scholarly journals Azithromycin and doxycycline resistance profiles of US Mycoplasma genitalium strains and their association with treatment outcomes

2021 ◽  
Author(s):  
Gwendolyn E. Wood ◽  
Nicole L. Jensen ◽  
Sabina Astete ◽  
Jørgen S. Jensen ◽  
George E. Kenny ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Treatment Efficacy ◽  
Inhibitory Concentration ◽  
Therapy Monitoring ◽  
Mycoplasma Genitalium ◽  
Clinical Treatment ◽  
Second Line Therapy ◽  
Sexually Transmitted ◽  
Rapid Spread ◽  
Poor Efficacy

Mycoplasma genitalium is a sexually-transmitted bacterium associated with non-gonococcal urethritis (NGU) in men and cervicitis, endometritis, and pelvic inflammatory disease in women. Effective treatment is challenging due to the inherent, and increasingly acquired, antibiotic resistance in this pathogen. In our treatment trial conducted from 2007 – 2011 in Seattle, WA, we demonstrated poor efficacy of azithromycin (AZM) and doxycycline (DOX) against M. genitalium among men with NGU. In the current study, we cultured M. genitalium from 74 of 80 (92.5%) PCR-positive men at enrollment (V-1), and defined the minimum inhibitory concentration (MIC) for AZM (N=56 isolates) and DOX (N=62 isolates). Susceptibility to AZM was bimodal; MICs were >8 μg/ml (44.6%) and <0.004 μg/ml (55.4%) for these isolates. The association of MIC with treatment efficacy was determined for men initially treated with either AZM (N=30) or DOX (N=24). Men treated with AZM were more likely to experience microbiologic treatment failure (p<0.001) if infected with isolates that had AZM MICs >8 μg/ml (18/18 men) as compared with isolates that had AZM MICs (1/12 men). Clinical treatment failure also was more likely to occur (p=0.002) with AZM MICs of >8 μg/ml (12/18 men) than with AZM MICs of <0.004 μg/ml (1/12 men). In contrast, DOX MICs ranged from <0.125 to 2 μg/ml and were not correlated with microbiologic (p=0.71) nor clinical treatment failure (p=0.41), demonstrating no relationship between DOX MICs and treatment efficacy. Given the rapid spread of AZM resistance and the emergence of quinolone resistance, the current second-line therapy, monitoring MICs and evaluating other potential treatments for M. genitalium will be critical.

Gonorrhoea treatment failure and ciprofloxacin resistance

1998 ◽  
Vol 9 (6) ◽  
pp. 323-325 ◽  
Author(s):  
P P L Ng ◽  
R K W Chan ◽  
A E Ling
Keyword(s):  
Treatment Failure ◽  
Inhibitory Concentration ◽  
Clinical Treatment ◽  
Gonococcal Infection ◽  
The Past ◽  
Treatment Failure Rate ◽  
Resistant Strains ◽  
Ciprofloxacin Resistance ◽  
Cure Rates

Summary: Ciprofloxacin-resistant strains of Neisseria gonorrhoeae have been on the increase over the past few years in Singapore and worldwide. The aim of this study is to correlate treatment failures with in vitro ciprofloxacin resistance of N. gonorrhoeae . A total of 694 patients attending the Department of STD Control (DSC) clinic in 1996 who were diagnosed to have gonococcal infection confirmed by culture were analysed. Treatment failure rates for ciprofloxacin were determined and the minimum inhibitory concentration (MIC) of ciprofloxacin were traced for all cases of treatment failure. The case notes of all patients who had strains with MICs of ciprofloxacin in the resistant ( 1 mug/ml) and less sensitive (0.125-0.5 mug/ml) range were also reviewed to determine the clinical outcome. Ciprofloxacin treatment failure rate was 1.7% (8/461) which was lower than the percentage of ciprofloxacin-resistant strains isolated in the laboratory. Of these 8 cases, 6 were resistant and 2 were less sensitive to ciprofloxacin. Cure rates with ciprofloxacin for resistant and less sensitive strains were 40% and 92% respectively. In conclusion, in vitro resistance to ciprofloxacin may not translate into clinical treatment failure. Clinical treatment failures, on the other hand, are also seen in less sensitive strains.

scholarly journals Prevalence of urogenital, anal, and pharyngeal infections with Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium: a cross-sectional study in Reunion island

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A. Calas ◽  
N. Zemali ◽  
G. Camuset ◽  
J. Jaubert ◽  
R. Manaquin ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Mycoplasma Genitalium ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Transmitted Infection ◽  
Cross Sectional ◽  
Sexually Transmitted ◽  
Urogenital Infection ◽  
High Prevalence

Abstract Background Recommendations for sexually transmitted infection (STI) screening vary significantly across countries. This study evaluated the prevalence of urogenital and extragenital infections with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG) in patients visiting a French STI clinic in the Indian Ocean region to determine whether current STI screening practices should be updated. Methods This cross-sectional study examined all patients who visited the STI clinic between 2014 and 2015. Triplex polymerase chain reaction screening for CT, NG, and MG was performed on urine, vaginal, pharyngeal, and anal specimens (FTD Urethritis Basic Kit, Fast Track Diagnostics, Luxembourg). Results Of the 851 patients enrolled in the study, 367 were women (367/851, 43.2%) and 484 were men (484/851, 56.0%). Overall, 826 urogenital specimens (826/851, 97.1%), 606 pharyngeal specimens (606/851, 71.2%), and 127 anal specimens (127/851, 14.9%) were taken from enrolled patients. The prevalence of urogenital CT and MG was high in women ≤25 years (19/186, 10.21%; 5/186, 2.69%) and in men who have sex with women ≤30 years (16/212, 7.54%; 5/212, 2.36%). Among patients with urogenital CT infection, 13.7% (7/51) had urethritis. All patients with urogenital MG infection were asymptomatic. Men who have sex with men had a high prevalence of pharyngeal CT (2/45, 4.44%) and NG (3/44, 6.81%) and a high prevalence of anal CT (2/27, 7.41%), NG (2/27, 7.40%), and MG (1/27, 3.70%). After excluding patients with concomitant urogenital infection, extragenital infections with at least 1 of the 3 pathogens were found in 20 swabs (20/91, 21.9%) taken from 16 patients (16/81, 19.7%), all of them asymptomatic. Conclusions Routine multisite screening for CT, NG, and MG should be performed to mitigate the transmission of STIs in high-risk sexually active populations.

Resistance-guided treatment of Mycoplasma genitalium infection at a UK sexual health centre

2021 ◽  
pp. 095646242098776
Author(s):  
Ruairi JH Conway ◽  
Seamus Cook ◽  
Cassandra Malone ◽  
Simon Bone ◽  
Mohammed Osman Hassan-Ibrahim ◽  
...  
Keyword(s):  
Single Dose ◽  
Confidence Interval ◽  
Sexual Health ◽  
Treatment Failure ◽  
Inflammatory Disease ◽  
Health Centre ◽  
Mycoplasma Genitalium ◽  
Macrolide Resistance ◽  
Fluoroquinolone Resistance ◽  
Treatment Failure Rate

We evaluated the ResistancePlus® MG assay in providing macrolide resistance-guided treatment (RGT) for Mycoplasma genitalium infection at a UK sexual health centre. M. genitalium–positive samples from men with urethritis and women with pelvic inflammatory disease (PID) were tested for macrolide resistance–mediating mutations (MRMMs). MRMM-positive infections were given moxifloxacin 400 mg; otherwise 2 g azithromycin (1 g single dose and then 500 mg OD) was given. Among 57  M. genitalium–positive patients (32 men and 25 women), MRMMs were detected in 41/57 (72% [95% confidence interval (95% CI) 58–83%). Thirty-two of 43 patients given RGT attended for test of cure. Treatment failure rate was significantly lower at 1/32 (3%) than 10/37 (27%) before RGT ( n = 37 [men = 23 and women = 17]; p = 0.008). Treatment failure was lower in male urethritis (0/15 vs. 7/21 p = 0.027) but not in female PID. There was a trend of a shorter time to negative test of cure (TOC) in male urethritis (55.1 [95% 43.7–66.4] vs. 85.1 [95% CI CI 64.1–106.0] days, p = 0.077) but not in female PID. Macrolide resistance is higher than previous UK reports and higher than expected. RGT reduces overall treatment failure and is particularly beneficial in M. genitalium urethritis. Fluoroquinolone resistance will continue to rise with increasing fluoroquinolone use, and RGT is critical to direct appropriate azithromycin use and prevent overuse of moxifloxacin.

scholarly journals Improved molecular laboratory productivity by consolidation of testing on the new random-access analyzer Alinity m

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Martin Obermeier ◽  
Monia Pacenti ◽  
Robert Ehret ◽  
Francesco Onelia ◽  
Rory Gunson ◽  
...  
Keyword(s):  
Trichomonas Vaginalis ◽  
Random Access ◽  
Mycoplasma Genitalium ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
B Virus ◽  
Immunodeficiency Virus ◽  
International Multicenter Study ◽  
Laboratory Productivity ◽  
Laboratory Workflow

AbstractObjectivesAutomated molecular analyzers have accelerated diagnosis, allowing earlier intervention and better patient follow-up. A recently developed completely automated molecular analyzer, Alinity™ m (Abbott), offers consolidated, continuous, and random-access testing that may improve molecular laboratory workflow.MethodsAn international, multicenter study compared laboratory workflow metrics across various routine analyzers and Alinity m utilizing assays for human immunodeficiency virus type 1 (HIV-1), hepatitis C virus (HCV), hepatitis B virus (HBV), high-risk human papillomavirus (HR HPV), and sexually transmitted infection (STI) (Chlamydia trachomatis [CT]/Neisseria gonorrhoeae [NG]/Trichomonas vaginalis [TV]/Mycoplasma genitalium [MG]). Three turnaround times (TATs) were assessed: total TAT (sample arrival to result), sample onboard TAT (sample loading and test starting to result), and processing TAT (sample aspiration to result).ResultsTotal TAT was reduced from days with routine analyzers to hours with Alinity m, independent of requested assays. Sample onboard TATs for standard workflow using routine analyzers ranged from 7 to 32.5 h compared to 2.75–6 h for Alinity m. The mean sample onboard TAT for STAT samples on Alinity m was 2.36 h (±0.19 h). Processing TATs for Alinity m were independent of the combination of assays, with 100% of results reported within 117 min.ConclusionsThe consolidated, continuous, random-access workflow of Alinity m reduces TATs across various assays and is expected to improve both laboratory operational efficiency and patient care.

scholarly journals Mycoplasma genitalium incidence, persistence, concordance between partners and progression: systematic review and meta-analysis

2019 ◽  
Vol 95 (5) ◽  
pp. 328-335 ◽  
Author(s):  
Manuel Cina ◽  
Lukas Baumann ◽  
Dianne Egli-Gany ◽  
Florian S Halbeisen ◽  
Hammad Ali ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antimicrobial Resistance ◽  
Meta Analysis ◽  
Age Distribution ◽  
Mycoplasma Genitalium ◽  
Developed Countries ◽  
Sexual Partners ◽  
Risk Of Bias ◽  
Infection Status ◽  
Sexually Transmitted

BackgroundMycoplasma genitalium is increasingly seen as an emerging sexually transmitted pathogen, and has been likened to Chlamydia trachomatis, but its natural history is poorly understood. The objectives of this systematic review were to determine M. genitalium incidence, persistence, concordance between sexual partners and the risk of pelvic inflammatory disease (PID).MethodsWe searched Medline, EMBASE, LILACS, IndMed and African Index Medicus from 1 January 1981 until 17 March 2018. Two independent researchers screened studies for inclusion and extracted data. We examined results in forest plots, assessed heterogeneity and conducted meta-analysis where appropriate. Risk of bias was assessed for all studies.ResultsWe screened 4634 records and included 18 studies; six (4201 women) reported on incidence, five (636 women) on persistence, 10 (1346 women and men) on concordance and three (5139 women) on PID. Incidence in women in two very highly developed countries was 1.07 per 100 person-years (95% CI 0.61 to 1.53, I2 0%). Median persistence of M. genitalium was estimated from one to three months in four studies but 15 months in one study. In 10 studies measuring M. genitalium infection status in couples, 39%–50% of male or female sexual partners of infected participants also had M. genitalium detected. In prospective studies, PID incidence was higher in women with M. genitalium than those without (risk ratio 1.73, 95% CI 0.92 to 3.28, I2 0%, two studies).DiscussionIncidence of M. genitalium in very highly developed countries is similar to that for C. trachomatis, but concordance might be lower. Taken together with other evidence about age distribution and antimicrobial resistance in the two infections, M. genitalium is not the new chlamydia. Synthesised data about prevalence, incidence and persistence of M. genitalium infection are inconsistent. These findings can be used for mathematical modelling to investigate the dynamics of M. genitalium.Registration numbersCRD42015020420, CRD42015020405

High Prevalence of Sexually Transmitted Infections and Risk Factors Among HIV-Positive Individuals in Yunnan, China

2021 ◽  
Author(s):  
Wei Tu ◽  
Yu-Ye Li ◽  
Yi-Qun Kuang ◽  
Rong-Hui Xie ◽  
Xing-Qi Dong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sexually Transmitted Infections ◽  
Genital Tract ◽  
Mycoplasma Genitalium ◽  
Cross Sectional Study ◽  
Multiple Infections ◽  
Hiv Positive ◽  
Cross Sectional ◽  
Sexually Transmitted ◽  
High Prevalence

Abstract Background Yunnan has the highest rates of HIV in the country. Other treatable sexually transmitted infections (STIs) are associated with accelerated HIV transmission and poor ART outcomes, but are only diagnosed by syndromic algorithms. Methods We recruited 406 HIV-positive participants for a cross-sectional study (204 ART-naive and 202 ART). Blood samples and first-voided urine samples were collected. Real-time polymerase chain reaction methods were used for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG). Syphilis and HSV-2 tests were also performed. Results Among 406 participants, the overall prevalence of STI was 47.0% and 45.1% in ART-naive individuals and 49.0% in ART individuals, respectively. Testing frequency was 11.6% (11.8% vs 11.4%), 33.2% (29.4% vs 37.1%), 3.2% (3.4% vs 3.0%), 2.0% (3.4% vs 0.5%) and 4.7% (6.4% vs 3.0%) for active syphilis, HSV-2, chlamydia, gonorrhoeae and genitalium. Percentage of multiple infections in both groups was 10.8% (22/204) in ART-naive participants and 9.9% (20/202) in ART participants. Females, age between 18 to 35 years, ever injected drugs, homosexual or bisexual, HIV/HBV coinfection, and not receiving ART were identified as risk factors. Self-reported asymptom was not eliminating of having a laboratory-diagnosed STI. Conclusions STI prevalence was 47.0% (45.1% vs 49.0%), HSV-2, syphilis and MG were the most common STIs in HIV-infected individuals. We found high prevalence (6.4%) of Mycoplasma genitalium in ART-naive individuals. ART can reduce the diversity of STI-HIV coinfection but not the prevalence. HIV-positive individuals tend to neglect or maybe hide their genital tract discomfort, thus we suggest strengthening STI joint screening and treatment services among HIV-infected individuals whether they describe genital tract discomfort or not.

scholarly journals In Vitro Activity of Lefamulin against Sexually Transmitted Bacterial Pathogens

2018 ◽  
Vol 62 (5) ◽  
Author(s):  
Susanne Paukner ◽  
Astrid Gruss ◽  
Jørgen Skov Jensen
Keyword(s):  
Chlamydia Trachomatis ◽  
Bacterial Pathogens ◽  
Mycoplasma Genitalium ◽  
Standard Of Care ◽  
Multidrug Resistant ◽  
In Vitro Activity ◽  
First Line ◽  
Content Type ◽  
Sexually Transmitted

ABSTRACT The pleuromutilin antibiotic lefamulin demonstrated in vitro activity against the most relevant bacterial pathogens causing sexually transmitted infections (STI), including Chlamydia trachomatis (MIC 50/90 , 0.02/0.04 mg/liter; n = 15), susceptible and multidrug-resistant Mycoplasma genitalium (MIC range, 0.002 to 0.063 mg/liter; n = 6), and susceptible and resistant Neisseria gonorrhoeae (MIC 50/90 , 0.12/0.5 mg/liter; n = 25). The results suggest that lefamulin could be a promising first-line antibiotic for the treatment of STI, particularly in populations with high rates of resistance to standard-of-care antibiotics.

Epididymo-orchitis

2019 ◽  
pp. 193-200
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Differential Diagnosis ◽  
Partner Notification ◽  
Mycoplasma Genitalium ◽  
Older Men ◽  
Sexually Transmitted ◽  
Testicular Pain ◽  
Younger Men

Epididymo-orchitis is inflammation of the epididymis +/– testes, usually caused by sexually transmitted pathogens in younger men (<35) and urinary pathogens in older men. Symptoms include testicular pain and swelling, often in combination with symptoms of urethritis (e.g. discharge, dysuria) or urinary tract infection (e.g. dysuria, frequency). Complications can include chronic epididymitis, abscess, hydrocele. and infertility. Common sexually transmitted pathogens include chlamydia, gonorrhoea, and Mycoplasma genitalium, while non-sexually acquired organisms include coliforms such as Escherichia coli. This chapter details diagnosis, and differential diagnosis of testicular pain and swelling, as well as investigations, and management of epididymo-orchitis, including partner notification and follow up.

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