The Efficacy of Azithromycin for the Treatment of Genital<i>Mycoplasma genitalium</i>: A Systematic Review and Meta-analysis

Lau, Andrew; Bradshaw, Catriona; Lewis, Dyani; Fairley, Christopher K.; Chen, Marcus Y; Kong, Fabian Yuh Shiong; Hocking, Jane S

doi:10.1093/cid/civ644

Cited by 134 publications

(96 citation statements)

References 52 publications

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“…This level of resistance is well above the threshold of 5% resistance above which the WHO typically recommends against the routine use of a drug for first-line treatment of an STI 30. A recent review reported that the efficacy of azithromycin 1 g for the treatment of urogenital MG has decreased from 85% prior to 2009 to 60% in early 2015 7. This had been postulated to be due to increasing prevalence of macrolide resistance due to the widespread use of azithromycin for the treatment of CT, NGU and MPC 7 31–33.…”

Section: Discussionmentioning

confidence: 99%

“…A recent review reported that the efficacy of azithromycin 1 g for the treatment of urogenital MG has decreased from 85% prior to 2009 to 60% in early 2015 7. This had been postulated to be due to increasing prevalence of macrolide resistance due to the widespread use of azithromycin for the treatment of CT, NGU and MPC 7 31–33. In a recent meta-analysis, persistent MG was associated with a pooled OR of 26 (95% CI 11 to 57) for persistent urethritis, demonstrating that failure to eradicate MG leads to persistent or recurrent signs and symptoms of urethritis in the majority of men 7.…”

Section: Discussionmentioning

confidence: 99%

“…Azithromycin has been recommended for treatment of MG but rising resistance has raised concerns about the use of this drug as the preferred option 7. Alternate treatment with moxifloxacin has been proposed but the high cost of this medication, the potential for hepatotoxicity and reports of resistance have also raised concerns 8…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and antibiotic resistance ofMycoplasma genitaliumamong STI clinic attendees in Western Canada: a cross-sectional analysis

et al. 2017

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ObjectivesTo determine the prevalence and correlates of Mycoplasma genitalium (MG) infection among men and women, determine the prevalence of gene mutations conferring resistance and compare test performance of female specimen types.MethodsA cross-sectional study was conducted on specimens collected for gonorrhoea (NG, Neisseria gonorrhoeae) and chlamydia (CT, Chlamydia trachomatis) among male and female Alberta STI clinic attendees using the M. genitalium transcription-mediated amplification-research use only test. Positive specimens were sequenced for 23SrRNA, parC and gyrA genes. Gender-stratified analysis compared test results using χ2 or Fisher’s exact test, Mann-Whitney U test and logistic regression. Female endocervical and urine specimens were compared.ResultsA total of 2254 individuals were tested; 53.8% (n=1212) were male. Male prevalence of MG was 5.3%; CT was 5.9% and NG was 1.8%. Correlates of male infection were a non-gonococcal urethritis diagnosis and NG coinfection. MG prevalence for women was 7.2%; CT was 5.8% and NG was 1.8%. Correlates of female infection were younger age, Indigenous/Other ethnicity and CT/NG coinfection. Nearly two-thirds of eligible specimens had mutations associated with macrolide resistance and 12.2% of specimens had a parC mutation signifying possible moxifloxacin resistance. There was high concordance (98.1%) of results between urine and endocervical swabs.ConclusionsThe high prevalence of MG relative to CT and NG supports the incorporation of MG testing into routine sexually transmissible infection screening. The high rate of resistance to macrolides and moxifloxacin raises concerns about treatment options. The good concordance of results between urine and endocervical swabs supports the use of female urine specimens for testing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prevalence and antibiotic resistance ofMycoplasma genitaliumamong STI clinic attendees in Western Canada: a cross-sectional analysis

et al. 2017

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“…Once diagnosed, treatment is complicated by the inherent resistance of M. genitalium to cell wall synthesis inhibitors, incomplete effectiveness of doxycycline, and development of azithromycin resistance in many strains (26). Moxifloxacin resistance has been reported (27), and worrisome multidrug resistance is increasing (28).…”

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Experimental Infection of Pig-Tailed Macaques (Macaca nemestrina) with Mycoplasma genitalium

et al. 2017

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Mycoplasma genitalium is an underappreciated cause of human reproductive tract disease, characterized by persistent, often asymptomatic, infection. Building on our previous experiments using a single female pig-tailed macaque as a model for Cosgrove Sweeney, and P. A. Totten, Infect Immun 81:2938 -2951, https://doi.org/10.1128/IAI.01322-12), we cervically inoculated eight additional animals, two of which were simultaneously inoculated in salpingeal tissue autotransplanted into abdominal pockets. Viable M. genitalium persisted in the lower genital tract for 8 weeks in three animals, 4 weeks in two, and 1 week in one; two primates resisted infection. In both animals inoculated in salpingeal pockets, viable M. genitalium was recovered for 2 weeks. Recovery of viable M. genitalium from lower genital tract specimens was improved by diluting the specimen in broth and by Vero cell coculture. Ascension to upper reproductive tract tissues was not detected, even among three persistently infected animals. M. genitalium-specific serum antibodies targeting the immunodominant MgpB and MgpC proteins appeared within 1 week in three animals inoculated both cervically and in salpingeal pockets and in one of three persistently infected animals inoculated only in the cervix. M. genitaliumspecific IgG, but not IgA, was detected in cervical secretions of serum antibodypositive animals, predominantly against MgpB and MgpC, but was insufficient to clear M. genitalium lower tract infection. Our findings further support female pigtailed macaques as a model of M. genitalium infection, persistence, and immune evasion. KEYWORDS Mycoplasma genitalium, animal model, antibody response, persistent infection, primateM ycoplasma genitalium is a fastidious, cell wall-less bacterium notable for its small size (0.1 m), reduced genome (580 kbp), parasitic lifestyle, and apparent specificity for the human host. In men, M. genitalium is a frequent cause of acute and chronic nonchlamydial nongonococcal urethritis (1-4), and in women, M. genitalium is increasingly recognized for its role in cervicitis, pelvic inflammatory disease, preterm birth, and spontaneous abortion (reviewed in reference 5). Additional studies have implicated M. genitalium in tubal factor infertility (6, 7) and endometritis (8). Significantly, M. genitalium infection increases cervical shedding (9) and the risk of acquiring and transmitting HIV (10, 11), further highlighting the potential adverse outcomes resulting from this underappreciated bacterial pathogen.M. genitalium infection can persist for months to years in infected patients (12-19), despite the presence of antibodies to M. genitalium in genital exudates of infected women (20) and in the sera of infected men (21). These data suggest that M. genitalium

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“…However, a test of cure for M. genitalium should be performed if available. Macrolide resistance is increasing worldwide, 5 and a recent study documented up to 50% macrolide resistance 6 in US M. genitalium strains; thus doxycycline is likely to be almost as effective as azithromycin. 7 Dual infections with N. gonorrhoeae and M. genitalium are rare, 6 and the combination of ceftriaxone and azithromycin is unlikely to increase macrolide resistance in M. genitalium, if this treatment combination is given only when gonorrhoea is identified by microscopy, culture or NAAT.…”

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confidence: 99%

Symptomatic urethritis should be confirmed by microscopy

Moi

Horner

2016

Int J STD AIDS

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The Efficacy of Azithromycin for the Treatment of GenitalMycoplasma genitalium: A Systematic Review and Meta-analysis

Cited by 134 publications

References 52 publications

Prevalence and antibiotic resistance ofMycoplasma genitaliumamong STI clinic attendees in Western Canada: a cross-sectional analysis

Prevalence and antibiotic resistance ofMycoplasma genitaliumamong STI clinic attendees in Western Canada: a cross-sectional analysis

Experimental Infection of Pig-Tailed Macaques (Macaca nemestrina) with Mycoplasma genitalium

Symptomatic urethritis should be confirmed by microscopy

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