1
|
Grygiel-Górniak B, Folga BA. Chlamydia trachomatis-An Emerging Old Entity? Microorganisms 2023; 11:1283. [PMID: 37317257 DOI: 10.3390/microorganisms11051283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/04/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023] Open
Abstract
Chlamydia trachomatis is an evasive pathogen that can prompt severe clinical manifestations in humans such as vaginitis, epididymitis, lymphogranuloma venereum, trachoma, conjunctivitis and pneumonia. If left untreated, chronic infections with C. trachomatis can give rise to long-lasting and even permanent sequelae. To shed some light on its widespread nature, data from original research, systematic reviews and meta-analyses from three databases was collected and analyzed in the context of chlamydial infection, related symptoms and appropriate treatment modalities. This review describes the bacterium's pervasiveness on a global scale, especially in developing countries, and suggests ways to halt its transmission and spread. Infections with C. trachomatis often go unnoticed, as many individuals are asymptomatic and unaware of their diagnosis, contributing to a delay in diagnosis and treatment. The high prevalence of chlamydial infection highlights the need for a universal screening and detection method enabling immediate treatment at its onset. Prognosis is favorable with antibiotic therapy and education for high-risk groups and their sexual partners. In the future, a quick, easily accessible, and inexpensive test should be developed to diagnose and treat infected individuals early on. Along with a vaccine against C. trachomatis, it would halt the transmission and spread of the pathogen worldwide.
Collapse
Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Barbara Anna Folga
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| |
Collapse
|
2
|
Braam JF, van Dam AP, Bruisten SM, van Rooijen MS, de Vries HJ, Schim van der Loeff MF, Vergunst CE. Macrolide-Resistant Mycoplasma genitalium Impairs Clinical Improvement of Male Urethritis After Empirical Treatment. Sex Transm Dis 2022; 49:360-367. [PMID: 34962241 PMCID: PMC8994036 DOI: 10.1097/olq.0000000000001591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mycoplasma genitalium (MG) is associated with urethritis in men and could play a role in clinical outcome. We examined clinical improvement of symptoms in men receiving empirical treatment for urethritis and correlated the outcome with Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), MG, and MG macrolide resistance-associated mutations (MRAM) status. METHODS At the sexually transmitted infection clinic in Amsterdam, the Netherlands, empirical treatment for gonococcal urethritis is 1 g ceftriaxone and for nongonococcal urethritis 1 g azithromycin. In 2018 to 2019, we tested urine samples of men with urethritis for CT, NG, and MG using transcription-mediated amplification assays. Mycoplasma genitalium-positive samples were tested for MRAM using quantitative polymerase chain reaction. Two weeks after receiving therapy, men were sent a text message inquiring after clinical improvement. RESULTS We evaluated 2505 cases of urethritis. The positivity rates of NG, CT, and MG were 26% (648 of 2489), 29% (726 of 2489), and 23% (522 of 2288), respectively. In 768 of 2288 of the cases (34%), no causative agent was detected. Most cases were infected with a single pathogen: NG, 417 of 2288 (18%); CT, 486 of 2288 (21%); and MG, 320 of 2288 (14%). The prevalence of MRAM among MG-positives was 74% (327 of 439). For 642 (25.6%) cases, we could evaluate clinical improvement after treatment of whom 127 (20%) indicated no improvement; 9% (15 of 174) in NG cases, 18% (35 of 195) in CT cases, 14% (4 of 28) in MG wild-type cases, and 40% (38 of 94) in MG-MRAM cases. Clinical improvement in MG-MRAM cases was significantly lower compared with all other groups (P < 0.001). CONCLUSIONS Presence of MG-MRAM is associated with lack of clinical improvement in azithromycin-treated nongonococcal urethritis.
Collapse
Affiliation(s)
- Joyce F. Braam
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Alje P. van Dam
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Department of Medical Microbiology, Amsterdam Institute for Infection and Immunity (AII)
| | - Sylvia M. Bruisten
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Department of Medical Microbiology, Amsterdam Institute for Infection and Immunity (AII)
| | | | - Henry J.C. de Vries
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Department of Dermatology
| | - Maarten F. Schim van der Loeff
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity (AII), Amsterdam University Medical Center (UMC), Amsterdam
| | - Clarissa E. Vergunst
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Department of Dermatology, NWZ, Den Helder, the Netherlands
| |
Collapse
|
3
|
Long S, Kenworthy S. Round Cells in Diagnostic Semen Analysis: A Guide for Laboratories and Clinicians. Br J Biomed Sci 2022; 79:10129. [PMID: 35996519 PMCID: PMC8915675 DOI: 10.3389/bjbs.2021.10129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/23/2021] [Indexed: 11/21/2022]
Abstract
Round cells in seminal fluid are defined as either leucocytes or immature germ cells. Laboratories undertaking semen analysis often report these combined as a concentration, with no further review, comment or direction for clinician action or review. Although numerous publications discuss the possible clinical relevance of these cells (particularly leucocytes) in infertility, the methods employed to differentiate them are often beyond the scope of most diagnostic laboratories. This paper aims to support healthcare scientists in understanding the clinical significance of round cells and aid their identification, differentiation and interpretation. This will support the quality of care the patient receives and direct clinicians to further considerations that may be appropriate for their patient and should consequently reduce indiscriminate and unnecessary use of antibiotics.
Collapse
Affiliation(s)
- S. Long
- University Hospitals Birmingham, Birmingham, United Kingdom
- *Correspondence: S. Long,
| | | |
Collapse
|
4
|
Desdorf R, Andersen NM, Chen M. Mycoplasma genitalium prevalence and macrolide resistance-associated mutations and coinfection with Chlamydia trachomatis in Southern Jutland, Denmark. APMIS 2021; 129:706-710. [PMID: 34580906 PMCID: PMC9297889 DOI: 10.1111/apm.13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
This study aims to investigate prevalence of Mycoplasma genitalium and macrolide resistance‐associated mutations and coinfection with other sexually transmitted bacteria in Southern Jutland, Denmark, where this information is very limited. Urinary samples from patients suspected of sexually transmitted bacterial infections collected at primary healthcare facilities in Southern Jutland are routinely tested for Chlamydia trachomatis and Neisseria gonorrhoeae. 601 of these samples were analysed with SpeeDx MG+23S reagents, which can detect M. genitalium and macrolide resistance‐mediating mutations in the 23S rRNA gene. Moreover, 147 C. trachomatis positive urinary samples from routine test were also analysed with the PCR assay to detect M. genitalium. 72 out of 601 samples were detected positive for C. trachomatis (12%), five samples (0.83%) positive for N. gonorrhoeae and 25 samples positive for M. genitalium (4.2%). 14 of the 25 M. genitalium samples were detected having 23S rRNA gene mutations associated with macrolide resistance (56%). 25 of 147 C. trachomatis positive samples were tested positive for M. genitalium (17%) and two of them were positive for M. genitalium and N. gonorrhoeae (1.4%). The high prevalence of M. genitalium and macrolide resistance‐associated mutation and the coinfection with C. trachomatis in the region suggesting that M. genitalium testing should be included in routine sexually transmitted infection screening.
Collapse
Affiliation(s)
- Rasmus Desdorf
- Focused Research Unit in Molecular Diagnostic and Clinical Research, IRS-Center Southern Jutland, University of Southern Denmark, Soenderborg, Denmark.,Department of Clinical Microbiology, Hospital of Southern Jutland, Soenderborg, Denmark
| | - Niles Moller Andersen
- Focused Research Unit in Molecular Diagnostic and Clinical Research, IRS-Center Southern Jutland, University of Southern Denmark, Soenderborg, Denmark.,Department of Clinical Microbiology, Hospital of Southern Jutland, Soenderborg, Denmark
| | - Ming Chen
- Focused Research Unit in Molecular Diagnostic and Clinical Research, IRS-Center Southern Jutland, University of Southern Denmark, Soenderborg, Denmark.,Department of Clinical Microbiology, Hospital of Southern Jutland, Soenderborg, Denmark
| |
Collapse
|
5
|
Taylor J, Sampene Ossei PP, Pradhan K, Adjah J, Agyeman-Duah E, Afranie BO, Donkor S, Ayibor W. Detecting Ureaplasma urealyticum among HIV-infected women with or without human papillomavirus using real-time PCR with the ANYPLEX™ II STI-7 assay system. J Taibah Univ Med Sci 2019; 14:295-299. [PMID: 31435420 PMCID: PMC6695007 DOI: 10.1016/j.jtumed.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives Human immunodeficiency virus (HIV) infections increase the chances of women contracting human papillomavirus (HPV), the prime causative agent of cervical cancer. Additionally, Ureaplasma urealyticum is the most frequent pathogen prevailing in sexually transmitted diseases in HIV-infected women. The aim of this study was to determine the presence of U. urealyticum among HIV-infected women with or without HPV in Ghana. Methods DNA samples were extracted from cervico-vaginal swabs obtained from 96 HIV-infected women attending the Kumasi South Hospital. U. urealyticum in the DNA samples was detected by real-time PCR with the Anyplex™ II STI-7 detection assay. Microsoft Excel was used to analyze the data, and the Chi-square test was used to determine associations and dependence among the variables. Results Among the study population, 93.75% (90/96) were positive for at least one pathogen.In total, 36.5% (35/96) of the women were infected by U. urealyticum, with 30.21% (29/96) being co-infected with HPV. There was no significant association (95% CI, p > 0.05) between U. urealyticum and HPV status among the HIV-infected women. Conclusion U. urealyticum and HPV are highly pathogenic, and their prevalence in this study reiterates the need for their routine screening in HIV-infected patients.
Collapse
Affiliation(s)
- John Taylor
- Department of Molecular Biology and Biotechnology, Tezpur University, Assam, India
- Corresponding address: Department of Molecular Biology and Biotechnology, Tezpur University, Assam, India.
| | - Paul P. Sampene Ossei
- Department of Pathology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Krishna Pradhan
- Department of Molecular Biology and Biotechnology, Tezpur University, Assam, India
| | - Joshua Adjah
- West Africa Center for Cell Biology of Infectious Pathogens (WACCBIP), Legon, Ghana
| | - Eric Agyeman-Duah
- Department of Molecular Medicine, Ulm University, Ulm, Baden-Württemberg, Germany
| | - Bright O. Afranie
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sampson Donkor
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - William Ayibor
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
6
|
Muller EE, Mahlangu MP, Lewis DA, Kularatne RS. Macrolide and fluoroquinolone resistance-associated mutations in Mycoplasma genitalium in Johannesburg, South Africa, 2007-2014. BMC Infect Dis 2019; 19:148. [PMID: 30760230 PMCID: PMC6373000 DOI: 10.1186/s12879-019-3797-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 02/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance in Mycoplasma genitalium is rising globally with resultant clinical treatment failure. We investigated the prevalence of mutations in the macrolide and fluoroquinolone resistance-determining regions of M. genitalium in Johannesburg, South Africa, and ascertained their association with HIV serostatus. METHODS Stored M. genitalium positive specimens, collected from STI and HIV patients enrolled in the Gauteng STI National Microbiological Surveillance programme (2007-2014) and a large HIV outpatient clinic-based study (2007) in Johannesburg, were tested for antimicrobial resistance. RESULTS We determined the prevalence of 23S rRNA gene mutations conferring macrolide resistance and mutations in the quinolone resistance-determining regions (QRDR) of the gyrA and parC genes in 266 M. genitalium positive DNA extracts. No macrolide resistance-associated mutations were detected in any of the specimens analysed. QRDR mutations with known M. genitalium-associated fluoroquinolone resistance were not detected in gyrA, however, one specimen (0.4%) contained a D87Y amino acid alteration in parC, which has been linked to fluoroquinolone treatment failure. The most common parC amino acid change detected, of unknown clinical significance, was P62S (18.8%). We found no significant association between QRDR mutations in M. genitalium and HIV-infection. CONCLUSIONS Ongoing antimicrobial resistance surveillance in M. genitalium is essential, as macrolide resistance may emerge given the recent incorporation of azithromycin into the 2015 South African national STI syndromic management guidelines.
Collapse
Affiliation(s)
- Etienne E Muller
- Sexually Transmitted Infections Section, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
| | - Mahlape P Mahlangu
- Sexually Transmitted Infections Section, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - David A Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity and Sydney Medical School-Westmead, University of Sydney, Sydney, Australia
| | - Ranmini S Kularatne
- Sexually Transmitted Infections Section, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
7
|
Bartoletti R, Wagenlehner FME, Bjerklund Johansen TE, Köves B, Cai T, Tandogdu Z, Bonkat G. Management of Urethritis: Is It Still the Time for Empirical Antibiotic Treatments? Eur Urol Focus 2018; 5:29-35. [PMID: 30318465 DOI: 10.1016/j.euf.2018.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 11/26/2022]
Abstract
CONTEXT Urethritis prevalence in Europe changed in the last years due to both the increase of migratory streams from North Africa and the more frequent exposition of males to relevant risk factors. Owing to these reasons, urethritis treatment should be optimized by accurate microbiological investigations to avoid the risk of persistence, recurrence, or reinfection. OBJECTIVE The aim of this systematic review is to optimize the treatments for urethritis and investigate the applicability of nucleic acid amplification test (NAAT) as the primary microbiological investigation. EVIDENCE ACQUISITION A literature search in Medline, Cochrane, and Google Scholar databases was conducted up to June 2018. Subject headings were selected as follows: Urethritis OR gonococcal urethritis OR non-gonococcal urethritis AND Antibiotics OR Recurrence. A total of 528 abstracts were identified and selected. Finally, 12 full-text articles were selected for a qualitative synthesis. The Preferred Reported Items for Systematic Reviews and Meta-Analyses statement was used to perform an accurate research checklist and report. EVIDENCE SYNTHESIS Empirical treatments are no more recommended, although a broad spectrum of antibiotic therapy may be initiated while awaiting the results from pathogens' microbiological characterization. First-line treatment for gonococcal urethritis consists of a single dose of ceftriaxone/azithromycin combined therapy. Specific therapies should be initiated for nongonococcal urethritis according to each single pathogen involved in the infection process. Owing to this reason, NAAT is mandatory in the clinical approach to the disease, although the Gram stain of urethral discharge or smear remains applicable for some less frequent nongonococcal urethritis. Moreover, the urethritis "modern view" also includes noninfectious etiologies that occurred after traumas or injection of irritating compounds. Sexual abstinence of at least 7 d should be observed from the start of treatment to avoid reinfection, while sexual partners should evenly be treated. CONCLUSIONS The treatment of urethritis implies accurate determination of pathogens involved in the infection process by NAAT with subsequent appropriate antibiotic therapy, thus avoiding the risk of antibiotic resistance and overuse of antibiotics indicated for empirical treatments. The population exposed to relevant risk factors should be adequately informed about the increased risk of developing infections and motivated toward the intensive use of condoms during sexual intercourses. PATIENT SUMMARY Urethritis is a sexually transmitted disease generally characterized by urethral discharge or other symptoms such as itching, tingling, and apparent difficulties in having a regular urinary flow. Microbiological investigations are mandatory to obtain satisfactory results from the treatment. Multiple antibiotic treatments are often necessary due to the high risk of multiple pathogens responsible for the disease. Similarly, sexual partners should be investigated and treated in the same way. Several risk factors such as immunodeficiency, multiple sexual partners, homo- and bisexuality, and alcohol abuse may be related to the disease. In these cases, the use of condom is strongly recommended.
Collapse
Affiliation(s)
- Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy.
| | - Florian M E Wagenlehner
- Clinic und Polyclinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Truls Erik Bjerklund Johansen
- Dept. of Urology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bela Köves
- Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Zafer Tandogdu
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Gernot Bonkat
- Alta Uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry (COB), University of Basel, Basel, Switzerland
| |
Collapse
|
8
|
Trembizki E, Buckley C, Bletchly C, Nimmo GR, Whiley DM. High levels of macrolide-resistant Mycoplasma genitalium in Queensland, Australia. J Med Microbiol 2017; 66:1451-1453. [PMID: 28893363 PMCID: PMC5845567 DOI: 10.1099/jmm.0.000584] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The macrolide azithromycin is recommended for treatment of Mycoplasma genitalium infection; however, M. genitalium strains possessing macrolide resistance-mediating mutations (MRMMs) are increasingly being reported. Here, we used the SpeeDx ResistancePlus MG kit, which provides simultaneous detection of M. genitalium and MRMMs, to assess MRMM carriage among M. genitalium infections in Queensland, Australia. Performance characteristics of the ResistancePlus MG kit for M. genitalium detection were compared to in-house PCR. Available M. genitalium PCR-positive (n=67) and negative (n=281) samples from the years 2011 to 2017 were tested using the SpeeDx ResistancePlus MG kit. In total, 63.6 % M. genitalium-positive samples were indicated to harbour MRMMs. The ResistancePlus MG method provided sensitivity and specificity of 97 and 99.6 % respectively compared to in-house PCR for M. genitalium detection. Such high levels of macrolide-resistant M. genitalium raise further concerns over future use of azithromycin for treatment of M. genitalium infection.
Collapse
Affiliation(s)
- Ella Trembizki
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland 4029, Australia
| | - Cameron Buckley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland 4029, Australia
| | - Cheryl Bletchly
- Pathology Queensland Central Laboratory, Brisbane, Queensland 4029, Australia
| | - Graeme R. Nimmo
- Pathology Queensland Central Laboratory, Brisbane, Queensland 4029, Australia
| | - David M. Whiley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland 4029, Australia
- Pathology Queensland Central Laboratory, Brisbane, Queensland 4029, Australia
- *Correspondence: David M. Whiley,
| |
Collapse
|
9
|
Prospective Evaluation of ResistancePlus MG, a New Multiplex Quantitative PCR Assay for Detection of Mycoplasma genitalium and Macrolide Resistance. J Clin Microbiol 2017; 55:1915-1919. [PMID: 28381611 PMCID: PMC5442548 DOI: 10.1128/jcm.02312-16] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/02/2017] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma genitalium is a significant pathogen for which first-line treatment is becoming less effective due to increased resistance to macrolides. As conventional culture and antimicrobial susceptibility testing is not feasible for routine detection of this pathogen, molecular markers such as detection of mutations in the 23S rRNA gene have been described to predict resistance. Recently, a novel multiplex quantitative PCR (qPCR) assay, ResistancePlus MG, has been described for the simultaneous detection of Mycoplasma genitalium and macrolide resistance. In the current study, the clinical performance of the assay was evaluated on 1,089 consecutive urine and anogenital swab samples in symptomatic and asymptomatic male and female patients. Overall, 6.0% were positive for M. genitalium, with 63.1% having macrolide resistance-associated mutations. Compared to the laboratory-validated qPCR method targeting the 16S rRNA gene and Sanger sequencing to determine 23S rRNA mutations, the sensitivity and specificity of M. genitalium detection were 98.5% and 100% and for detection of macrolide resistance mutations were 100.0% and 96.2%, respectively. This assay offers a considerable advantage in clinical settings for M. genitalium testing by making the results of macrolide resistance and mutation analyses simultaneously available, which is increasingly important with escalating macrolide resistance.
Collapse
|
10
|
Estcourt C, Sutcliffe L, Mercer CH, Copas A, Saunders J, Roberts TE, Fuller SS, Jackson LJ, Sutton AJ, White PJ, Birger R, Rait G, Johnson A, Hart G, Muniina P, Cassell J. The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundSexually transmitted infection (STI) diagnoses are increasing and efforts to reduce transmission have failed. There are major uncertainties in the evidence base surrounding the delivery of STI care for men.AimTo improve the sexual health of young men in the UK by determining optimal strategies for STI testing and careObjectivesTo develop an evidence-based clinical algorithm for STI testing in asymptomatic men; model mathematically the epidemiological and economic impact of removing microscopy from routine STI testing in asymptomatic men; conduct a pilot randomised controlled trial (RCT) of accelerated partner therapy (APT; new models of partner notification to rapidly treat male sex partners of people with STIs) in primary care; explore the acceptability of diverse venues for STI screening in men; and determine optimal models for the delivery of screening.DesignSystematic review of the clinical consequences of asymptomatic non-chlamydial, non-gonococcal urethritis (NCNGU); case–control study of factors associated with NCNGU; mathematical modelling of the epidemiological and economic impact of removing microscopy from asymptomatic screening and cost-effectiveness analysis; pilot RCT of APT for male sex partners of women diagnosed withChlamydia trachomatisinfection in primary care; stratified random probability sample survey of UK young men; qualitative study of men’s views on accessing STI testing; SPORTSMART pilot cluster RCT of two STI screening interventions in amateur football clubs; and anonymous questionnaire survey of STI risk and previous testing behaviour in men in football clubs.SettingsGeneral population, genitourinary medicine clinic attenders, general practice and community contraception and sexual health clinic attenders and amateur football clubs.ParticipantsMen and women.InterventionsPartner notification interventions: APTHotline [telephone assessment of partner(s)] and APTPharmacy [community pharmacist assessment of partner(s)]. SPORTSMART interventions: football captain-led and health adviser-led promotion of urine-based STI screening.Main outcome measuresFor the APT pilot RCT, the primary outcome, determined for each contactable partner, was whether or not they were considered to have been treated within 6 weeks of index diagnosis. For the SPORTSMART pilot RCT, the primary outcome was the proportion of eligible men accepting screening.ResultsNon-chlamydial, non-gonococcal urethritis is not associated with significant clinical consequences for men or their sexual partners but study quality is poor (systematic review). Men with symptomatic and asymptomatic NCNGU and healthy men share similar demographic, behavioural and clinical variables (case–control study). Removal of urethral microscopy from routine asymptomatic screening is likely to lead to a small rise in pelvic inflammatory disease (PID) but could save > £5M over 20 years (mathematical modelling and health economics analysis). In the APT pilot RCT the proportion of partners treated by the APTHotline [39/111 (35%)], APTPharmacy [46/100 (46%)] and standard patient referral [46/102 (45%)] did not meet national standards but exceeded previously reported outcomes in community settings. Men’s reported willingness to access self-sampling kits for STIs and human immunodeficiency virus infection was high. Traditional health-care settings were preferred but sports venues were acceptable to half of men who played sport (random probability sample survey). Men appear to prefer a ‘straightforward’ approach to STI screening, accessible as part of their daily activities (qualitative study). Uptake of STI screening in the SPORTSMART RCT was high, irrespective of arm [captain led 28/56 (50%); health-care professional led 31/46 (67%); poster only 31/51 (61%)], and costs were similar. Men were at risk of STIs but previous testing was common.ConclusionsMen find traditional health-care settings the most acceptable places to access STI screening. Self-sampling kits in football clubs could widen access to screening and offer a public health impact for men with limited local sexual health services. Available evidence does not support an association between asymptomatic NCNGU and significant adverse clinical outcomes for men or their sexual partners but the literature is of poor quality. Similarities in characteristics of men with and without NCNGU precluded development of a meaningful clinical algorithm to guide STI testing in asymptomatic men. The mathematical modelling and cost-effectiveness analysis of removing all asymptomatic urethral microscopy screening suggests that this would result in a small rise in adverse outcomes such as PID but that it would be highly cost-effective. APT appears to improve outcomes of partner notification in community settings but outcomes still fail to meet national standards. Priorities for future work include improving understanding of men’s collective behaviours and how these can be harnessed to improve health outcomes; exploring barriers to and facilitators of opportunistic STI screening for men attending general practice, with development of evidence-based interventions to increase the offer and uptake of screening; further development of APT for community settings; and studies to improve knowledge of factors specific to screening men who have sex with men (MSM) and, in particular, how, with the different epidemiology of STIs in MSM and the current narrow focus on chlamydia, this could negatively impact MSM’s sexual health.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Collapse
Affiliation(s)
- Claudia Estcourt
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- Barts Health NHS Trust, London, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Sutcliffe
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Catherine H Mercer
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew Copas
- Research Department of Infection and Population Health, University College London, London, UK
| | - John Saunders
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- Barts Health NHS Trust, London, UK
| | - Tracy E Roberts
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Sebastian S Fuller
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- Public Health England, London, UK
| | - Louise J Jackson
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Andrew John Sutton
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Peter J White
- Medical Research Council Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Ruthie Birger
- Medical Research Council Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Greta Rait
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anne Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Graham Hart
- Research Department of Infection and Population Health, University College London, London, UK
| | - Pamela Muniina
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jackie Cassell
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
| |
Collapse
|
11
|
Tabrizi SN, Tan LY, Walker S, Twin J, Poljak M, Bradshaw CS, Fairley CK, Bissessor M, Mokany E, Todd AV, Garland SM. Multiplex Assay for Simultaneous Detection of Mycoplasma genitalium and Macrolide Resistance Using PlexZyme and PlexPrime Technology. PLoS One 2016; 11:e0156740. [PMID: 27271704 PMCID: PMC4894623 DOI: 10.1371/journal.pone.0156740] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/18/2016] [Indexed: 11/18/2022] Open
Abstract
Mycoplasma genitalium is a cause of non-gonoccocal urethritis (NGU) in men and cervicitis and pelvic inflammatory disease in women. Recent international data also indicated that the first line treatment, 1 gram stat azithromycin therapy, for M. genitalium is becoming less effective, with the corresponding emergence of macrolide resistant strains. Increasing failure rates of azithromycin for M. genitalium has significant implications for the presumptive treatment of NGU and international clinical treatment guidelines. Assays able to predict macrolide resistance along with detection of M. genitalium will be useful to enable appropriate selection of antimicrobials to which the organism is susceptible and facilitate high levels of rapid cure. One such assay recently developed is the MG 23S assay, which employs novel PlexZyme™ and PlexPrime™ technology. It is a multiplex assay for detection of M. genitalium and 5 mutations associated with macrolide resistance. The assay was evaluated in 400 samples from 254 (186 males and 68 females) consecutively infected participants, undergoing tests of cure. Using the MG 23S assay, 83% (331/440) of samples were positive, with 56% of positives carrying a macrolide resistance mutation. Comparison of the MG 23S assay to a reference qPCR method for M. genitalium detection and high resolution melt analysis (HRMA) and sequencing for detection of macrolide resistance mutations, resulted in a sensitivity and specificity for M. genitalium detection and for macrolide resistance of 99.1/98.5% and 97.4/100%, respectively. The MG 23S assay provides a considerable advantage in clinical settings through combined diagnosis and detection of macrolide resistance.
Collapse
Affiliation(s)
- Sepehr N. Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- * E-mail:
| | | | | | - Jimmy Twin
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia
| | - Marin Poljak
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Victoria, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Victoria, Australia
| | | | | | | | - Suzanne M. Garland
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| |
Collapse
|
12
|
Moi H, Horner PJ. 2016 European guideline on the management of non-gonococcal urethritis published. Euro Surveill 2016; 21:30248. [DOI: 10.2807/1560-7917.es.2016.21.22.30248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Harald Moi
- Institute of Medicine, University of Oslo, Oslo, Norway
- Olafia Clinic, Oslo University Hospital, Oslo, Norway
| | - Paddy J Horner
- Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
13
|
Paulsen LK, Dahl ML, Skaare D, Grude N. Prevalence of M. genitalium and U. urealyticum in urine tested for C. trachomatis. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:121-5. [PMID: 26813816 DOI: 10.4045/tidsskr.14.1574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium and Ureaplasma urealyticum cause sexually transmitted infections. While M. genitalium is an established aetiological agent, U. urealyticum is still controversial as a pathogen. Testing for these microbes is not yet widely available in Norway, and knowledge of their prevalence is limited. In this study we have investigated the prevalence of M. genitalium and U. urealyticum in a heterogeneous population from Vestfold and Telemark. MATERIAL AND METHOD Urine samples (n = 4,665) received by the laboratory for testing for Chlamydia trachomatis in the period from February 2011 to January 2012 were subsequently tested for M. genitalium and U. urealyticum. Samples were analysed using an in-house PCR protocol. RESULTS The prevalence of C. trachomatis, M. genitalium and U. urealyticum was 11.9%, 3.6% and 17.9% respectively. M. genitalium was found most frequently in women aged 20-24 years (5.1%), while the proportion of samples positive for U. urealyticum was greatest in persons aged 15-24 years (22.8%). INTERPRETATION M. genitalium was highly prevalent in urine samples submitted for C. trachomatis testing. M. genitalium testing was requested for only a minority of the samples analysed, suggesting limited knowledge of this microbe. U. urealyticum was the most predominant microbe in the study, which may indicate that it is largely non-pathogenic.
Collapse
Affiliation(s)
| | | | | | - Nils Grude
- Mikrobiologisk avdeling Sykehuset i Vestfold
| |
Collapse
|
14
|
Abstract
For many years an increase in cases of urethritis has been observed in western Europe. In order to be able to combat this continuous rise, the perception of sexually transmitted diseases must be promoted, the clarification and screening must be intensified and therapy must be rapidly and correctly carried out. In addition to the commonest pathogens causing urethritis, namely chlamydia and gonococci, many other pathogenic microbes must be taken into consideration in the diagnostics. With respect to therapy, apart from the increasing resistance formation of Mycoplasma genitalium, the decreasing effectiveness of standard forms of treatment of other microbes must be emphasized. For chronic and recurrent urethritis in particular a broad clarification of the pathogen should be carried out to enable targeted treatment and also partner treatment. Priority must again be given to primary prevention.
Collapse
Affiliation(s)
- S Lautenschlager
- Dermatologisches Ambulatorium, Stadtspital Triemli, Herman Greulich Str. 70, 8004, Zürich, Schweiz,
| |
Collapse
|
15
|
Cox C, McKenna JP, Watt AP, Coyle PV. Ureaplasma parvum and Mycoplasma genitalium are found to be significantly associated with microscopy-confirmed urethritis in a routine genitourinary medicine setting. Int J STD AIDS 2015; 27:861-7. [PMID: 26378187 DOI: 10.1177/0956462415597620] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/29/2015] [Indexed: 11/17/2022]
Abstract
Inflammation of the urethra defined by an excess of polymorphonuclear leukocytes in the absence of sexually transmitted Chlamydia trachomatis and Neisseria gonorrhoeae is called non-chlamydial non-gonococcal urethritis (NCNGU). Although Mycoplasma genitalium is now recognised as causing a sexually transmitted infection, the clinical significance of the other Mollicute species is less clear. This study used specific real-time quantitative polymerase chain reaction assays to detect and quantify four Mollicute species, M. genitalium, M. hominis, Ureaplasma urealyticum and U. parvum, in urine specimens from men with and without NCNGU. A total of 165 urine specimens from male patients attending a genitourinary medicine clinic were eligible for the study, with microscopy-confirmed (≥5 polymorphonuclear leukocytes in urethral swab) NCNGU in 75 (45.5%) and non-confirmed NCNGU in 90 (54.5%). Chi-squared statistical analysis indicated a significantly higher prevalence of U. parvum (17.3% vs. 5.6%; p = 0.03) and M. genitalium (12% vs. 0%; p < 0.001) in NCNGU. In a subset analysis, M. genitalium was also significantly (p = 0.03) higher in men who have sex with men (MSM; 13.5%) compared to non-MSM (3.1%). No significant associations were reported for U. urealyticum and M. hominis In conclusion, this study supports a clinically significant role in NGNCU for both U. parvum and M. genitalium.
Collapse
Affiliation(s)
- Ciara Cox
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - James P McKenna
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - Alison P Watt
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - Peter V Coyle
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| |
Collapse
|
16
|
Falk L, Enger M, Jensen JS. Time to eradication of Mycoplasma genitalium after antibiotic treatment in men and women. J Antimicrob Chemother 2015; 70:3134-40. [PMID: 26283670 DOI: 10.1093/jac/dkv246] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/19/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objectives of this study were to evaluate the time to a Mycoplasma genitalium-negative test after start of treatment and to monitor if and when antibiotic resistance developed. METHODS Sexually transmitted disease (STD) clinic attendees with suspected or verified M. genitalium infection were treated with azithromycin (5 days, 1.5 g; n = 85) or moxifloxacin (n = 5). Subjects with symptomatic urethritis or cervicitis of unknown aetiology were randomized to either doxycycline (n = 49) or 1 g of azithromycin as a single dose (n = 51). Women collected vaginal specimens and men collected first-catch urine 12 times during 4 weeks. Specimens were tested for M. genitalium with a quantitative MgPa PCR and for macrolide resistance-mediating mutations with a PCR targeting 23S rRNA. CLINICAL TRIALS REGISTRATION NCT01661985. RESULTS Ninety M. genitalium cases were enrolled. Of 56 patients with macrolide-susceptible strains before treatment with azithromycin (1.5 g, n = 46; 1 g single oral dose, n = 10), 54 (96%) had a negative PCR test within 8 days. In four patients, M. genitalium converted from macrolide susceptible to resistant after a 10 day lag time with negative tests (azithromycin 1.5 g, n = 3; 1 g single oral dose, n = 1). Moxifloxacin-treated subjects (n = 4) were PCR negative within 1 week. Six of eight (75%) remained positive despite doxycycline treatment. CONCLUSIONS PCR for M. genitalium rapidly became negative after azithromycin treatment. Macrolide-resistant strains were detected after initially negative tests. Test of cure should be recommended no earlier than 3-4 weeks.
Collapse
Affiliation(s)
- Lars Falk
- Department of Dermatology and Venereology, Region Östergötland, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden R&D Department of Local Health Care, Region Östergötland, SE-581 85 Linköping, Sweden
| | - Martin Enger
- Department of Dermatology and Venereology, Västervik Hospital, SE-593 81 Västervik, Sweden
| | - Jørgen Skov Jensen
- Microbiology and Infection Control, Sexually Transmitted Infections, Research and Development, Statens Serum Institut, Copenhagen, DK-2300 København S, Denmark
| |
Collapse
|
17
|
Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis 2015; 15:294. [PMID: 26220178 PMCID: PMC4518518 DOI: 10.1186/s12879-015-1043-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/21/2015] [Indexed: 02/08/2023] Open
Abstract
Non-gonococcal urethritis (NGU), or inflammation of the urethra, is the most common treatable sexually transmitted syndrome in men, with approximately 20-50 % of cases being due to infection with Chlamydia trachomatis and 10-30 % Mycoplasma genitalium. Other causes are Ureaplasma urealyticum, Trichomonas vaginalis, anaerobes, Herpes simplex virus (HSV) and adenovirus. Up to half of the cases are non-specific. Urethritis is characterized by discharge, dysuria and/or urethral discomfort but may be asymptomatic. The diagnosis of urethritis is confirmed by demonstrating an excess of polymorpho-nuclear leucocytes (PMNLs) in a stained smear. An excess of mononuclear leucocytes in the smear indicates a viral etiology. In patients presenting with symptoms of urethritis, the diagnosis should be confirmed by microscopy of a stained smear, ruling out gonorrhea. Nucleid acid amplifications tests (NAAT) for Neisseria gonorrhoeae, C. trachomatis and for M. genitalium. If viral or protozoan aetiology is suspected, NAAT for HSV, adenovirus and T. vaginalis, if available. If marked symptoms and urethritis is confirmed, syndromic treatment should be given at the first appointment without waiting for the laboratory results. Treatment options are doxycycline 100 mg x 2 for one week or azithromycin 1 gram single dose or 1,5 gram distributed in five days. However, azithromycin as first line treatment without test of cure for M. genitalium and subsequent Moxifloxacin treatment of macrolide resistant strains will select and increase the macrolide resistant strains in the population. If positive for M. genitalium, test of cure samples should be collected no earlier than three weeks after start of treatment. If positive in test of cure, moxifloxacin 400 mg 7-14 days is indicated. Current partner(s) should be tested and treated with the same regimen. They should abstain from intercourse until both have completed treatment. Persistent or recurrent NGU must be confirmed with microscopy. Reinfection and compliance must be considered. Evidence for the following recommendations is limited, and is based on clinical experience and guidelines. If doxycycline was given as first therapy, azithromycin five days plus metronidazole 4-500 mg twice daily for 5-7 days should be given. If azithromycin was prescribed as first therapy, doxycycline 100 mg x 2 for one week plus metronidazole, or moxifloxacin 400 mg orally once daily for 7-14 days should be given.
Collapse
Affiliation(s)
- Harald Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway.
| | - Karla Blee
- Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
| | - Patrick J Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| |
Collapse
|
18
|
Treatment efficacy, treatment failures and selection of macrolide resistance in patients with high load of Mycoplasma genitalium during treatment of male urethritis with josamycin. BMC Infect Dis 2015; 15:40. [PMID: 25645440 PMCID: PMC4318211 DOI: 10.1186/s12879-015-0781-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/23/2015] [Indexed: 12/31/2022] Open
Abstract
Background Azithromycin has been widely used for Mycoplasma genitalium treatment internationally. However, the eradication efficacy has substantially declined recent decade. In Russia, josamycin (another macrolide) is the recommended first-line treatment for M. genitalium infections, however, no data regarding treatment efficacy with josamycin and resistance in M. genitalium infections have been internationally published. We examined the M. genitalium prevalence in males attending an STI clinic in Moscow, Russia from December 2006 to January 2008, investigated treatment efficacy with josamycin in male urethritis, and monitored the M. genitalium DNA eradication dynamics and selection of macrolide resistance in M. genitalium during this treatment. Methods Microscopy and real-time PCRs were used to diagnose urethritis and non-viral STIs, respectively, in males (n = 320). M. genitalium positive patients were treated with recommended josamycin regimen and treatment efficacy was monitored using quantitative real-time PCR. Macrolide resistance mutations were identified using sequencing of the 23S rRNA gene. Results Forty-seven (14.7%) males were positive for M. genitalium only and most (85.1%) of these had symptoms and signs of urethritis. Forty-six (97.9%) males agreed to participate in the treatment efficacy monitoring. All the pre-treatment M. genitalium specimens had wild-type 23S rRNA. The elimination of M. genitalium DNA was substantially faster in patients with lower pre-treatment M. genitalium load, and the total eradication rate was 43/46 (93.5%). Of the six patients with high pre-treatment M. genitalium load, three (50%) remained positive post-treatment and these positive specimens contained macrolide resistance mutations in the 23S rRNA gene, i.e., A2059G (n = 2) and A2062G (n = 1). Conclusions M. genitalium was a frequent cause of male urethritis in Moscow, Russia. The pre-treatment M. genitalium load might be an effective predictor of eradication efficacy with macrolides (and possibly additional antimicrobials) and selection of macrolide resistance. Additional in vivo and in vitro data are crucial to support the recommendation of using josamycin as first-line treatment for M. genitalium infections in Russia. It would be valuable to develop international M. genitalium management guidelines, and quantitative diagnostic PCRs determining also M. genitalium load and resistance mutations (for macrolides and ideally also moxifloxacin) should ideally be recommended.
Collapse
|
19
|
Wold C, Sorthe J, Hartgill U, Olsen A, Moghaddam A, Reinton N. Identification of macrolide-resistant Mycoplasma genitalium
using real-time PCR. J Eur Acad Dermatol Venereol 2015; 29:1616-20. [DOI: 10.1111/jdv.12963] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- C. Wold
- Fürst Medical Laboratory; Oslo Norway
| | - J. Sorthe
- Fürst Medical Laboratory; Oslo Norway
| | - U. Hartgill
- Olafia Clinic; Oslo University Hospital; Oslo Norway
| | - A.O. Olsen
- Olafia Clinic; Oslo University Hospital; Oslo Norway
- Norwegian National Advisory Unit on Sexually Transmitted Infections; Oslo Norway
| | | | | |
Collapse
|
20
|
Taylor-Robinson D. Diagnosis and antimicrobial treatment of Mycoplasma genitalium infection: sobering thoughts. Expert Rev Anti Infect Ther 2015; 12:715-22. [PMID: 24834454 DOI: 10.1586/14787210.2014.919220] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The discovery of Mycoplasma genitalium in 1980-1981 eventually led to it becoming recognized as an important cause of non-gonococcal urethritis in men and also some genital tract diseases in women. Subsequent to the original isolation, further attempts failed over the next decade and reliable detection only became possible with the use of nucleic acid amplification techniques. Although tetracyclines, particularly doxycycline, were the first choice for treatment of non-gonococcal urethritis prior to the finding of M. genitalium, they were unsatisfactory for the treatment of M. genitalium-associated disease; the organisms were often not eliminated leading, for example, to chronic urethritis. However, the introduction of azithromycin, used as single-dose therapy for chlamydial infections, resulted in clearance of the mycoplasmal organisms from the genital tract and clinical recovery without the development of chronic disease. Nevertheless, such success was short-lived as M. genitalium, through mutation, began to develop resistance to azithromycin and M. genitalium mutants also began to circulate in some populations. In an attempt to counteract this, clinicians should give extended therapy, and in the future, microbiologists, using real-time PCRs, might be able to determine the existence of resistant strains in the local population and so advise on the most appropriate antibiotic. Other than azithromycin, there are a few options, moxifloxacin being one, although the recently reported resistance to this antibiotic is disturbing. In the short to medium term, combination therapy and/or the advent of a new antibiotic might abate the spread of resistance, but in the long term, there is potential for increasing prevalence of untreatable M. genitalium disease. In the future, attempts to develop a vaccine and, of equal importance, one to Chlamydia trachomatis, would not be out of place.
Collapse
Affiliation(s)
- David Taylor-Robinson
- Section of Infectious Diseases, Wright-Fleming Institute, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| |
Collapse
|
21
|
Bissessor M, Tabrizi SN, Twin J, Abdo H, Fairley CK, Chen MY, Vodstrcil LA, Jensen JS, Hocking JS, Garland SM, Bradshaw CS. Macrolide resistance and azithromycin failure in a Mycoplasma genitalium-infected cohort and response of azithromycin failures to alternative antibiotic regimens. Clin Infect Dis 2014; 60:1228-36. [PMID: 25537875 DOI: 10.1093/cid/ciu1162] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Our aim was to determine the efficacy of 1 g azithromycin and alternative antibiotic regimens in a prospective cohort of Mycoplasma genitalium-infected participants, and factors associated with azithromycin failure. METHODS Consecutive eligible M. genitalium-infected men and women attending the Melbourne Sexual Health Centre between July 2012 and June 2013 were treated with 1 g of azithromycin and retested by polymerase chain reaction (PCR) on days 14 and 28. Cure was defined as PCR negative on day 28. Cases failing azithromycin were treated with moxifloxacin, and those failing moxifloxacin were treated with pristinamycin. Pre- and posttreatment samples were assessed for macrolide resistance mutations (MRMs) by high-resolution melt analysis. Mycoplasma genitalium samples from cases failing moxifloxacin were sequenced for fluoroquinolone resistance mutations. Multivariable analysis was used to examine associations with azithromycin failure. RESULTS Of 155 participants treated with 1 g azithromycin, 95 (61% [95% confidence interval {CI}, 53%-69%]) were cured. Pretreatment MRM was detected in 56 (36% [95% CI, 28%-43%]) participants, and strongly associated with treatment failure (87% [95% CI, 76%-94%]; adjusted odds ratio, 47.0 [95% CI, 17.1-129.0]). All 11 participants who had MRM detected in posttreatment samples failed azithromycin. Moxifloxacin was effective in 53(88% [95% CI, 78%-94%]) of 60 cases failing azithromycin; all failures had gyrA and parC mutations detected in pretreatment samples. Six of 7 patients failing moxifloxacin treatment received pristinamycin, and all were PCR negative 28 days after pristinamycin treatment. CONCLUSIONS We report a high azithromycin failure rate (39%) in an M. genitalium-infected cohort in association with high levels of pretreatment macrolide resistance. Moxifloxacin failure occurred in 12% of patients who received moxifloxacin; all had pretreatment fluoroquinolone mutations detected. Pristinamycin was highly effective in treating macrolide- and quinolone-resistant strains.
Collapse
Affiliation(s)
- Melanie Bissessor
- Melbourne Sexual Health Centre, Alfred Hospital Melbourne School of Population and Global Health
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne Department of Microbiology, Infectious Diseases, The Royal Women's Hospital, Murdoch Childrens Research Institute
| | - Jimmy Twin
- Department of Microbiology, Infectious Diseases, The Royal Women's Hospital, Murdoch Childrens Research Institute
| | - Houda Abdo
- Department of Microbiology, Infectious Diseases, The Royal Women's Hospital, Murdoch Childrens Research Institute
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Hospital Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Hospital Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Hospital Melbourne School of Population and Global Health Department of Microbiology, Infectious Diseases, The Royal Women's Hospital, Murdoch Childrens Research Institute
| | | | | | | | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Hospital Melbourne School of Population and Global Health Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
22
|
Abstract
Corynebacterium propinquum is usually considered part of the normal human oropharyngeal flora and is rarely responsible for clinical infection. We report here what seems to be the first case of acute purulent urethral discharge in a young Iranian man with urethritis acquired after orogenital contact. Attention should be devoted to less common nondiphtheriae Corynebacterium species for differential diagnosis.
Collapse
|
23
|
Diagnosis of ureaplasma urealyticum septic polyarthritis by PCR assay and electrospray ionization mass spectrometry in a patient with acute lymphoblastic leukemia. J Clin Microbiol 2014; 52:3456-8. [PMID: 24958801 DOI: 10.1128/jcm.00963-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of polyarthritis with axial involvement in a young female patient treated for acute lymphoblastic leukemia. Detection in the hip fluid of Ureaplasma urealyticum by broad-range PCR followed by electrospray ionization mass spectrometry allowed the diagnosis of septic arthritis and ad integrum recovery upon adapted antibiotic therapy.
Collapse
|
24
|
Deguchi T, Ito S, Hagiwara N, Yasuda M, Maeda SI. Antimicrobial chemotherapy ofMycoplasma genitalium-positive non-gonococcal urethritis. Expert Rev Anti Infect Ther 2014; 10:791-803. [DOI: 10.1586/eri.12.38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
25
|
Saunders JM, Mercer CH, Sutcliffe LJ, Cassell JA, Estcourt CS. Factors associated with asymptomatic non-chlamydial non-gonococcal urethritis in heterosexual men: findings from a case-control study. Int J STD AIDS 2013; 24:627-31. [DOI: 10.1177/0956462413477554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Summary The significance of asymptomatic non-chlamydial non-gonococcal urethritis (NCNGU) is unclear. Organisms associated with NCNGU, e.g. Mycoplasma genitalium, for which there is no widely available test, are linked to reproductive sequelae in women but UK guidance no longer recommends urethral smear microscopy to screen for asymptomatic NCNGU. This case-control study of heterosexual male genitourinary (GU) medicine clinic attenders aimed to identify clinical, demographic and sexual behaviour factors associated with asymptomatic NCNGU so that we could determine whether the presence or absence of symptoms provides a rational basis for deciding to whom we should offer microscopy and whom we should treat. Men with asymptomatic NCNGU were very similar to men with symptomatic NCNGU, except for more consistent condom use. Asymptomatic and symptomatic NCNGU could be different ends of the same clinical syndrome. Until the microbiological basis of NCNGU is understood, we recommend treatment of men with NCNGU irrespective of symptoms.
Collapse
Affiliation(s)
- J M Saunders
- Blizard Institute, Barts and the London Queen Mary's School of Medicine & Dentistry, Barts Health NHS Trust, Barts Sexual Health Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 5BE
| | - C H Mercer
- Institute of Epidemiology and Health, Faculty of Population Health, University College, London
| | - L J Sutcliffe
- Blizard Institute, Barts and the London Queen Mary's School of Medicine & Dentistry, London
| | - J A Cassell
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton
| | - C S Estcourt
- Blizard Institute, Barts and the London Queen Mary's School of Medicine & Dentistry, and Barts Health NHS Trust, London, UK
| |
Collapse
|
26
|
Urethritis and antimicrobial resistance. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2013. [DOI: 10.2478/sjdv-2013-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Urethritis is a clinical syndrome which is characterized by mucopurulent or purulent urethral discharge with or without dysuria, due to an increased number of polymorphonuclear leukocytes in the anterior urethra. Antimicrobial therapy and preventive measures are essential in the management of bacterial urethritis. However, these drugs may cause antimicrobial resistance, resulting in unsuccessful treatment and complications of urethritis. Resistance of Neisseria gonorrhoeae to antibiotics is well known for decades, and in recent years there are more cases of resistance of Chlamydia trachomatis and Mycoplasma genitalium to different antibiotics. There is a danger that in the future certain strains of N. gonorrhoeae will be resistant to all available antimicrobial agents, unless new antibiotics to which resistance will not develop rapidly or an effective vaccine are developed.
Collapse
|
27
|
Contribution of topoisomerase IV mutation to quinolone resistance in Mycoplasma genitalium. Antimicrob Agents Chemother 2013; 57:1772-6. [PMID: 23357772 DOI: 10.1128/aac.01956-12] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mechanism of quinolone resistance in Mycoplasma genitalium remains poorly understood due to difficulties with in vitro culture, especially of clinical isolates. In this study, to confirm the association between mutations in topoisomerases and antimicrobial susceptibilities to quinolones, ciprofloxacin-resistant mutant strains were selected using the cultivable type strain ATCC 33530. Sequence analysis revealed that the mutant strains harbored mutations in topoisomerase IV: Gly81Cys in ParC, Pro261Thr in ParC, or Asn466Lys in ParE. The MICs of all quinolones tested against the mutant strains were 2- to 16-fold higher than those against the wild-type strain. No cross-resistance was observed with macrolides or tetracyclines. We determined the inhibitory activities of quinolones against DNA gyrase and topoisomerase IV in order to investigate the correlation between antimicrobial susceptibility and inhibitory activity against the target enzymes, considered the primary targets of quinolones. Furthermore, using enzymatic analysis, we confirmed that Gly81Cys in the ParC quinolone resistance-determining region (QRDR) contributed to quinolone resistance. This is the first study to isolate quinolone-resistant mutant strains of M. genitalium harboring substitutions in the parC or parE gene in vitro and to measure the inhibitory activities against the purified topoisomerases of M. genitalium.
Collapse
|
28
|
Approaching the quality of antibiotic prescriptions in primary care using reimbursement data. Eur J Clin Microbiol Infect Dis 2012; 32:325-32. [PMID: 22983401 DOI: 10.1007/s10096-012-1743-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
Our objectives for this investigation were: (i) to design quality measures of outpatient antibiotic use that could be calculated at the individual general practitioner (GP) level using reimbursement data only; and (ii) to analyse the variability in antibiotic prescriptions between GPs regarding these measures in south-eastern France. Based on the literature and international therapeutic guidelines, we designed a set of quality measures in an exploratory attempt to assess the quality of antibiotic prescriptions. We performed a cross-sectional study of antibiotic prescriptions in adults in south-eastern France in 2009, using data from the outpatient reimbursement database of the French National Health Insurance (NHI). We carried out a cluster analysis to group GPs according to their antibiotic prescribing behaviour. Six quality measures were calculated at the GP level, with wide variations in practice regarding all these measures. A six-cluster solution was identified, with one cluster grouping 56 % of the sample and made up of GPs having the most homogeneous pattern of prescription for all six quality measures, probably reflecting better antibiotic prescribing. Total pharmaceutical expenses (per patient), penicillin combinations use, quinolone use and seasonal variation of quinolone use were all positively associated with a more heterogeneous and possibly less appropriate use of antibiotics in a multivariate analysis. These quality measures could be useful to assess GPs' antibiotic prescribing behaviour in countries where no information system provides easy access to data linking drug use to a clinical condition.
Collapse
|
29
|
Weinstein SA, Stiles BG. Recent perspectives in the diagnosis and evidence-based treatment of Mycoplasma genitalium. Expert Rev Anti Infect Ther 2012; 10:487-99. [PMID: 22512757 DOI: 10.1586/eri.12.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Mycoplasma genitalium is a globally important sexually transmitted pathogen. Men infected with M. genitalium frequently present with dysuria, while women may present with or without urogenital symptoms. In some populations, M. genitalium is significantly associated with HIV-1 infection, and is also an etiological agent in pelvic inflammatory disease. However, there is insufficient evidence to establish a causative role of the organism in obstetric complications, including tubal factor infertility. Although several nucleic acid amplification tests offer rapid, sensitive methods for detecting M. genitalium, there is no standardized assay. Available evidence supports treatment of M. genitalium infections with an extended regimen of azithromycin and resistant strains respond to moxifloxacin. Accumulating evidence indicates growing fluoroquinolone resistance, including against moxifloxacin, emphasizing the need for new therapeutic strategies to treat M. genitalium infections.
Collapse
Affiliation(s)
- Scott A Weinstein
- Women's and Children's Hospital, North Adelaide, South Australia, Australia.
| | | |
Collapse
|
30
|
Twin J, Jensen JS, Bradshaw CS, Garland SM, Fairley CK, Min LY, Tabrizi SN. Transmission and selection of macrolide resistant Mycoplasma genitalium infections detected by rapid high resolution melt analysis. PLoS One 2012; 7:e35593. [PMID: 22532861 PMCID: PMC3331984 DOI: 10.1371/journal.pone.0035593] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 03/19/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) causes urethritis, cervicitis and pelvic inflammatory disease. The MG treatment failure rate using 1 g azithromycin at an Australian Sexual Health clinic in 2007-9 was 31% (95%CI 23-40%). We developed a rapid high resolution melt analysis (HRMA) assay targeting resistance mutations in the MG 23S rRNA gene, and validated it against DNA sequencing by examining pre- and post-treatment archived samples from MG-infected patients. METHODOLOGY/PRINCIPAL FINDINGS Available MG-positive pre-treatment (n = 82) and post-treatment samples from individuals with clinical treatment failure (n = 20) were screened for 23S rRNA gene mutations. Sixteen (20%) pre-treatment samples possessed resistance mutations (A2058G, A2059G, A2059C), which were significantly more common in patients with symptomatic azithromycin-treatment failure (12/26; 44%) than in those clinically cured (4/56; 7%), p<0.001. All 20 patients experiencing azithromycin-failure had detectable mutations in their post-treatment samples. In 9 of these cases, the same mutational types were present in both pre- and post-treatment samples indicating transmitted resistance, whilst in 11 of these cases (55%), mutations were absent in pre-treatment samples indicating likely selection of resistant isolates have occurred. HRMA was able to detect all mutational changes determined in this study by DNA sequencing. An additional HRMA assay incorporating an unlabelled probe was also developed to detect type 4 single-nucleotide polymorphisms found in other populations, with a slightly lower sensitivity of 90%. CONCLUSIONS/SIGNIFICANCE Treatment failure is associated with the detection of macrolide resistance mutations, which appear to be almost equally due to selection of resistant isolates following exposure to 1 g azithromycin and pre-existing transmitted resistance. The application of a rapid molecular assay to detect resistance at the time of initial detection of infection allows clinicians to shorten the time to initiate effective second line treatment. This has the potential to reduce transmission of resistant strains and to avoid sequelae associated with persistent untreated infection.
Collapse
Affiliation(s)
- Jimmy Twin
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia.
| | | | | | | | | | | | | |
Collapse
|
31
|
Jensen A, Kleveland C, Moghaddam A, Haaheim H, Hjelmevoll S, Skogen V. Chlamydia trachomatis,Mycoplasma genitaliumandUreaplasma urealyticumamong students in northern Norway. J Eur Acad Dermatol Venereol 2012; 27:e91-6. [DOI: 10.1111/j.1468-3083.2012.04528.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Stanley B, Gibson S. Audit of receptionists' records of symptoms and concurrence with clinician consultation: data collected for the Department of Health. Int J STD AIDS 2011; 22:684-5. [PMID: 22096058 DOI: 10.1258/ijsa.2009.009444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Audit of reliability of data collected by genitourinary (GU) medicine reception staff in north Cumbria for Department of Health mandatory returns suggests that receptionist-logged presence or absence of symptoms does not concur well with subsequent symptom disclosure to clinicians during consultations, even after the use of patient-completed symptom-specific questionnaires. Triage or fast-tracking based upon symptoms in order to select those at risk of sexually transmitted infection (STI) is likely to fail for a significant proportion of patients. Department of Health symptoms data need to be interpreted with caution.
Collapse
Affiliation(s)
- B Stanley
- Department of Genitourinary Medicine, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
| | | |
Collapse
|
33
|
Weinstein SA, Stiles BG. A review of the epidemiology, diagnosis and evidence-based management of Mycoplasma genitalium. Sex Health 2011; 8:143-58. [PMID: 21592428 DOI: 10.1071/sh10065] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 08/30/2010] [Indexed: 11/23/2022]
Abstract
Mycoplasma genitalium is attracting increasing recognition as an important sexually transmitted pathogen. Presented is a review of the epidemiology, detection, presentation and management of M. genitalium infection. Accumulating evidence suggests that M. genitalium is an important cause of non-gonococcal, non-chlamydial urethritis and cervicitis, and is linked with pelvic inflammatory disease and, possibly, obstetric complications. Although there is no standard detection assay, several nucleic acid amplification tests have >95% sensitivity and specificity for M. genitalium. To date, there is a general lack of established protocols for screening in public health clinics. Patients with urethritis or cervicitis should be screened for M. genitalium and some asymptomatic sub-groups should be screened depending on individual factors and local prevalence. Investigations estimating M. genitalium geographic prevalence document generally low incidence, but some communities exhibit infection frequencies comparable to that of Chlamydia trachomatis. Accumulating evidence supports an extended regimen of azithromycin for treatment of M. genitalium infection, as data suggest that stat 1 g azithromycin may be less effective. Although data are limited, azithromycin-resistant cases documented to date respond to an appropriate fluoroquinolone (e.g. moxifloxacin). Inconsistent clinical recognition of M. genitalium may result in treatment failure and subsequent persistence due to ineffective antibiotics. The contrasting nature of existing literature regarding risks of M. genitalium infection emphasises the need for further carefully controlled studies of this emerging pathogen.
Collapse
Affiliation(s)
- Scott A Weinstein
- Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5003, Australia.
| | | |
Collapse
|
34
|
|
35
|
Saunders JM, Hart G, Estcourt CS. Is asymptomatic non-chlamydial non-gonococcal urethritis associated with significant clinical consequences in men and their sexual partners: a systematic review. Int J STD AIDS 2011; 22:338-41. [DOI: 10.1258/ijsa.2011.010338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Opinions are divided on whether to screen asymptomatic men for non-chlamydial non-gonococcal urethritis (NCNGU). We systematically reviewed the literature to determine whether male asymptomatic NCNGU is associated with significant clinical outcomes for men and/or their sexual partners. We searched electronic databases and reference lists from retrieved articles and reviews. No studies reporting clinical outcomes in men with asymptomatic NCNGU were identified. Two eligible studies report rates of sexually transmitted infections (STIs) in female partners of men with asymptomatic NCNGU; Chlamydia trachomatis was detected in 2.4% and 8.3% of these women. The evidence available is insufficient in quality and breadth to enable us to conclude whether asymptomatic NCNGU is associated with significant health consequences for men or their sexual partners; however, clinical consequences of asymptomatic NCNGU are poorly investigated. Clinicians should be aware of the limitations of the evidence on which current screening guidelines for asymptomatic men are based.
Collapse
Affiliation(s)
- J M Saunders
- Barts and The London School of Medicine & Dentistry Queen Mary University of London Barts Sexual Health Centre St Bartholomew's Hospital
| | - G Hart
- Centre for Sexual Health and HIV Research University College London, London, UK
| | - C S Estcourt
- Barts and The London School of Medicine & Dentistry Queen Mary University of London Barts Sexual Health Centre St Bartholomew's Hospital
| |
Collapse
|
36
|
[AIDS Study Group/Spanish AIDS Consensus Plan Document on sexually transmitted infections in HIV-infected patients]. Enferm Infecc Microbiol Clin 2011; 29:286.e1-19. [PMID: 21419527 DOI: 10.1016/j.eimc.2010.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 10/22/2010] [Accepted: 10/28/2010] [Indexed: 10/26/2022]
Abstract
Sexually transmitted infections (STI) are a major public health problem. Considering their high morbidity and potential short and long term after effects, physicians must have enough knowledge on the management of these infections for a correct prevention, diagnosis and treatment. HIV infection is associated with STI, not only because they share route of transmission, but also because they lead to an increased risk of HIV transmission. In this article, we summarise the updated clinical practice guidelines, for the evaluation, management and prevention of STI in HIV-infected patients, from a panel of experts in HIV, dermatologists, proctologic surgeons, and microbiologists on behalf of the Spanish AIDS Study Group (GESIDA) and the National AIDS Plan (PNS).
Collapse
|
37
|
|