Antibiotic treatment of symptomatic Mycoplasma genitalium infection in Scandinavia: a controlled clinical trial

Björnelius, Eva; Anagrius, Carin; Bojs, G.; Carlberg, Hans; Johannisson, G; Johansson, Emma; Moi, Harald; Jensen, Jørgen Skov; Lidbrink, Peter

doi:10.1136/sti.2007.027375

Cited by 123 publications

(143 citation statements)

References 30 publications

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“…The susceptibility of M. genitalium to various antibiotics is outlined in Table 3 and presented in more detail elsewhere (226). Although tetracyclines were used to treat NGU before M. genitalium was discovered, they are not the antibiotics of choice for M. genitalium-associated disease (12,145). This was also true for women for whom cefoxitin and doxycycline failed to eradicate endometrial M. genitalium (63).…”

Section: Antimicrobial Susceptibility Treatment and Preventionmentioning

confidence: 99%

“…Since then, M. genitalium has been found in up to 40% of men presenting with chronic disease after treatment with doxycycline (209,229). Indeed, in several clinical studies (36, 82, 83, 134, 205, 229), a strong correlation was found between M. genitalium infection and persistent or recurrent NGU, probably due to tetracyclines and, more recently, azithromycin (17, 18) eradicating M. genitalium from only a subset of the patients (12,46). Other aspects of treatment are discussed below.…”

Section: Chronic Ngumentioning

confidence: 99%

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Mycoplasma genitalium: from Chrysalis to Multicolored Butterfly

2011

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SUMMARY The history, replication, genetics, characteristics (both biological and physical), and factors involved in the pathogenesis of Mycoplasma genitalium are presented. The latter factors include adhesion, the influence of hormones, motility, possible toxin production, and immunological responses. The preferred site of colonization, together with current detection procedures, mainly by PCR technology, is discussed. The relationships between M. genitalium and various diseases are highlighted. These diseases include acute and chronic nongonococcal urethritis, balanoposthitis, chronic prostatitis, and acute epididymitis in men and urethritis, bacterial vaginosis, vaginitis, cervicitis, pelvic inflammatory disease, and reproductive disease in women. A causative relationship, or otherwise strong association, between several of these diseases and M. genitalium is apparent, and the extent of this, on a subjective basis, is presented; also provided is a comparison between M. genitalium and two other genital tract-orientated mollicutes, namely, Mycoplasma hominis , the first mycoplasma of human origin to be discovered, and Ureaplasma species. Also discussed is the relationship between M. genitalium and infertility and also arthritis in both men and women, as is infection in homosexual and immunodeficient patients. Decreased immunity, as in HIV infections, may enhance mycoplasmal detection and increase disease severity. Finally, aspects of the antimicrobial susceptibility and resistance of M. genitalium , together with the treatment and possible prevention of mycoplasmal disease, are discussed.

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Section: Antimicrobial Susceptibility Treatment and Preventionmentioning

confidence: 99%

Section: Chronic Ngumentioning

confidence: 99%

Mycoplasma genitalium: from Chrysalis to Multicolored Butterfly

2011

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“…An extended regime (1.5 g over 5 days) is often prescribed if singledose AZM is unsuccessful, but there is contention regarding the effectiveness of this extended treatment (19,20). Alarmingly, studies investigating the effectiveness of either 1 g or 1.5 g AZM treatment have reported microbiological treatment failure in 16% to 33% of patients (19,(21)(22)(23)(24).…”

mentioning

confidence: 99%

Fluoroquinolone and Macrolide Resistance-Associated Mutations in Mycoplasma genitalium

et al. 2013

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dMycoplasma genitalium is a significant sexually transmitted pathogen, causing up to 25% of cases of nongonococcal urethritis in men, and it is strongly associated with cervicitis and pelvic inflammatory disease in women. Currently, the usual first-line treatment is the macrolide antibiotic azithromycin, but an increasing incidence of treatment failure over the last 5 years suggests the emergence of antibiotic resistance. The mutations responsible for macrolide resistance have been found in the 23S rRNA gene in numerous M. genitalium populations. A second-line antibiotic, the fluoroquinolone moxifloxacin, was thought to be a reliable alternative when azithromycin began to fail, but recent studies have identified mutations that may confer fluoroquinolone resistance in the genes parC and gyrA. The aim of this study was to determine the prevalence of antibiotic resistance in M. genitalium in Sydney, Australia, by detecting relevant mutations in the 23S rRNA gene, parC, and gyrA. M. genitalium-positive DNA extracts of specimens, collected from patients attending sexual health clinics in Sydney, were tested by PCR amplification and DNA sequence alignment. The 186 specimens tested included 143 initial patient specimens and 43 second, or subsequent, specimens from 24 patients. We identified known macrolide resistance-associated mutations in the 23S rRNA gene in 43% of the initial patient samples and mutations potentially associated with fluoroquinolone resistance in parC or gyrA sequences in 15% of the initial patient samples. These findings support anecdotal clinical reports of azithromycin and moxifloxacin treatment failures in Sydney. Our results indicate that further surveillance is needed, and testing and treatment protocols for M. genitalium infections may need to be reviewed. Mycoplasma genitalium, one of the smallest known self-replicating organisms (1), is an obligate parasite, preferring the human genital tract as its host environment (2-4). In men, M. genitalium is a significant cause of both acute and chronic nongonococcal urethritis (NGU) (5-7) and is estimated to account for 15% to 25% of cases of NGU in some populations (2). In women, M. genitalium has been significantly associated with both cervicitis (2, 8-10) and pelvic inflammatory disease (2,(11)(12)(13)(14), and it has been identified in up to 7.3% of women in high-risk populations (15). In Australia, M. genitalium has been reported to account for between 4.5% and 9% of cases of NGU (16, 17), while it was identified in 4% of women attending a Sydney sexual health clinic and was the second most common cause of cervicitis (9).The usual treatment regime for clinically diagnosed NGU and cervicitis is a single dose of 1 g azithromycin (AZM) (18). An extended regime (1.5 g over 5 days) is often prescribed if singledose AZM is unsuccessful, but there is contention regarding the effectiveness of this extended treatment (19,20). Alarmingly, studies investigating the effectiveness of either 1 g or 1.5 g AZM treatment have reported microbiological treatment f...

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“…18 In one study, M. genitalium eradication rates in women treated with azithromycin were 88% compared with 37% with doxycycline. 19 Azithromycin is available locally, and the treatment cost for 1 g in Haiti ranges from 40 to 200 Haitian Gourdes (US $0.93-$4.65). In addition to providing coverage for both C. trachomatis and M. genitalium, a single dose of azithromycin also has the advantage of use in directly observed therapy (DOT) protocols for immediate onsite treatment.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Sexually Transmitted Infections in Rural Southwestern Haiti: The Grand'Anse Women's Health Study

Jobe

Downey

Hammar

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. The study attempts to define socioeconomic, clinical, and laboratory correlates in vaginitis and other sexually transmitted infections in rural southwestern Haiti. A convenience sample of subjects recruited from a rural women's health clinic and attending an established clinic at the Haitian Health Foundation (HHF) clinic was studied. A standardized history and physical examination, including speculum examination, and collection of blood, urine, and vaginal swabs were obtained from the women at the rural clinic. Additional vaginal swab samples only for Nucleic Acid Amplification Test (NAAT) testing were obtained from women at the HHF clinic in Jé ré mie. Laboratory results from Leon subjects were positive for Gardnerella vaginalis in 41% (41 of 100), Trichomonas vaginalis in 13.5% (14 of 104), Candida sp. in 9% (9 of 100), Mycoplasma genitalium in 6.7% (7 of 104), Chlamydia trachomatis in 1.9% (2 of 104), and Neisseria gonorrhea in 1% (1 of 104) of patients. Human immunodeficiency virus (HIV) antibody tests were negative in 100% (103 of 103) of patients, and syphilis antibody testing was positive for treponemal antibodies in 7.7% (8 of 104) patients. For subjects from the HHF, 19.9% were positive for T. vaginalis, 11.9% were positive for C. trachomatis, 10.1% were positive for M. genitalium, and 4.1% were positive for N. gonorrhea. Infections with G. vaginalis, T. vaginalis, and Candida were the most common. N. gonorrhea, C. trachomatis, Candida sp., T. vaginalis, and M. genitalium infections were associated with younger age (less than 31 years old).

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Antibiotic treatment of symptomatic Mycoplasma genitalium infection in Scandinavia: a controlled clinical trial

Cited by 123 publications

References 30 publications

Mycoplasma genitalium: from Chrysalis to Multicolored Butterfly

Mycoplasma genitalium: from Chrysalis to Multicolored Butterfly

Fluoroquinolone and Macrolide Resistance-Associated Mutations in Mycoplasma genitalium

Epidemiology of Sexually Transmitted Infections in Rural Southwestern Haiti: The Grand'Anse Women's Health Study

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