Harassment and discrimination are prevalent in this sample and associated with gender, ethnicity, sexuality, disability and year group. Reporting is rare and perceived as ineffective. These findings have informed local developments, future strategies and the development of a national prevention policy.
Background/introductionNational guidelines recommend testing men with non-gonococcal urethritis(NGU) for Mycoplasma genitalium(MG) where testing is available. Recent studies have shown concerning levels of macrolide resistance and high rates of treatment failure with 1 g azithromycin. In response to this, we changed our standard treatment of NGU to doxycycline and implemented a test and treat pathway for MG in male NGU.Aim(s)/objectivesTo determine the prevalence of MG and to measure clearance rates of infection post-treatment.MethodsFrom 1st September 2015 first void urine samples from men with NGU were routinely tested for MG using the Fast Track Diagnostics™ urethritis PCR. Men with confirmed MG were given 5days azithromycin and offered test of cure at 4 weeks.Results304 men had NGU over 5months. Mean age 33.2 years, 64.5% heterosexual, 77.6% white ethnicity and 8.2% HIV-positive. Tests for MG were performed in 230/304 (76%). 16.5% (38/230) were MG positive compared with 22.5% chlamydia. 6 (15.8%) men with MG were co-infected with chlamydia and 1 (2.6%) had urethral gonorrhoea. 20/38 men with MG (52.6%) were given azithromycin 5days, 8/38 (21.1%) had azithromycin 1g stat. 7/38 (18.4%) re-tested positive at 4 weeks, 6 of whom had initially had azithromycin 5days. All were given moxifloxacin 400mg for either 7, 10 or 14 days.Discussion/conclusionThe high rates of MG found support routine testing in men with NGU. Despite appropriate treatment, some men returned with positive TOC suggestive of macrolide failure. This demonstrates a need for more widely available MG diagnostics with resistance testing in the UK and attention to antimicrobial stewardship so that NGU can be better managed.
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