Clinical efficacy of azithromycin for male nongonococcal urethritis

Urethritis due to Corynebacterium glucuronolyticum

“…Netzel and Rand describe C. glucuronolyticum as susceptible to beta-lactams, gentamicin, rifampin, and vancomycin; many strains are resistant to ciprofloxacin, clindamycin, erythromycin, and tetracycline [8]. In the treatment of patients with NGU or nongonococcal chlamydial urethritis (NGCU), the guidelines of the Centers for Disease Control and Prevention (CDC) in the United States of America (USA), the Japanese Society for Sexually Transmitted Diseases [9], and the European Association of Urology (EAU) [10] commonly recommend azithromycin or doxycycline as the first choice, and treatment with fluoroquinolones as the second choice. Maeda et al [11] found that a single dose of 1 g azithromycin was effective in 32 (84.2%) of 38 men with non-mycoplasmal, non-ureaplasmal NGCU.…”

Prevalence of genital Mycoplasma, Ureaplasma, Gardnerella, and human papillomavirus in Japanese men with urethritis, and risk factors for detection of urethral human papillomavirus infection

“…The most common microorganism responsible for NGU is Chlamydia trachomatis, which is detected in approximately 30% of the patients with NGU [1]. Various infectious microorganisms, for example Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum (biovar 2), Ureaplasma parvum (biovar 1), and Gardnerella vaginalis are detected in patients with non-chlamydial NGU [2][3][4][5]. M. genitalium, especially, is widely regarded as a third pathogen of male urethritis, in addition to Neisseria gonorrhoeae and C. trachomatis [1,2].…”

Diagnosis and Management of UncomplicatedChlamydia trachomatisInfections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

“…Takahashi et al performed a prospective study of azithromycin for NGU and reported 89% microbiological efficacy by urine PCR in 27 CT-infected subjects (81% efficacy in symptomatic men and 100% in asymptomatic men), but was limited in that all men with a repeat positive CT test had testing performed ≤14 days after therapy, introducing the possibility of a false-positive NAAT; doxycycline was not studied [15]. There were 2 RCTs of azithromycin-vs doxycyclinecontaining regimens for symptomatic NGU in men that reported contradictory microbiological outcome results based on urine TMA testing [16,17].…”

“…The fourth study of rectal CT therapy was a prospective observational study in MSM and women by Hathorn et al in which 42 subjects receiving azithromycin and 40 receiving doxycycline during different study phases had an estimated efficacy, adjusting for possible reinfection, of 79% and 100%, respectively, at 6 weeks posttherapy [14]. The study was limited with a high loss-to-follow-up rate (about 50% of subjects), and almost as many subjects received azithromycin during the doxycycline treatment phase and were excluded from analysis.There were 3 publications addressing treatment of NGU due to CT infection [15][16][17]. Takahashi et al performed a prospective study of azithromycin for NGU and reported 89% microbiological efficacy by urine PCR in 27 CT-infected subjects (81% efficacy in symptomatic men and 100% in asymptomatic men), but was limited in that all men with a repeat positive CT test had testing performed ≤14 days after therapy, introducing the possibility of a false-positive NAAT; doxycycline was not studied [15].…”