Positivity at test of cure following first-line treatment for genital Mycoplasma genitalium: follow-up of a clinical cohort

OBJECTIVES

To describe antibiotic use for treatment of Mycoplasma genitalium (MG) at an urban sexual health centre in Australia. To describe MG positivity rates in those returning for 1 month test of cure (TOC) following first-line antibiotic treatment for MG.

METHODS

Retrospective cross-sectional case-note review for all patients diagnosed with MG at Sydney Sexual Health Centre from 2009 to 2013.

RESULTS

Two hundred and eighteen MG cases were identified; 66% were male and 90% were symptomatic at presentation. Four people did not return for treatment. Azithromycin containing regimens were prescribed as first-line treatment in 88% of cases; azithromycin 1 g stat in 75% of cases and a course of extended azithromycin 1 g stat plus 500 mg daily for 4 days in 14% of cases. TOC was performed in 53% (95% CI 46% to 60%) of cases and 28% (95% CI 20% to 38%) of these cases were MG-positive at TOC. Of those having a MG-positive result at TOC, 26% received azithromycin 1 g stat and 33% received extended azithromycin. Accounting for cases lost to follow-up in azithromycin containing regimens, the positive MG TOC rate was estimated to be between 15% and 61%.

CONCLUSIONS

High rates of MG positivity were found in those attending TOC following first-line treatment of MG with azithromycin containing regimens.

Occurrence of catalase in pleuropneumonia-like organisms and bacterial L forms

Weibull, C. (Central Bacteriological Laboratory of Stockholm City, Stockholm, Sweden) and Kerstin Hammarberg. Occurrence of catalase in pleuropneumonia-like organisms and bacterial L forms. J. Bacteriol. 84:520-525. 1962.-The catalase activity of six pleuropneumonia-like organisms (PPLO), four stable Proteus L forms, and four normal strains of Proteus mirabilis was determined quantitatively. The PPLO (strains of the species Mycoplasma agalactiae, hominis, laidlawii, mycoides, and strains isolated from tissue cultures) exhibited no measurable catalase activity. The L forms decomposed H(2)O(2) approximately ten times as rapidly as the normal bacteria from which they were derived.

Mycoplasma pneumoniae: proposed nomenclature for atypical pneumonia organism (Eaton agent)

The light intensity-fusion frequency relationship of the goldfish electroretinogram follows the Ferry-Porter law except at the higher intensities. Maximum fusion frequency increases with temperature thus contradicting the results of studies elsewhere on the behavioral responses in sunfish.

Culture and metabolism of Mycoplasma gallisepticum

Gill, James W. (University of New Hampshire, Durham). Culture and metabolism of Mycoplasma gallisepticum. J. Bacteriol. 83:213-218. 1962.-Mycoplasma gallisepticum A5969, a strong-growing pleuropneumonia-like organism pathogenic for poultry, was found to be intolerant of extremes of temperature and potassium ion concentration. It ferments glucose to the benefit of cell yield, but glycolysis appears not to be essential to growth. Anaerobic growth can be maintained if pyruvate is added as a hydrogen recipient.A transamination system between glutamic acid and aspartic acid, more rapid toward the formation of aspartic acid, was found in a frozen-cell preparation. Two small peptides were observed to be produced by the organism and liberated into the medium under normal growth conditions. The composition of the peptides shows a relationship to the cell wall of certain bacteria.

Morphology of pleuropneumonia-like organisms and bacterial L forms grown in liquid media

Weibull, C. (Central Bacteriological Laboratory of Stockholm City, Stockholm, Sweden) and Britt-Marie Lundin. Morphology of pleuropneumonia-like organisms and bacterial L forms grown in liquid media. J. Bacteriol. 85:440-445. 1963.-Cells of Mycoplasma hominis, M. laidlawii, and two tissue-culture strains of pleuropneumonia-like organisms (PPLO) moving freely in liquid medium were photographed with an electronic flash as the light source. The photomicrographs thus obtained demonstrated that, in young cultures of high viability, the cells of these organisms were mainly filamentous or, in the case of M. laidlawii, coccoid. In old cultures of the same organisms containing predominantly nonviable cells, granular and vesicular elements were found. By the use of the same photographic technique, liquid cultures of a stable Proteus L form were studied. Although no filaments of uniform thickness were found, there were spherical bodies and some threadlike material connected with the spheres. When samples of PPLO cultures containing filamentous forms were transferred to agar blocks, the filaments were converted to more or less spherical bodies. This conversion could be prevented by fixing the PPLO with formaldehyde. The morphology of Proteus L forms was not noticeably altered by fixation with this reagent.

Size and shape of pleuropneumonia-like organisms grown in liquid media

Weibull, C. (Central Bacteriological Laboratory of Stockholm City, Stockholm, Sweden), and Britt-Marie Lundin. Size and shape of pleuropneumonia-like organisms grown in liquid media. J. Bacteriol. 84:513-519. 1962.-Samples of liquid cultures containing mainly nonaggregated cells of Mycoplasma agalactiae or M. laidlawii were transferred to agar blocks containing the same medium as the liquid cultures. By use of a phase-contrast microscope, photomicrographs were made of the slide cultures immediately after they had been prepared, and the dimensions of a large number of pleuropneumonia-like organisms (PPLO) were measured. These measurements indicated that, in young cultures (incubated for 24 to 48 hr), the size of the cells did not vary much more than that of ordinary bacteria; 95% of the cells had a width of 0.2 to 0.6 mu. The growth of individual PPLO was followed during incubation of the slide cultures. It was found that 80 to 100% of the cells present in liquid overnight cultures divided and gave rise to microcolonies within a few hours. Rod-shaped, ellipsoidal, and spherical cells were seen in these cultures. Liquid cultures incubated for several days contained mainly spherical cells. Fewer than 5% of the cells in these cultures showed any indication of growth during incubation in slide cultures for 5 days. Photomicrographs of cells of M. agalactiae moving freely in liquid medium were taken with an electronic flash as the light source. The photographs thus obtained directly demonstrated the existence of rod-shaped cells.

ARGININE METABOLISM IN PLEUROPNEUMONIA-LIKE ORGANISMS ISOLATED FROM MAMMALIAN CELL CULTURE

Schimke, Robert T. (National Institutes of Health, Bethesda, Md.) and Michael F. Barile. Arginine metabolism in pleuropneumonia-like organisms isolated from mammalian cell culture. J. Bacteriol. 86:195-206. 1963.-Arginine degradation is a significant metabolic process for pleuropneumonia-like organisms (PPLO; Mycoplasma) isolated from cell culture. The conversion of arginine to ornithine in PPLO-contaminated cell culture was rapid, and occurred by the arginine dihydrolase pathway involving arginine deiminase, ornithine transcarbamylase, and carbamyl phosphokinase. In the absence of PPLO contamination, arginine conversion to ornithine was minimal and took place by an arginase activity present in the cell culture, but not in the PPLO. All five PPLO strains isolated from cell culture accomplished the conversion of arginine to ornithine, and contained the requisite enzyme of the arginine dihydrolase system, whereas PPLO-free cell cultures did not. Supplementation of PPLO culture broth with arginine increased the extent of PPLO growth. When the arginine content of the culture limited growth, arginine was completely converted to ornithine. When growth was limited in the presence of excess arginine, citrulline was the major breakdown product. It is suggested that the conversion of arginine to ornithing constitutes a significant, and possibly major, source of adenosine triphosphate for this class of organisms.

PHOSPHORUS DISTRIBUTION IN PLEUROPNEUMONIA-LIKE AND L-TYPE ORGANISMS

Langenfeld, M. G. (University of South Dakota, Vermillion) and P. F. Smith. Phosphorus distribution in pleuropneumonia-like and L-type organisms. J. Bacteriol. 86:1216-1219. 1963.-Sterol-requiring and sterol-nonrequiring pleuropneumonia-like organisms, salt-requiring and salt-nonrequiring L forms, and their parent bacteria, were analyzed for total, acid-soluble, lipid, and nucleic acid phosphorus. Total phosphorus in all types of organisms was equivalent, except for salt-requiring L forms in which it was greatly elevated. The elevated total phosphorus reflected a great increase in acid-soluble phosphorus in the salt-requiring L forms. The lipid phosphorus content of pleuropneumonia-like organisms and salt-nonrequiring L forms was significantly greater than in the other types of organisms. The nucleic acid phosphorus content of salt-requiring L forms was lower than that of all other organisms

THE RELATIONSHIP OF A TYPE OF MYCOPLASMA ISOLATED FROM TISSUE CULTURES TO A NEW HUMAN ORAL MYCOPLASMA

A previously unidentified type of Mycoplasma found as a contaminant in tissue cultures and in a culture of Eaton agent, is identical with a newly recognized human oral type.

I am indebted to Drs Herdersheê and Chanock for sending me their cultures and relevant information.

STARCH GEL ELECTROPHORESIS OF A FRACTION OF CERTAIN OF THE PLEUROPNEUMONIA-LIKE GROUP OF MICROORGANISMS

Fowler, Richard C. (George Washington University School of Medicine, Washington, D.C.), Don W. Coble, Norman C. Kramer, and Thomas McP. Brown. Starch gel electrophoresis of a fraction of certain of the pleuropneumonia-like group of microorganisms. J. Bacteriol. 86:1145-1151. 1963.-Starch gel electrophoresis is suggested as a means of further characterizing strains of the pleuropneumonia-like group of microorganisms (PPLO), defined herein as including both the various "L" forms of bacteria and the Mycoplasmataceae. The techniques used may be varied to "select" other groups of proteins or classes of compounds (e.g., glycoproteins, lipoproteins, and enzymes). Only the results by starch gel electrophoresis on the soluble portion of sonically treated, washed cultures, grown in a pancreatic digest of beef heart enriched with bovine serum, are reported. As yet, differences appear more significant than similarities among the electrophoretically separable proteins. The demonstration of characteristic protein patterns for each strain studied suggests possibilities of further dividing serological groups into sero-logically distinct subtypes. Tentative migration values (E(f)) have been assigned to the protein bands for convenience in designation. Numerous interrelationships are thereby suggested.

ISOLATION AND BIOLOGICAL ASPECTS

Armstrong, D. (The Children's Hospital of Philadelphia, Philadelphia, Pa.), G. Henle, N. L. Somerson, and L. Hayflick. Cytopathogenic mycoplasmas associated with two human tumors. I. Isolation and biological aspects. J. Bacteriol. 90:418-424. 1965.-Mycoplasmas were isolated from cell cultures of two benign human tumors. The first isolate contained two mycoplasmas, one a well-known human species (Mycoplasma hominis type I) and frequent tissue culture contaminant, and the other a recently reported new type. The second isolate was a mycoplasma of the newly described type. The mycoplasmas could be reisolated, after one or more passages through tissue culture, from extracts of the original tumor tissue. The relationship of the organisms to the neoplasms remains obscure. Both isolates produce cytopathic effect (CPE) and acidification of medium in a variety of tissue cultures. The CPE may be diminished, but not abolished, by increasing concentrations of arginine in the tissue culture media. Infection of various tissue cultures with the mycoplasmas did not result in interference to super-infection with vesicular stomatitis virus.

LIPID COMPOSITION AND SYNTHESIS IN THE PLEUROPNEUMONIA-LIKE ORGANISM MYCOPLASMA GALLISEPTICUM

Tourtellotte, Mark E. (University of Connecticut, Storrs), Robert G. Jensen, George W. Gander, and Harold J. Morowitz. Lipid composition and synthesis in the pleuropneumonia-like organism Mycoplasma gallisepticum. J. Bacteriol. 86:370-379. 1963.-A simple method of extracting lipids from cells of Mycoplasma gallisepticum by use of silicic acid columns is described. Proteolipids (peptides) extracted with chloroform-methanol (2:1) by other methods were not extracted with the lipid by this method, nor were proteins and nucleic acids. Fractionation of lipids of M. gallisepticum demonstrated the presence of saturated hydrocarbons, free fatty acids, cholesterol, cholesterol esters, di- and triglycerides, phosphatidic acids, cephalins, inositides, phosphatidyl choline, and sphingomyelin. The fatty acid composition of the various fractions was also determined. The positive identification of cholesterol and cholesterol esters in this organism by chromatography, melting point, and infrared spectroscopy confirms reports by others that cholesterol is present in the pleuropneumonia group of microorganisms. The incorporation of P(32) orthophosphate into four phospholipid fractions, of oleic acid-1-C(14) into neutral and phospholipids, and cholesterol-4-C(14) into cholesterol esters clearly demonstrated the ability of M. gallisepticum to synthesize these lipids from simpler compounds. Between 70 and 80% of the lipid of this organism was found in the membrane.

AEROSOLS AS A SOURCE OF WIDESPREAD MYCOPLASMA CONTAMINATION OF TISSUE CULTURES

Mycoplasma isolates were cultured from 15 antibiotic-free cell cultures obtained from a single laboratory. Complement-fixation tests showed that these isolates were antigenically related to each other but were unrelated to M. hominis type 1, M. hominis type 2, M. arthritidis, M. laidlawii type B, Mycoplasma sp. H.Ep. #2 (Barile), or M. salivarium. Examination of serum used to feed the infected cell lines revealed no Mycoplasma. Infection resulting from cross-contamination by a single Mycoplasma strain from one cell culture to another was investigated. Although the organisms were not found in the air over the work area, aerosols containing these contaminants were produced in tissue culture bottles during the trypsinization of cell monolayers. The minimal infectious dose of Mycoplasma for tissue cultures was measured, and it was determined that one organism was capable of initiating an infection in a tissue culture. The pattern of contamination and the small dose required for infection indicated that Mycoplasma contamination was spread from one tissue culture to another via aerosols. It was demonstrated that Mycoplasma can be transferred from one cell culture to another through the use of a common burette for dispensing medium.

MORPHOLOGY OF HUMAN GENITAL "T-STRAIN" PLEUROPNEUMONIA-LIKE ORGANISMS

Ford, Denys K. (University of British Columbia, Vancouver, Canada), and Joyce Macdonald. Morphology of human genital "T-strain" pleuropneumonia-like organisms. J. Bacteriol. 85:649-653. 1963.-The morphology of Shepard's "T-strain" organisms from the human genital tract was investigated. The incubation of "T-strains" in 20% CO(2) with 80% nitrogen for 4 to 5 days caused surface outgrowth from the central core of the colonies embedded in the agar. Filtration through HA, PH, and VC Millipore filters showed that the elementary particles of "T-strains" were between 0.3 and 0.1 mu in diameter. "T-strain" pleuropneumonia-like organisms (PPLO) from broth cultures, stained by Giemsa's method, were seen to be minute, spherical particles, similar in size to the particles of the large-colony strains. Colonies of "T-strains," when prepared by the microculture, fixed-agar-block, and Formvar methods, resembled those of large-colony PPLO. It was concluded that "T-strain" organisms were true PPLO.