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Pristinamycin for Mycoplasma Genitalium?

In a recent study it was mentioned that Pristinamycin was effective in controlling Mycoplasma Genitalium that is both resistant to macrolides and moxyfloxacin in one community in Australia.  


Synercid is the only medicine in the US that is close to Pristinamycin but is not allowed for use for anything but strep and staph infections, plus it has to be injected daily by IV, which makes it impossible to get legally.  That is pretty stupid since you can buy virginiamycin in 50 pound bags to mix in with animal feed which is basically the same stuff.

Pristinamycin is apparently used quite a bit in Europe for Mycoplasma Genitalium.  Does anyone have any info on success rates before I get a plane ticket to Paris?  Seems to me it would be worth it to fly over for a week and take advantage of their socialized medicine to get a prescription, and check out the Mona Lisa and the Eiffel Tower while you are there.  I have searched online and can't really find too much specific to M. Genitalium.
24 Responses
Avatar universal
I don't think anyone on this forum is likely to have any experience with this drug for M gen or any opinions about it. Or quinupristin (Synercid®).

M gen causes only about 10% of NGU. As best is known, it's pretty much harmless, especially for men. No complications of M gen have ever been reported in men -- no known urethral stricture, epididymitis, infertility, etc, only urethritis itself which is typically mild. Its role in causing serious disease in women remains a matter of uncertainty, but but most studies suggest it's not a major player in PID, infertility, etc -- not nearly as important in this regard as gonorrhea or chlamydia. Probably the large majority of M gen infections never cause symptoms, and for sure most infections are never diagnosed or treated, and clear up on their own. I cannot imagine it is worth the time and expense to travel internationally to get some new drug for it. And while moxifloxacin resistance may be common in some parts of Australia, it appears to be effective in most geographic areas.

As for any drug not being "allowed" for treatment of certain infections, that reflects a misunderstanding. In the US, Synercid might be approved by the FDA only for staph and strep, but once a drug is on the market and approved for any particular purpose, it can be prescribed for anything at the prescribing provider's discretion. (The only exceptions are for narcotics and other drugs with addiction/abuse potential.) Few docs would agree to it for an infection for which it has never even been studied, like M gen, and whether your insurance would cover it is a another matter. But there are no legal restrictions if you can talk your doctor into it.
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I have experienced epididymitis, prostatitis, back pain, and pain down my legs.  I also have it in my throat which is causing chest pains and dull headaches.  I have been on Moxi for a little over a week now and it doesn't seem to be helping much at all.  I have been fighting this for over 3 months now and my local doctors have been of no help whatsoever and have had to do all the research myself and present it to them for treatment as they had never heard of it.  Therefore, if I have to spend a few grand to take care of it once and for all, it would be money well spent before it starts to affect my job.

Pristinamycin isn't a new drug, it has been around forever, but since you have to take 4,000 mg a day (2x500 x 4 times a day) it hasn't been as widely used as all the other drugs that only require one or two pills a day, thus the lack of resistance to it.
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"I have experienced epididymitis, prostatitis, back pain, and pain down my legs." I remain skeptical you have really had all these (professionally diagnosed) and that M gen is the cause of any of it.
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After going round and round with my primary care doctor who couldn't believe that 3 weeks of doxy wouldn't have cured my ailment, I have been seeing a urologist who is working with an infectious disease specialist.  So, who should I be talking to instead?

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In general, ID specialists are far more likely to be knowledgeable that urologists about infections, antibiotics, STDs in general, and M genitalium in particular than most urologists -- even for infections that primarily involve the genitourinary tract.
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I'm in similar condition.  Completed a 14-day Avelox treatment, discharge seems to be gone, but uncomfort sensation lingers for 5 weeks now.

Start getting uncomfort feeling on my left testis and the left butt and leg.
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Where could you get Pristinamycin?
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We can not tell you where to get medication.
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Interesting information on the study

Avatar universal
What your doctors should be doing is lab testing for resistance to specific antibiotics as different strains of m.genitalium post resistance to different antibiotics. Instead it just sound like they are throwing whatever they can at it that has been shown to treat it without knowing which mutations for resistance your mycoplasma has. I received the traditional Azithromycin treatment (1g) and it failed. Then I read studies that Avalox was supposed to be a 100% cure and it failed for me - the infection came back 3 weeks later. Then I had to see another doctor and he put me on the long term dose of Azithromycin which I knew would fail but they wouldn't listen to me. Luckily I found a doctor that would listen and I did a 21 day treatment of Doxycycline with the hopes that my type of M. genitalium would not have resistance and luckily it worked. More than likely you will need a long term dose of antibiotics that the m. genitalium is not resistant to due to the replication rate of mycoplasma (which is 21 days) I hope this helps.
Avatar universal
My infection with m.genitalium was certainly not harmless. I had reactive athritis due to it. I also had extremely painful urination and discharge. There were also major side effects from the anti-biotics I took trying to get rid of it.

Much of the current research on NGU, Prostatiis and PID is actually pointing at m. genitalium as a cause when patients tests negative for other traditional infections and m.genitalium is quickly gaining attention for it's ability to mutate and form resistance to all anti-biotics.

The arthritis came from the Moxifloxacin/Avelox, it's a side effect of it and it even can have stronger ones. I can't walk properly since 3 months because of tendon damages.
Avatar universal
Thanks for the info.  I was on Avelox for 14-day and I have not had discharge for over 7 weeks now. And the MG DNA test from urine is also negative.  

However, I have symptome of chronic prostatitis, but doctors are not seeing any actual infections, and told me I should not be on AB.

Initially I had doxy for 3 weeks, but the UTI just came back after 2 weeks.  I think a lot of people are as desperate as I am.

Can more people share their experience or methods to alleviate the symptoms?

Avatar universal
Mycoplasma Genitalium is horrific. I can't understand why more isn't known or published about it. It just doesn't clear up like Chlamydia does. Why is there not more noise about it!?

Looking across MedHelp you can see the threads that start off with 'I had unprotected oral'  and are largely left unanswered. With hindsight it's obvious that Mycoplasma is behind it. I'm hoping that those folk got cleared up ok in the absence of knowing what they really had.

M Gen needs far more exposure. It's #3 in the U.S. and no-one is crowing about it.
I had it for 16 years before finally getting it cleared up with Avelox, I had tried every antibiotic under the sun. I live outside of Provincetown, MA and because of the homosexual population here they happened to open up a clinic that tested for MG as part of some homosexual antibiotic resistance in hiv-1 compromised patients study and there was a flyer I saw and well I knew years ago this was the likely culprit and mind you I went on my life tried to ignore lingering prostatitis that would flare up wildly at times that all the while within 2 weeks of a 6 months course of Avelox it was clear and it was as if everything felt 16 years ago. Mind you I do not feel any lasting damage and I feel 1903402489239429342 better you have no idea. I cried upon ejaculating for the first time feeling normal since before I received oral sex from a female and gave me this horrific std I had for 16 years that became chronic bacterial prostatitis. Needless to say, there is a cure. There seems to be only 1 antibiotic that works once it becomes prostatitis and that is Avelox also known as Moxifloxacin. Now if you happen to have them, even more, rarer form than you require Pristinamycin and it is not available in the united states but it is able to be received via the right channels from India if you know where to look. But please try the Avelox first because pristinamycin is called that for a reason it is used in the direst of cases and they want to keep the profile pristine with no resistance to it. Not to be ******* played with or you'll have an even more virulent form than currently floating around.
mcl509, your posts are like the sacred texts of MG. So inspirational. Please update us whenever you're back.
I have had mGen for over one year know and I too have prostatitis symptoms that come and go .. blocked feeling with ejaculation, hardly any semen coming out plus blood in the semen.
I cannot take Avelox (quinolones) ... you say that when mGen causes prostatitis that the only hope is Avelox !!!  Am i doomed???  Surely I can get rid of this plus my prostatitis with another antibiotc?
I don't know what meds you've taken, but I found this -


It lists some other antibiotics to take because of the resistance found. It does recommend moxiflaxin for complicated cases (which yours is if you have prostatitis), but it does have a regimen with doxy and azithromycin.

This mentions another new antibiotic, josamycin - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589104/ It's only for uncomplicated, but it may be worth trying.

Why can't you take avelox? Is that an absolute no for you? Is it something that you could take and be very closely monitored because the benefits outweigh the risks? I know sometimes they are just an absolute no, but sometimes there are work-arounds so you can try it.

What is your urologist saying? If you aren't under the care of a urologist, you should be.
Avatar universal
I have been diagnosed by myco g and have been on doxy first for 14 days then 28 days then tried azithromycin for 5 days then a longer 3 week course. Still no effect. Then got on moxifloxacin for 10 days. Symptoms got worse after day 5. Symptoms are pain in the left side of stomach and back pain. Very slight pain/discomfort in penis which is hardly noticeable. Did start out with discharge but this has gone away. Main problem is pain in lower left side and discomfort in back area which seems to be moving up my back. Going on for a year now. Just been prescribed Pristinamycin so heres hoping.
The pain is a moxifloxacin side effect, it damages your body.
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How did this treatment go? Same boat!
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Hey May1203. no good. the pristinamycin was going well after day 3. but after i finished symptoms returned after a couple of days. Just had another test but the symptoms are still there. Don't know whats next.
Hey ashton, was your test negative?  I know you mentioned symptoms persisted, but they could be due to another cause.  Did your TOC (test of cure) come back negative for MG after the pristinamycin course? Can you describe your dosage as well?  Any feed back would be much appreciated!
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Hey Ashton. Did the Pristinamycin kill the Mycoplasma?
Have you had a new test after the treatment?
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hi there
did u retest for ur MG?
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hey ashton
how are you right now?
can u share?
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Hi Guys, has anyone from the US been able to get their hands on pristinamycin?
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Update:  I took a trip to France and saw a doctor there, which cost about $100 to have one come to your hotel room.  Took the Pristinamycin and some steroids as prescribed which was about another $100.  Symptoms went away for 2 months but came back briefly for a month then went away for good.  I think there is a lot of validity to the fact that you shouldn't focus on it too much and carry tension in your pelvic floor thus aggravating the issue.  I kept taking tamsulosin for several months then eventually quit taking that as well. Glad to put it behind me.  No guarantees it works for anyone else, but worked for me.  I guess if you have a couple thousand to spend, hop on a plane.
Avatar universal
Update:  Went to Paris, had doctor come to my hotel room for $100.  Got Pristinamycin and a steroid prescription, another $100.  Symptoms disappeared after taking meds but reappeared for a month then disappeared completely.  I kept taking Tamsulosin for several months. I think there is a lot of validity to the statement that you shouldn't think about it too much and carry all of that pelvic floor tension, which only makes matters worse.  No guarantees, but I have been issue free for over a year now.  Glad that is all behind me now.
Hi stoopid34, congratulations! One question: For how long time have you taken pristinamycin? 4g (1g each 6 hours) for 10 days? Or longer? Symptoms reappeared after treatment with pristinamycin and then disappeared completely? ...strange. One more question: how much was pristinamycin? You wrote $100 - this is really cheap. When I order it it would be much more expansive. 80 pills 500 mg (10 days treatment) would be more then 400 EUR.
Hi stoopid34, hve your symptoms come back at all?  Can you pleeeasse help us out and give some info on this process? I've been struggling with NGU (suspected M. genitalium) for 3 months now, after taking azitrhomycin and moxifloxicin to no avail.  Do you speak French? Can you explain how you located a private doctor? Did he speak english/can you provide a contact?

Edit: explain the process of finding a French doctor, that is. I am legit going to do this if I can be sure I'll be able to get the  pristinamycin.  Thanks!
Hello, I am suffering from pain and burning sensation in my penis and my urethra for about 2 years, I saw many many doctors here in Canada , took many medications like azitromycin and doxycyclin but was not effective, took a session of Levofloxacin for 14 days but could not continue after the day 10 because of tendon problem. finally the doctors told me they can not do anything for me! Sound ridiculous isn't it?  So could you please help me, which city in France you went? you saw a general doctor or an urologist? please help me I am sick for 2 years. my personal life , professional life and sexual life ruined . thanks a alot , by the way I can speak french well. oh last question for how many days you took Pristinamycin?

again thank you so much
Avatar universal
Update:  I ended up taking a 5-day course of moxifloxacin.  My symptoms remained about 2 weeks after, and during that time, my appointment with an infectious disease specialist finally came.  My urine was tested for Mycoplasma  and Ureaplasma DNA, which came back negative, leukocytes indicated I was not fighting an infection.  My symptoms faded over about 2 weeks  after completing antibiotics.  Never did confirm what I had but overall, my symptoms were milder than what most are reporting.   I never had a substantive discharge, only evidence (split urination from dried discharge in the morning, staining on inside of underwear) and a discomfort in my urethra (not burning pain while urinating).  Symptoms still come back occasionally, but are very mild (just urethral discomfort).  

I'm not 100% clear on what the cause was, but I suspect it may have been from marijuana withdrawal (after ~15 years of daily use), which coincided with insomnia and cognitive difficulties.  Occasional marijuana use brings back these symptoms, as well as the mild feelings of discomfort in my  urethra.   However, original discharge symptoms appeared several days after having sex with a new partner, who was also sleeping with someone else at the time, and had several symptoms (minimal vaginal lubrication, miscarriages), which may  have indicated PID.  

In summary, its a mystery, but moxifloxicin seemed to have worked.  Be very careful about straining joints and ligaments on azithromycin/moxifloxacin.
Do not just take 5 days of any medicine for MG from this point forward. Doctors have no clue. Every patient with MG should take 14, better 21 days of medicine . Minocyline and combination of moxi or sotifloxicam or pristinamycin. That will kill most of the resistant bugs and not allow any of the non resistant bugs to mutate. Doctors and scientists are way way way behind the boat. If yours still stays after this, you will need to wait till new meds are out or try Synercid or other meds that work for other types of mycoplasma. Very difficult. You dont want to cause mutation in your own body.
Avatar universal
Hi. If your reading this then I assume you think you have Mycoplasma genitalium. I had it for 2 years and so I will share my story and how I finally cured myself. Btw trichomoniasis  is a similar condition so please have a chat with the doctor so you can go in the correct direction.
After a 1 night stand and doing some anal I found out I had discharge and so went to the clinic. I was told it was a ngu, which means it could be anything apart from gonorrhoea. Btw gonorrhoea is now getting totally resistant to antibiotics so please do always wear a condom because gonorrhoea is agony. I will always wear condoms from now on because these diseases are getting dangerous.
So anyway, the doctor advised me to take doxycycline for the usual dosage as opposed to azithromycin which is the preferred treatment in America. After 2 years of research I would say that the NHS is correct in using doxycycline for now as it doesn’t promote antibiotic resistance compared to azithromycin which does, If you have just been diagnosed with MG then I would ignore both of these and go straight for moxifloxacin because both of these only has around a 40% cure rate. Many doctors who are worth their salt are now going for this method and as someone who has tried all of these, I would do this method. You can buy all of these 3 online using something like https://www.doctorfox.co.uk/. You don’t have to declare anything to the doctor on here so no record on your doctors computer.
All of these 3 methods failed for me and part of that reason is because of bacteria load. I researched for 2 years and gained a lot of knowledge on this. In clinical trials there has been evidence showing that having a low bacteria load is usually the difference between failure and success.
After more research and speaking with 2 consultants I decided to try something called Pristinamycin. It is not registered in the UK but it is in France and one or two other countries. The consultant had never heard of it so I had to show evidence that it was tolerable. After finding the information that he needed, he wrote a private prescription and I got it in Lloyds pharmacy albeit after they had to ring around a few places to find it. It cost me nearly 600 pounds. Gulp.
At this point it had been almost 2 years and so it was time to go to battle with this stubborn *****. The antibiotic resistance problem is very real so I had to prepare in advance. I concluded that to lower my bacteria load, I had to use a combination of diet, pills and supplements. First I bought doxycycline again but this time it was only used to lower the bacteria load. I did a 10 day course of 200mg twice a day. As the consultant advised I also had to improve my gut bacteria and so used the activia or yacult drink and also a gut bacteria supplement called pro ven which contains 25 billion cultures. I also used myco herbal supplement, bee polen, zinc, garlic, turmeric and muli vitimins. This lot along with special foods (which I will mention) started at the same time as the doxycycline prior to taking the main drugs – Pristinamycin and minocin 10 days later. So the foods I had were a yogurt drink called kefr and kimchi (disgusting) which really improved my gut bacteria and oddly enough, my skin. I ate raw cranberrys and cranberry juice which is good for fighting infections. I stayed away from all sugars . For my main meals I had sweet potato, jacket potatoes, haddock fish, lentils, veg and anything organic. No tea, coffee, chocolate, sweets or anything like that, only green tea and cranberry juice. So after 10 days I started the Pristinamycin and minocin. I had no reactions apart from a little diarrhea. I had 1g twice a day of Pristinamycin and 100mg once a day for minocin together with the doxycycline and all the supplements mentioned. No reactions as I’ve mentioned but I was nervous because taking 3 antibiotics isn’t for the faint hearted.
For many days after the course was finished my penis was swollen and as the consultant told me, it was like taking domestos bleach so its understanable. Interestingly this 3rd consultant told me that for a few years after a strong treatment, the nerve endings inside the urethra can tingle giving false messages to the brain and so she gave me some cream to relax the nerves. Its called clotrimazole.
I hope nobody has to go through all that but at least it may help someone with my personal experience.

So are you completely symptom free? Testing negative?
After posting this i still had lots of swelling and months later and a few consultations with the consultant, the after effects were that the nerve inside the penis was causing the swelling. Of course i didn't believe her for months but 2 days after taking her recommended tablets ( Amitriptline 10mg) the swelling went down and has stayed down.I feel normal again.  I feel that my post above did cure it but a lot of people may mistake the swelling for an std. If many of your tests are coming back negative then i advise that it could possibly be that the nerve has been affected.
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