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    1. Chlamydial Infections

      Chlamydial Infections

      1. Introduction
      2. Epidemiology in the United States
      3. Microbiology, Pathogenesis, and Transmission
      4. Clinical Manifestations
      5. Laboratory Diagnosis
      6. Screening for Chlamydial Infection
      7. Treatment of Adolescents and Adults
      8. Management of Sex Partners
      9. Treatment of Neonates and Children
      10. Counseling and Education
      11. Prevention
      12. Summary Points
    2. Gonococcal Infections

      Gonococcal Infections

      1. Introduction
      2. Epidemiology in the United States
      3. Gonococcal Antimicrobial Susceptibility
      4. Microbiology, Pathogenesis, and Transmission
      5. Clinical Manifestations
      6. Laboratory Diagnosis
      7. Screening for Gonococcal Infection
      8. Treatment
      9. Management of Sex Partners
      10. Counseling and Education
      11. Prevention
      12. Summary Points
    3. Syphilis

      Syphilis

      1. Introduction
      2. Epidemiology in the United States
      3. Microbiology, Pathogenesis, and Transmission
      4. Clinical Manifestations
      5. Laboratory Diagnostic Tests
      6. Screening for Syphilis
      7. Treatment
      8. Post-Treatment Follow Up
      9. Management of Sex Partners
      10. Counseling and Education
      11. Prevention
      12. Summary Points
    4. Genital Herpes

      Genital Herpes

      1. Introduction
      2. Epidemiology in the United States
      3. Microbiology, Pathogenesis, and Transmission
      4. Clinical Manifestations
      5. Laboratory Diagnosis
      6. Screening for HSV-2 Infection
      7. Treatment
      8. Genital HSV in Pregnancy and Neonatal Herpes
      9. Prevention
      10. Patient Counseling and Education
      11. Summary Points
    5. Human Papillomavirus Infection

      Human Papillomavirus Infection

      1. Introduction
      2. Epidemiology in the United States
      3. Microbiology, Pathogenesis, and Transmission
      4. Clinical Manifestations
      5. Diagnosis and Screening Tests
      6. Screening Recommendations for HPV-Related Cancers
      7. Treatment of Anogenital Warts
      8. Prevention of HPV Infection
      9. Counseling and Education
      10. Summary Points
    6. Pelvic Inflammatory Disease

      Pelvic Inflammatory Disease

      1. Introduction
      2. Epidemiology
      3. Microbiology and Pathogenesis
      4. Clinical Manifestations
      5. Diagnosis
      6. Treatment
      7. Management of Sex Partners
      8. Counseling and Education
      9. Summary Points
    7. Vaginitis

      Vaginitis

      1. Introduction
      2. Diagnostic Approach for Vaginitis
      3. Bacterial Vaginosis
      4. Trichomoniasis
      5. Vulvovaginal Candidiasis
      6. Summary Points
    8. Mpox

      Mpox

      1. Introduction
      2. Epidemiology
      3. Virology, Pathogenesis, and Transmission
      4. Clinical Manifestations
      5. Laboratory Diagnosis
      6. Treatment
      7. Infection Control in Health Care Settings
      8. Prevention of Mpox Infection
      9. Counseling and Education
      10. Summary Points
    9. Mycoplasma genitalium

      Mycoplasma genitalium

      1. Introduction
      2. Epidemiology in the United States
      3. Microbiology, Pathogenesis, and Transmission
      4. Antimicrobial Susceptibility in Mycoplasma genitalium
      5. Clinical Manifestations
      6. Laboratory Diagnostic Tests and Resistance Assays
      7. Diagnostic Testing and Screening Guidelines
      8. Treatment of Mycoplasma genitalium Infection
      9. Counseling and Education
      10. Summary Points
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    1. Chlamydial Infections

      Chlamydial Infections

      1. Introduction
      2. Epidemiology in the United States
      3. Microbiology, Pathogenesis, and Transmission
      4. Clinical Manifestations
      5. Laboratory Diagnosis
      6. Screening for Chlamydial Infection
      7. Treatment of Adolescents and Adults
      8. Management of Sex Partners
      9. Treatment of Neonates and Children
      10. Counseling and Education
      11. Prevention
      12. Summary Points
    2. Gonococcal Infections

      Gonococcal Infections

      1. Introduction
      2. Epidemiology in the United States
      3. Gonococcal Antimicrobial Susceptibility
      4. Microbiology, Pathogenesis, and Transmission
      5. Clinical Manifestations
      6. Laboratory Diagnosis
      7. Screening for Gonococcal Infection
      8. Treatment
      9. Management of Sex Partners
      10. Counseling and Education
      11. Prevention
      12. Summary Points
    3. Syphilis

      Syphilis

      1. Introduction
      2. Epidemiology in the United States
      3. Microbiology, Pathogenesis, and Transmission
      4. Clinical Manifestations
      5. Laboratory Diagnostic Tests
      6. Screening for Syphilis
      7. Treatment
      8. Post-Treatment Follow Up
      9. Management of Sex Partners
      10. Counseling and Education
      11. Prevention
      12. Summary Points
    4. Genital Herpes

      Genital Herpes

      1. Introduction
      2. Epidemiology in the United States
      3. Microbiology, Pathogenesis, and Transmission
      4. Clinical Manifestations
      5. Laboratory Diagnosis
      6. Screening for HSV-2 Infection
      7. Treatment
      8. Genital HSV in Pregnancy and Neonatal Herpes
      9. Prevention
      10. Patient Counseling and Education
      11. Summary Points
    5. Human Papillomavirus Infection

      Human Papillomavirus Infection

      1. Introduction
      2. Epidemiology in the United States
      3. Microbiology, Pathogenesis, and Transmission
      4. Clinical Manifestations
      5. Diagnosis and Screening Tests
      6. Screening Recommendations for HPV-Related Cancers
      7. Treatment of Anogenital Warts
      8. Prevention of HPV Infection
      9. Counseling and Education
      10. Summary Points
    6. Pelvic Inflammatory Disease

      Pelvic Inflammatory Disease

      1. Introduction
      2. Epidemiology
      3. Microbiology and Pathogenesis
      4. Clinical Manifestations
      5. Diagnosis
      6. Treatment
      7. Management of Sex Partners
      8. Counseling and Education
      9. Summary Points
    7. Vaginitis

      Vaginitis

      1. Introduction
      2. Diagnostic Approach for Vaginitis
      3. Bacterial Vaginosis
      4. Trichomoniasis
      5. Vulvovaginal Candidiasis
      6. Summary Points
    8. Mpox

      Mpox

      1. Introduction
      2. Epidemiology
      3. Virology, Pathogenesis, and Transmission
      4. Clinical Manifestations
      5. Laboratory Diagnosis
      6. Treatment
      7. Infection Control in Health Care Settings
      8. Prevention of Mpox Infection
      9. Counseling and Education
      10. Summary Points
    9. Mycoplasma genitalium

      Mycoplasma genitalium

      1. Introduction
      2. Epidemiology in the United States
      3. Microbiology, Pathogenesis, and Transmission
      4. Antimicrobial Susceptibility in Mycoplasma genitalium
      5. Clinical Manifestations
      6. Laboratory Diagnostic Tests and Resistance Assays
      7. Diagnostic Testing and Screening Guidelines
      8. Treatment of Mycoplasma genitalium Infection
      9. Counseling and Education
      10. Summary Points
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  • 0%Lesson 1
    Anogenital Warts
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      Bacterial Vaginosis
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        Candidiasis - Vulvovaginal
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          Cervicitis
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            Chancroid
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            1. 5A.Core Concepts
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            Chlamydial Infections
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              Epididymitis
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                Gonococcal Infections
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                  Granuloma Inguinale (Donovanosis)
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                    Hepatitis A
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                          Genital Herpes
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                            HIV Infection
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                              HPV Infection: Prevention
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                                HPV-Associated Cancers and Precancers
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                                  Lymphogranuloma venereum (LGV)
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                                  1. 0%Lesson 18
                                    Mpox
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                                    1. 0%Lesson 19
                                      Mycoplasma genitalium
                                      Activities
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                                        Pediculosis Pubis
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                                          Pelvic Inflammatory Disease (PID)
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                                            Penicillin Allergy
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                                              Proctitis, Proctocolitis, and Enteritis
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                                                Scabies
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                                                  Sexual Assault and Abuse and STIs
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                                                    Syphilis
                                                    Activities
                                                    1. 0%Lesson 28
                                                      Trichomoniasis
                                                      Activities
                                                      1. 0%Lesson 29
                                                        Urethritis
                                                        Activities
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                                                        Lesson 19. Mycoplasma genitalium

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                                                        Table of Contents
                                                        • Mycoplasma genitalium
                                                        • References
                                                        • Tables
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                                                        References

                                                        • Bjartling C, Osser S, Persson K. Mycoplasma genitalium in cervicitis and pelvic inflammatory disease among women at a gynecologic outpatient service. Am J Obstet Gynecol. 2012;206:476.e1-8.
                                                          [PubMed Abstract] -
                                                        • Cohen CR, Mugo NR, Astete SG, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect. 2005;81:463-6.
                                                          [PubMed Abstract] -
                                                        • Couldwell DL, Tagg KA, Jeoffreys NJ, Gilbert GL. Failure of moxifloxacin treatment in Mycoplasma genitalium infections due to macrolide and fluoroquinolone resistance. Int J STD AIDS. 2013;24:822-8.
                                                          [PubMed Abstract] -
                                                        • Daley GM, Russell DB, Tabrizi SN, McBride J. Mycoplasma genitalium: a review. Int J STD AIDS. 2014;25:475-87.
                                                          [PubMed Abstract] -
                                                        • Dehon PM, Hagensee ME, Sutton KJ, Oddo HE, Nelson N, McGowin CL. Histological Evidence of Chronic Mycoplasma genitalium-Induced Cervicitis in HIV-Infected Women: A Retrospective Cohort Study. J Infect Dis. 2016;213:1828-35.
                                                          [PubMed Abstract] -
                                                        • Dehon PM, McGowin CL. The immunopathogenesis of Mycoplasma genitalium infections in women: A Narrative Review. Sex Transm Dis. 2017;44:428-432.
                                                          [PubMed Abstract] -
                                                        • Dize L, Barnes P Jr, Barnes M, et al. Performance of self-collected penile-meatal swabs compared to clinician-collected urethral swabs for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium by nucleic acid amplification assays. Diagn Microbiol Infect Dis. 2016;86:131-5.
                                                          [PubMed Abstract] -
                                                        • Falk L, Fredlund H, Jensen JS. Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection. Sex Transm Infect. 2005;81:73-8.
                                                          [PubMed Abstract] -
                                                        • Falk L, Jensen JS. Successful outcome of macrolide-resistant Mycoplasma genitalium urethritis after spectinomycin treatment: a case report. J Antimicrob Chemother. 2017;72:624-625.
                                                          [PubMed Abstract] -
                                                        • Francis SC, Kent CK, Klausner JD, et al. Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005-2006. Sex Transm Dis. 2008;35:797-800.
                                                          [PubMed Abstract] -
                                                        • Gaydos CA. Mycoplasma genitalium: Accurate diagnosis Is necessary for adequate treatment. J Infect Dis. 2017;216:S406-S411.
                                                          [PubMed Abstract] -
                                                        • Getman D, Jiang A, O'Donnell M, Cohen S. Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States. J Clin Microbiol. 2016;54:2278-83.
                                                          [PubMed Abstract] -
                                                        • Golden MR, Workowski KA, Bolan G. Developing a Public Health Response to Mycoplasma genitalium. J Infect Dis. 2017;216:S420-S426.
                                                          [PubMed Abstract] -
                                                        • Gottesman T, Yossepowitch O, Samra Z, Rosenberg S, Dan M. Prevalence of Mycoplasma genitalium in men with urethritis and in high risk asymptomatic males in Tel Aviv: a prospective study. Int J STD AIDS. 2017;28:127-32.
                                                          [PubMed Abstract] -
                                                        • Haggerty CL, Taylor BD. Mycoplasma genitalium: an emerging cause of pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2011;2011:959816.
                                                          [PubMed Abstract] -
                                                        • Haggerty CL, Totten PA, Astete SG, Ness RB. Mycoplasma genitalium among women with nongonococcal, nonchlamydial pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2006;2006:30184.
                                                          [PubMed Abstract] -
                                                        • Horner PJ, Martin DH. Mycoplasma genitalium Infection in Men. J Infect Dis. 2017;216:S396-S405.
                                                          [PubMed Abstract] -
                                                        • Jensen JS, Cusini M, Gomberg M, Moi H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2016;30:1650-6.
                                                          [PubMed Abstract] -
                                                        • Jensen JS, Cusini M, Gomberg M, Moi H. Background review for the 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2016;30:1686-93.
                                                          [PubMed Abstract] -
                                                        • Jernberg E, Moghaddam A, Moi H. Azithromycin and moxifloxacin for microbiological cure of Mycoplasma genitalium infection: an open study. Int J STD AIDS. 2008;19:676-9.
                                                          [PubMed Abstract] -
                                                        • Jurstrand M, Jensen JS, Magnuson A, Kamwendo F, Fredlund H. A serological study of the role of Mycoplasma genitalium in pelvic inflammatory disease and ectopic pregnancy. Sex Transm Infect. 2007;83:319-23.
                                                          [PubMed Abstract] -
                                                        • Lau A, Bradshaw CS, Lewis D, et al. The efficacy of azithromycin for the treatment of genital Mycoplasma genitalium: a systematic review and meta-analysis. Clin Infect Dis. 2015;61:1389-99.
                                                          [PubMed Abstract] -
                                                        • Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61:418-26.
                                                          [PubMed Abstract] -
                                                        • Manhart LE, Broad JM, Golden MR. Mycoplasma genitalium: should we treat and how? Clin Infect Dis. 2011;53 Suppl 3:S129-42.
                                                          [PubMed Abstract] -
                                                        • Manhart LE, Critchlow CW, Holmes KK, et al. Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis. 2003;187:650-7.
                                                          [PubMed Abstract] -
                                                        • Manhart LE, Jensen JS, Bradshaw CS, Golden MR, Martin DH. Efficacy of antimicrobial therapy for Mycoplasma genitalium infections. Clin Infect Dis. 2015;61 Suppl 8:S802-17.
                                                          [PubMed Abstract] -
                                                        • Manhart LE. Has the time come to systematically test for Mycoplasma genitalium? Sex Transm Dis. 2009;36:607-8.
                                                          [PubMed Abstract] -
                                                        • McGowin CL, Totten PA. The Unique microbiology and molecular pathogenesis of Mycoplasma genitalium. J Infect Dis. 2017 Jul 15;216:S382-S388.
                                                          [PubMed Abstract] -
                                                        • Moi H, Reinton N, Moghaddam A. Mycoplasma genitalium in women with lower genital tract inflammation. Sex Transm Infect. 2009;85:10-4.
                                                          [PubMed Abstract] -
                                                        • Munson E, Bykowski H, Munson KL, et al. Clinical Laboratory Assessment of Mycoplasma genitalium Transcription-mediated amplification using primary female urogenital specimens. J Clin Microbiol. 2016;54:432-8.
                                                          [PubMed Abstract] -
                                                        • Oakeshott P, Aghaizu A, Hay P, et al. Is Mycoplasma genitalium in women the "New Chlamydia?" A community-based prospective cohort study. Clin Infect Dis. 2010;51:1160-6.
                                                          [PubMed Abstract] -
                                                        • Read TRH, Fairley CK, Murray GL, et al. Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation. Clin Infect Dis. 2019;68:554-60.
                                                          [PubMed Abstract] -
                                                        • Seña AC, Lensing S, Rompalo A, et al. Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy. J Infect Dis. 2012;206:357-65.
                                                          [PubMed Abstract] -
                                                        • Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL. Clinical presentation of Mycoplasma genitalium infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease. Clin Infect Dis. 2009;48:41-7.
                                                          [PubMed Abstract] -
                                                        • Simms I, Eastick K, Mallinson H, et al. Associations between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease. Sex Transm Infect. 2003;79:154-6.
                                                          [PubMed Abstract] -
                                                        • Stamm WE, Running K, Hale J, Holmes KK. Etiologic role of Mycoplasma hominis and Ureaplasma urealyticum in women with the acute urethral syndrome. Sex Transm Dis. 1983;10:318-22.
                                                          [PubMed Abstract] -
                                                        • Svenstrup HF, Fedder J, Kristoffersen SE, Trolle B, Birkelund S, Christiansen G. Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility--a prospective study. Fertil Steril. 2008;90:513-20.
                                                          [PubMed Abstract] -
                                                        • Taylor-Robinson D, Jensen JS. Mycoplasma genitalium: from Chrysalis to multicolored butterfly. Clin Microbiol Rev. 2011;24:498-514.
                                                          [PubMed Abstract] -
                                                        • U.S. Food and Drug Administration. FDA permits marketing of first test to aid in the diagnosis of a sexually-transmitted infection known as Mycoplasma genitalium. January 23, 2019
                                                          [FDA News Release] -
                                                        • Unemo M, Salado-Rasmussen K, Hansen M, et al. Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 2016. Clin Microbiol Infect. 2018;24:533-9.
                                                          [PubMed Abstract] -
                                                        • Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
                                                          [2021 STI Treatment Guidelines] -

                                                        Tables

                                                        Table 1. 2021 STI Treatment Guidelines: Mycoplasma genitalium
                                                        Recommended Regimens if M. genitalium Resistance Testing is Available

                                                        Recommended if macrolide sensitive:
                                                        Doxycycline followed by Azithromycin

                                                        Doxycycline followed by Azithromycin

                                                        Tradename:
                                                        Doxycycline 100 mg orally 2 times/day for 7 days, followed by Azithromycin 1 g orally initial dose, followed by 500 mg orally once daily for 3 additional days (2.5 g total of Azithromycin)
                                                        Recommended if macrolide resistant:
                                                        Doxycycline followed by Moxifloxacin

                                                        Doxycycline followed by Moxifloxacin

                                                        Tradename:
                                                        Doxycycline 100 mg orally 2 times/day for 7 days, followed by Moxifloxacin 400 mg orally once daily for 7 days
                                                        Source: Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187. [2021 STI Treatment Guidelines]

                                                        Table 2. 2021 STI Treatment Guidelines: Mycoplasma genitalium
                                                        Recommended Regimens if M. genitalium Resistance Testing is Not Available

                                                        Recommended if M. genitalium is detected by an FDA-cleared NAAT:
                                                        Doxycycline followed by Moxifloxacin

                                                        Doxycycline followed by Moxifloxacin

                                                        Tradename:
                                                        Doxycycline 100 mg orally 2 times/day for 7 days, followed by Moxifloxacin 400 mg orally once daily for 7 days
                                                        Source: Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187. [2021 STI Treatment Guidelines]

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