Pelvic Inflammatory Disease

To the Editor: In the review by Brunham et al. (May 21 issue),1 Mycoplasma genitalium is included as an etiologic agent of pelvic inflammatory disease. Studies have shown that this pathogen may be as prevalent as Chlamydia trachomatis in genital infections2; hence, guidance on treatment for infection with this organism is critically important. As such, it is surprising that Brunham states, “Substitution of azithromycin for doxycycline covers M. genitalium and simplifies dosing.” Such a statement ignores the widespread macrolide resistance (approximately 40%) among M. genitalium isolates.3,4 Furthermore, a recent randomized trial showed that clinical cure rates were low . . .