Antimicrobial resistance in Mycoplasma genitalium and Mycoplasma hominis: a systematic review in urology.

Abstract

Introduction: Mycoplasma genitalium and Mycoplasma hominis are urogenital mycoplasmas associated with urethritis, prostatitis, epididymitis, and pelvic inflammatory disease. In the last decade, acquired resistance to macrolides and fluoroquinolones in M. genitalium, together with intrinsic and acquired resistance to tetracyclines in M. hominis, have emerged as growing challenges in urology and sexual medicine.

Material and methods: A systematic review was conducted following the PRISMA guideline, searching PubMed, Scopus, and Web of Science (2015-2025). Clinical, epidemiological, and molecular studies describing genetic resistance mechanisms, as well as meta-analyses and clinical guidelines, were included. After applying inclusion and exclusion criteria, 42 articles were selected.

Results: In M. genitalium, macrolide resistance is associated with mutations in 23S rRNA (A2058G, A2059G), while fluoroquinolone resistance is linked to variants in parC and gyrA (S83I, D87N). In M. hominis, intrinsic macrolide resistance is complemented by the presence of tet(M), which contributes to doxycycline treatment failures. Globally, macrolide resistance in M. genitalium reaches 30-50% in Europe and the Americas, and over 60% in Asia; dual macrolide-fluoroquinolone resistance is emerging, with epidemic foci in Japan and China. In M. hominis, tetracycline resistance ranges from 10-30%, with regional variability.

Conclusions: Antimicrobial resistance in M. genitalium and M. hominis limits the effectiveness of traditional empirical therapies and requires the implementation of molecular detection and resistance testing. Resistance-guided treatment and epidemiological surveillance are essential to optimize clinical management and curb the spread of multidrug-resistant strains.