Epidemiological and clinical rationale for screening and diagnosis of <i>Mycoplasma genitalium</i> infections

McGowin, Chris L.; Rohde, Rodney E.; Redwine, Gerald D.

doi:10.29074/ascls.27.1.47

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…In men with mild symptoms, a potential option is to review the patient after 3–7 days, when the results of the NAAT(s) are available, as sometimes urethritis can resolve without treatment [ 44 ]. If laboratory tests are positive, or in the case of persistent microscopic urethritis, appropriate antimicrobial treatment, depending on which microorganism is detected, can then be administered at the second visit [ 45 ]. If the laboratory tests are negative, only treat if patient has symptoms and microscopic evidence of urethritis, or observable purulent or muco-purulent discharge on examination.…”

Section: Treatmentmentioning

confidence: 99%

Management of non-gonococcal urethritis

2015

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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.

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Section: Treatmentmentioning

confidence: 99%

Management of non-gonococcal urethritis

2015

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“… 1 2 Based on these studies, routine testing has been suggested to detect and treat M. genitalium in asymptomatic attenders in healthcare settings 6 and the recommendation has also been extended to low risk general populations. 7 Multiplex NAATs are being used increasingly to detect multiple sexually transmitted pathogens, 8 9 increasing pressure for their routine use in asymptomatic populations.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Mycoplasma genitalium in different population groups: systematic review andmeta-analysis

et al. 2018

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BackgroundMycoplasma genitalium is a common cause of non-gonococcal non-chlamydial urethritis and cervicitis. Testing of asymptomatic populations has been proposed, but prevalence in asymptomatic populations is not well established. We aimed to estimate the prevalence of M. genitalium in the general population, pregnant women, men who have sex with men (MSM), commercial sex workers (CSWs) and clinic-based samples.MethodsWe searched Embase, Medline, IndMED, African Index Medicus and LILACS from 1 January 1991 to 12 July 2016 without language restrictions. We included studies with 500 participants or more. Two reviewers independently screened and selected studies and extracted data. We examined forest plots and conducted random-effects meta-analysis to estimate prevalence, if appropriate. Between-study heterogeneity was examined using the I2 statistic and meta-regression.ResultsOf 3316 screened records, 63 were included. In randomly selected samples from the general population, the summary prevalence was 1.3% (95% CI 1.0% to 1.8%, I2 41.5%, three studies, 9091 people) in countries with higher levels of development and 3.9% (95% CI 2.2 to 6.7, I2 89.2%, three studies, 3809 people) in countries with lower levels. Prevalence was similar in women and men (P=0.47). In clinic based samples, prevalence estimates were higher, except in asymptomatic patients (0.8%, 95% CI 0.4 to 1.4, I2 0.0%, three studies, 2889 people). Summary prevalence estimates were, in the following groups: pregnant women 0.9% (95% CI 0.6% to 1.4%, I2 0%, four studies, 3472 people), MSM in the community 3.2% (95% CI 2.1 to 5.1, I2 78.3%, five studies, 3012 people) and female CSWs in the community 15.9% (95% CI 13.5 to 18.9, I2 79.9%, four studies, 4006 people).DiscussionThis systematic review can inform testing guidelines for M. genitalium. The low estimated prevalence of M. genitalium in the general population, pregnant women and asymptomatic attenders at clinics does not support expansion of testing to these groups.Registration numbersPROSPERO: CRD42015020420

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“…The most recent European International Union against Sexually Transmitted Infections (IUSTI) M. genitalium guidelines published in August 2016 argue against screening asymptomatic individuals for M. genitalium. 11 Before the publication of these guidelines, a number of authors advocated for screening high-risk populations for this infection 12–16 . Given this lack of clarity, it was decided to include screening for M. genitalium in a Belgian PrEP demonstration project in MSM that commenced in 2015.…”

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confidence: 99%

The Population-Level Effect of Screening for Mycoplasma genitalium on Antimicrobial Resistance: A Quasi-Experimental Study

et al. 2021

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Background: No studies have evaluated the utility and risks of screening for Mycoplasma genitalium in men who have sex with men taking preexposure prophylaxis (PrEP). We made use of a quasi-experimental design to evaluate the effect of screening for M. genitalium in a demonstration PrEP cohort with 3-monthly follow-up. Methods:We compared the proportion of PrEP participants with M. genitalium clearance, the duration of persistence, proportion with incident symptoms, the incidence of fluoroquinolone and macrolide resistance, and the proportion of noncleared infections with resistance-associated mutations between 2 groups: those in whom the first episode of M. genitalium was treated and those in whom it was not treated.Results: M. genitalium was detected in 70 of 179 individuals. The first episode of infection was treated in 46 individuals. Treatment was not significantly associated with the incidence of symptomatic infections or the acquisition of genotypic resistance. Treatment was associated with a higher probability of clearance of infection but at the expense of increasing the proportion of remaining infections that were resistant. In the nontreated group, the infections that did not clear were less likely to be fluoroquinolone resistant (1/6 [16.7%]) than those that did clear (4/4 [100%]; P = 0.048). In contrast, in the treated group, there was no significant difference in the proportion of fluoroquinolone resistance between the infections that persisted and cleared.Conclusions: If screening and treatment increase the ratio of resistant to susceptible M. genitalium in a population, then this could play a role in the spread of antimicrobial resistance.V arious countries are reporting alarming increases in both bacterial sexually transmitted infection (STI) incidence and antimicrobial resistance (AMR). [1][2][3][4] Neisseria gonorrhoeae and Mycoplasma genitalium are of particular concern because they may become untreatable in the not-too-distant future. 1,3,5 One strategy proposed to counter the increased incidence and AMR in these STIs is enhanced screening of these infections in high STI prevalence populations. 1,[6][7][8] Others have argued that the available evidence suggests that this strategy has little or no effect on the prevalence of these infections and results in dangerous increases antimicrobial consumption and thus the risk of AMR emerging. 9,10 No studies that we are aware of have evaluated the utility of screening for M. genitalium in high-STI-prevalence populations. 4 We made use of a quasi-experiment design to evaluate the effect of screening for M. genitalium in a cohort of men who have sex with men (MSM) taking HIV preexposure prophylaxis (PrEP). The most recent European International Union against Sexually Transmitted Infections (IUSTI) M. genitalium guidelines published in August 2016 argue against screening asymptomatic individuals for M. genitalium. 11 Before the publication of these guidelines, a number of authors advocated for screening high-risk populations for this infection. [12][13]...

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Epidemiological and clinical rationale for screening and diagnosis of Mycoplasma genitalium infections

Cited by 8 publications

References 27 publications

Management of non-gonococcal urethritis

Management of non-gonococcal urethritis

Prevalence of Mycoplasma genitalium in different population groups: systematic review andmeta-analysis

The Population-Level Effect of Screening for Mycoplasma genitalium on Antimicrobial Resistance: A Quasi-Experimental Study

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