Abstract
As macrolide-resistant Mycoplasma genitalium (MG) becomes more prevalent, resistance-guided therapy (RGT) for MG has been recommended in clinical guidelines to improve first-line antibiotic selection and increase cure rates. This study adopted an incidence-based approach and a healthcare sector perspective to measure the cost of illness of MG in Australia. Two management strategies, RGT and non-RGT, were examined. A decision tree model was developed to replicate the clinical pathways among non-pregnant women, men who have sex with men (MSM) and men who have sex with women (MSW). The burden of managing a woman diagnosed with MG was lower under RGT compared to non-RGT (AUD 249 vs. 283). For MSM, the expected per-person cost was AUD 240 and AUD 279 under RGT and non-RGT. For MSW, non-RGT would cost an additional AUD 23. Overall, this study found that the economic burden of MG under RGT is lower than under non-RGT for both women and men in Australia. RGT offers cost savings while improving MG clinical management and helping to slow the spread of macrolide resistance.
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References
The Australian Centre for Disease Control. National Notifiable Diseases Surveillance System (NNDSS) [Available from: https://www.cdc.gov.au/diseases/surveillance-systems-and-networks/national-notifiable-diseases-surveillance-system-nndss#nationally-notifiable-diseases.
Walker, J. et al. Mycoplasma genitalium incidence, organism load, and treatment failure in a cohort of young Australian women. Clin. Infect. Dis. 56(8), 1094–1100 (2013).
Ong JJ, Ruan L, Lim AG, Bradshaw CS, Taylor-Robinson D, Unemo M, Horner PJ, Vickerman P, Zhang L. Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical model. eClinicalMedicine. 2021;33.
Bradshaw, C. S. et al. Mycoplasma genitalium in men who have sex with men at male-only saunas. Sex Transm Infect. 85(6), 432–435 (2009).
Couldwell, D. L. et al. Mycoplasma genitalium: high prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in western Sydney. Sex Transm Infect. 94(6), 406–410 (2018).
Read, T. R. H. et al. Symptoms, sites, and significance of mycoplasma genitalium in men who have sex with men. Emerg Infect Dis. 25(4), 719–727 (2019).
Latimer, R. L. et al. The clinical indications for testing women for & Mycoplasma genitalium. Sexually Trans. Infect. 98(4), 277–285 (2021).
Walker, J. et al. ‘The difference in determinants of Chlamydia trachomatis and Mycoplasma genitalium in a sample of young Australian women. BMC Infect. Dis. 11(1), 35 (2011).
Lusk, M. J. et al. Mycoplasma genitalium is associated with cervicitis and HIV infection in an urban Australian STI clinic population. Sex Transm Infect. 87(2), 107–109 (2011).
Stewart, J. D., Webb, B., Francis, M., Graham, M. & Korman, T. M. Should we routinely test for Mycoplasma genitalium when testing for other sexually transmitted infections?. Med. J. Aust. 212(1), 30–31 (2020).
Shilling, H. S. et al. Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009–2019. Sex Transm Infect. 98(2), 115–120 (2022).
Manhart, L. E., Broad, J. M. & Golden, M. R. Mycoplasma genitalium: should we treat and how?. Clin Infect Dis. 53(Suppl 3), S129–S142 (2011).
McGowin, C. L. & Anderson-Smits, C. Mycoplasma genitalium: an emerging cause of sexually transmitted disease in women. PLoS Pathog. 7(5), e1001324 (2011).
Lis, R., Rowhani-Rahbar, A. & Manhart, L. E. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 61(3), 418–426 (2015).
Taylor, B. D. et al. Risk factors for Mycoplasma genitalium endometritis and incident infection: a secondary data analysis of the T cell Response Against Chlamydia (TRAC) Study. Sex Transm Infect. 94(6), 414–420 (2018).
Htaik K, Vodstrcil LA, Plummer EL, Sfameni AM, Machalek DA, Manhart LE, Bradshaw CS. Systematic Review and Meta-analysis of the Association Between Mycoplasma Genitalium and Pelvic Inflammatory Disease (PID). Clinical Infectious Diseases. 2024:ciae295.
Bissessor, M. et al. The contribution of Mycoplasma genitalium to the aetiology of sexually acquired infectious proctitis in men who have sex with men. Clin. Microbiol. Infect. 22(3), 260–265 (2016).
Lewis, J., Horner, P. J. & White, P. J. Incidence of pelvic inflammatory disease associated with mycoplasma genitalium infection: Evidence synthesis of cohort study data. Clin Infect Dis. 71(10), 2719–2722 (2020).
Ong, J. J. et al. Australian sexually transmitted infection (STI) management guidelines for use in primary care 2022 update. Sex Health. 20(1), 1–8 (2023).
Workowski, K. A. et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 70(4), 1–187 (2021).
Jensen, J. S. et al. 2021 European guideline on the management of Mycoplasma genitalium infections. J. Eur. Acad. Dermatol. Venereol. 36(5), 641–650 (2022).
Jensen, J. S., Cusini, M., Gomberg, M. & Moi, H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 30(10), 1650–1656 (2016).
Soni, S. et al. British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium (2018). Int. J. STD AIDS 30(10), 938–950 (2019).
Machalek, D. A. et al. Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis. Lancet. Infect. Dis 20(11), 1302–1314 (2020).
Chua TP, Vodstrcil LA, Murray GL, Plummer EL, Jensen JS, Unemo M, Chow EPF, Low N, Whiley DM, Sweeney EL, Hocking JS, Danielewski JA, Garland SM, Fairley CK, Zhang L, Bradshaw CS, Machalek DA. Evolving patterns of macrolide and fluoroquinolone resistance in Mycoplasma genitalium: an updated systematic review and meta-analysis. Lancet Microbe. 6(7), 101047 (2025).
Manhart, L. E., Geisler, W. M., Bradshaw, C. S., Jensen, J. S. & Martin, D. H. Weighing potential benefits and harms of mycoplasma genitalium testing and treatment approaches. Emerg Infect Dis. 28(8), e220094 (2022).
Durukan, D. et al. Resistance-guided antimicrobial therapy using doxycycline-moxifloxacin and doxycycline-25 g azithromycin for the treatment of mycoplasma genitalium infection: Efficacy and tolerability. Clin. Infect. Dis. 71(6), 1461–1468 (2020).
ASHM. Australian sexually transmitted infections management guidelines for use in primary care [Available from: https://sti.guidelines.org.au/sexually-transmissible-infections/mycoplasma-genitalium/.
Ong, J. J. et al. Cost-effectiveness of testing for Mycoplasma genitalium among men who have sex with men in Australia. Sex Transm Infect. 99(6), 398–403 (2023).
Adawiyah, R. A. et al. Cost-effectiveness of resistance-guided therapy for Mycoplasma genitalium in Australia. Sci Rep. 14(1), 12856 (2024).
Jo, C. Cost-of-illness studies: Concepts, scopes, and methods. Clin Mol Hepatol. 20(4), 327–337 (2014).
Ness, R. B. et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 186(5), 929–937 (2002).
Sittimart, M. et al. An overview of the perspectives used in health economic evaluations. Cost Effect. Resource Alloc. 22(1), 41 (2024).
Independent Health and Aged Care Pricing Authority. National Hospital Cost Data Collection (NHCDC) Public Sector 2021–22 [Available from: https://www.ihacpa.gov.au/resources/national-hospital-cost-data-collection-nhcdc-public-sector-2021-22 (2022).
Department of Health and Aged Care. Medicare Benefits Schedule [Available from: https://www.mbsonline.gov.au/.
Department of Health and Aged Care. Pharmaceutical Benefits Scheme [Available from: https://www.pbs.gov.au/pbs/home.
World Health Organization. Recommendations for the treatment of Trichomonas vaginalis, Mycoplasma genitalium, Candida albicans, bacterial vaginosis and human papillomavirus (anogenital warts) Geneva: World Health Organization; (2024). [Available from: https://iris.who.int/handle/10665/378215.
Frenzer, C., Egli-Gany, D., Vallely, L. M., Vallely, A. J. & Low, N. Adverse pregnancy and perinatal outcomes associated with Mycoplasma genitalium: systematic review and meta-analysis. Sex Transm Infect. 98(3), 222–227 (2022).
Vodstrcil, L. A. et al. Combination therapy for mycoplasma genitalium, and new insights into the utility of parC mutant detection to improve cure. Clin Infect Dis. 75(5), 813–823 (2022).
Doyle, M. et al. Nonquinolone options for the treatment of mycoplasma genitalium in the era of increased resistance. Open Forum Infect Dis. 7(8), 291 (2020).
Read, T. R. H. et al. Outcomes of resistance-guided sequential treatment of mycoplasma genitalium infections: A prospective evaluation. Clin Infect Dis. 68(4), 554–560 (2019).
Rein, D. B., Kassler, W. J., Irwin, K. L. & Rabiee, L. Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial. Obstet Gynecol. 95(3), 397–402 (2000).
Price, M. J. et al. The natural history of Chlamydia trachomatis infection in women: A multi-parameter evidence synthesis. Health Technol Assess. 20(22), 1–250 (2016).
Armour, M., Lawson, K., Wood, A., Smith, C. A. & Abbott, J. The cost of illness and economic burden of endometriosis and chronic pelvic pain in Australia: A national online survey. PLoS ONE 14(10), e0223316 (2019).
Australian Bureau of Statistics. Consumer Price Index, Australia 2025 [Available from: https://www.abs.gov.au/statistics/economy/price-indexes-and-inflation/consumer-price-index-australia/latest-release.
OECD. Purchasing power parities (PPP) [Available from: https://data.oecd.org/conversion/purchasing-power-parities-ppp.htm#indicator-chart.
Funding
This study was supported by the Australian Research Council Industrial Transformation Research Hub to Combat Antimicrobial Resistance (ARC ITRP; IH190100021). The funder of this research was not involved in the study design; the collection, analysis, and interpretation of data; the writing of the report; nor the decision to submit the paper for publication.
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QC, JJO, CJB, RB and VW conceived and designed the study. VW supervised the study. CW and RAA contributed to data curation. QC conducted the data analysis. All authors contributed to the interpretation of the results. QC drafted the manuscript which all authors commented on. All authors critically reviewed and approved the final manuscript.
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This study used publicly available secondary data extracted from previously published literature. No human participants were recruited, and no individual-level data were collected. Therefore, institutional ethics approval and informed consent were not required.
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Cheng, Q., Watts, C., Al Adawiyah, R. et al. Cost of illness of Mycoplasma genitalium in Australia: an incidence-based approach incorporating resistance-guided therapy. Sci Rep (2026). https://doi.org/10.1038/s41598-026-36992-3
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DOI: https://doi.org/10.1038/s41598-026-36992-3
