Prevalence of Mycoplasma genitalium in men with urethritis and in high risk asymptomatic males in Tel Aviv: a prospective study

Abstract

We sought to investigate the prevalence of Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in men presenting to a sexually transmitted infection (STI) clinic, with special attention to M. genitalium, its occurrence in Israeli patients, coinfections, and risk factors. In a cross-sectional study, 259 men were successively enrolled in the Tel Aviv Levinsky Clinic for STIs between November 2008 and November 2010. There were 118 men with urethritis and 141 high-risk men without symptoms. M. genitalium, C. trachomatis, N. gonorrhoeae, and T. vaginalis were detected using nucleic acid amplification tests. Demographic characteristics and risk factors were documented. The overall prevalence of infection with M. genitalium, C. trachomatis, N. gonorrhoeae, and T. vaginalis, were 6.6%, 12.7%, 23.1%, and 0%, respectively. Prevalences in men with urethritis were 11.9%, 22%, and 49%, for M. genitalium, C. trachomatis, and N. gonorrhoeae, respectively. Prevalences in men without symptoms were 2.1%, 5.0%, and 1.4%, for M. genitalium, C. trachomatis, and N. gonorrhoeae, respectively. Co-infections were found only in symptomatic individuals, in whom 5.9% were infected concomitantly with C. trachomatis and N. gonorrhoeae, and 2.5% had dual infection with M. genitalium and N. gonorrhoeae. N. gonorrhoeae, C. trachomatis, and M. genitalium were significantly more prevalent in patients with urethritis. M. genitalium was significantly more prevalent in the heterosexual population than in homosexual males. To conclude, we have found that M. genitalium infection is associated with urethritis in Israeli men, and more so in the heterosexual population. Testing men for M. genitalium as a cause of non-gonococcal urethritis is warranted, particularly because of its poor response to doxycycline and possible failure of azithromycin.

Prevalence of Mycoplasma genitalium in men with urethritis in a large public hospital in Brussels, Belgium: An observational, cross-sectional study

“…These prevalence rates are similar to those found in men with objective NGU from recent series: 16.7% in London [ 4 ] and 11.9% in Tel Aviv [ 16 ]. In Amsterdam, prevalence in men reporting symptoms of urethritis was 5.9%.…”

Prevalence of Polymicrobial Infection in Urethritis

“…Literature review for polymicrobial urethritis showed that majority of the studies are about the coexistence of both GU and NGU pathogens (16,17). However, coexistence of GU-NGU pathogens was detected only in 17.3% our patients.…”

The resistance of causative agents of sexually transmitted infections to azithromycin

“…Высокая эффективность азитромицина при цервицитах, обусловленных C. trachomatis, уретритах, обусловленных C. trachomatis и M. genitalium [3-5, 19, 20, 26], ранее позволяли относить азитромицин к препаратам первой линии выбора при указанных ИППП. В настоящее время приведены многочисленные доказательства роста резистентности к азитромицину [24,25,27].…”

“…В исследовании T. Gottesman и соавт. [25], проведенном в Тель-Авиве, подчеркнута необходимость обследования пациентов с негонококковыми уретритами на наличие M. genitalium, так как поражения, обусловленные этим возбудителем, характеризуются недостаточным эффектом при назначении доксициклина и возможным его отсутствием при назначении азитромицина.…”