• Multivitamins (should avoid for 2 hours after treatment)
• Anticoagulants (Warfarin)
• Penicillins
• Barbiturates
• Antiepileptic medications (Carbamazepine, Phenytoin)
• Isotretinoin
• Rifampin

Moxifloxacin

• Antacids (take 4 hours before or 8 hours after)
• Zinc (take 4 hours before or 8 hours after)
• Iron (take 4 hours before or 8 hours after)
• Multivitamins (take 4 hours before or 8 hours after)
• Sucralfate (take 4 hours before or 8 hours after)
• Videx (take 4 hours before or 8 hours after)
• Blood Glucose Lowering Agents- may enhance the hypoglycemic effect
• Corticosteroids
• Hydroxychloroquine
• Methylphenidate
• NSAIDs
• Rifampin
• Vitamin K Agonists- Warfarin
• Caution in QT prolonging medications
  
  

Emergency Side Effects

These medicines can cause dangerous and potentially life-threatening side effects. If any of the emergency side effects listed in the manufacturer’s pamphlet or those below happen to you please stop taking the medicine and call 911 or seek immediate medical help in person.

• Sudden onset of chest pain
• Shortness of breath
• Difficulty or painful swallowing
• Severe skin rash and/or itching
• Facial or throat swelling
• Severe bloody diarrhea
• Severe pain and rapid bruising at the site of injury
• Pain, stiffness, swelling, inflammatory and/or loss of strength
• Seizures
• Tremors
• Numbness or loss of sensation or feeling in body parts
• Hallucinations
• Severe mood changes
  
  

Other Side Effects

This medicine can also cause other side effects including (this list is not all inclusive):

• Sun sensitivity (be sure to wear SPF while taking this medication)
• Skin hyperpigmentation
• Abdominal discomfort
• Diarrhea
• Vaginal yeast infections
• Nausea and vomiting
• Headache
• Dizziness
• Insomnia
  
  

Risks

Accurate Information

We have evaluated your health history and your specific health information you provided and determined it is safe to proceed with this treatment at this time. If your health history changes including diagnoses or medications please message or call us before you take the medicine to ensure it's safe to proceed. Some medications and conditions can cause dangerous interactions with the medicine we are prescribing and we will help you evaluate that risk and decide on an appropriate treatment plan.

Treatment Failure

This treatment is not guaranteed to be effective. It may not work or may only partially resolve the condition for which you are seeking treatment. If the treatment is not working, or if you are experiencing new or worsening symptoms, give us a call or message us anytime. If it is an emergency, call 911 or seek immediate medical help in person. You may need to seek alternative treatment such as those listed below or in the follow up plan.

Misdiagnosis or Delayed Diagnosis

Through telehealth, there is also a risk that we misdiagnose or fail to diagnose conditions that you may have which could affect our recommendation for treatment. This risk exists with a doctor in person as well but they may have additional resources to aid their evaluation. We use evidence-based practice and guidelines as well as clinical decision-making to minimize these risks.

Accepting or Declining Our Recommendation

We have based our recommendation on your specific case and medical guidelines, but there may be alternative treatments or strategies that may be helpful to you. Some may be more or less effective than what we provide. Some treatments may require an in-person exam or procedure which we can’t provide. Message us or talk to your doctor in person to discuss alternative treatments.

Share with Your In-Person Healthcare Team

You can access your records anytime. We strongly recommend that you update your in-person doctor, pharmacist, and the rest of your healthcare team to let them know about any new medicines you are taking or other changes in your health.

You can also ask us questions anytime and we are happy to help you share any information about your health with your in-person healthcare team.

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