Epidemiologic Correlates and Antibiotic Treatment Patterns of Mycoplasma genitalium in the U.S. Military Health System, 2022

Abstract

Background. *Mycoplasma genitalium* (MG) is a sexually transmitted pathogen associated with urethritis, cervicitis, pelvic inflammatory disease, and increasing antimicrobial resistance. Contemporary guidelines recommend resistance-guided therapy when available, or sequential doxycycline followed by moxifloxacin when resistance testing is unavailable. Data on MG epidemiology and treatment patterns in U.S. military populations are limited. Methods. We analyzed de-identified Armed Forces Health Surveillance Division data linked with Military Health System (MHS) data for active-duty service members (ADSMs) aged 18–55 years who were not deployed and underwent MG nucleic acid amplification testing in 2022. We evaluated correlates of MG positivity using an individually matched case-control design; MG-positive cases were matched to MG-negative tested controls on sex and age, with up to four controls per case. We used conditional logistic regression to estimate matched odds ratios (mORs) and 95% confidence intervals (CIs). Among MG-positive cases, we described antibiotic dispensing patterns using Pharmacy Data Transaction Service (PDTS) records. We used logistic regression to evaluate correlates of guideline-concordant antibiotic dispensing (GCAD), defined as doxycycline 3 days before through 7 days after the MG test date, followed by moxifloxacin dispensed from the test date through 14 days afterward. Results. The analysis included 317 MG-positive cases and 1,213 MG-negative matched controls. Race/ethnicity and prior STI history were independently associated with MG positivity. Non-Hispanic Black race/ethnicity had 2.4 times higher odds of MG positivity than Non-Hispanic White race/ethnicity (adjusted mOR, 2.42; 95% CI, 1.78–3.28). Prior laboratory-confirmed chlamydia, gonorrhea, or syphilis in the preceding 12 months had 1.6 times higher odds of MG positivity than those without prior STI history (adjusted mOR, 1.57; 95% CI, 1.13–2.16). Among MG-positive cases, 202 of 317 (63.7%) had moxifloxacin dispensed from the MG test date through 14 days afterward, while 102 (32.2%) met the primary GCAD definition. Compared with Army service members, Air Force/Space Force service members had lower odds of GCAD (OR, 0.27; 95% CI, 0.12–0.56), as did Marine Corps service members (OR, 0.08; 95% CI, <0.01–0.41). Conclusions. Among ADSMs tested for MG in the MHS, MG positivity was most consistently associated with Non-Hispanic Black race/ethnicity and recent laboratory-confirmed STI history. Moxifloxacin dispensing after MG testing was common, but only about one-third of MG-positive cases had dispensing consistent with GCAD, largely because many moxifloxacin-containing dispenses were not preceded by the recommended doxycycline. Variation in GCAD by service branch warrants further evaluation of MG treatment guidance, result follow-up, and sequential dispensing pathways in military practice.