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Adawiyah RA, Bradshaw CS, Vodstrcil LA, Fairley CK, Zhang L, Ong JJ. Cost-effectiveness of resistance-guided therapy for Mycoplasma genitalium in Australia. Sci Rep 2024; 14:12856. [PMID: 38834637 DOI: 10.1038/s41598-024-63056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/24/2024] [Indexed: 06/06/2024] Open
Abstract
The recommended first-line treatment for Mycoplasma genitalium infections is azithromycin. However, the prevalence of macrolide resistance for M. genitalium has increased to more than 50% worldwide. In 2013, Australia introduced a resistance-guided therapy (RGT) strategy to manage M. genitalium infections. This study assesses the cost-effectiveness of the RGT approach compared to no RGT (i.e., without macrolide resistance profile test) in women, men who have sex with men (MSM), and men who have sex with women (MSW) in Australia. We constructed dynamic transmission models of M. genitalium infections in women, MSM, and MSW in Australia, each with a population of 100,000. These models compared the costs and quality-adjusted life-years (QALYs) gained between RGT and no RGT scenarios from a healthcare perspective over ten years. All costs are reported in 2022 Australian dollars (Australian $). In our model, RGT is cost saving in women and MSM, with the incremental net monetary benefit of $1.3 million and $17.9 million, respectively. In MSW, the RGT approach is not cost-effective, with an incremental cost-effectiveness ratio of -$106.96 per QALY gained. RGT is cost saving compared to no RGT for M. genitalium infections in women and MSM, supporting its adoption as the national management strategy for these two population groups.
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Affiliation(s)
- Rabiah Al Adawiyah
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
| | - Catriona S Bradshaw
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Lenka A Vodstrcil
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Christopher K Fairley
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Lei Zhang
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
- Clinical Medical Research Center, Children's Hospital of Nanjing Medical University, Nanjing Medical University, 210008, Nanjing, Jiangsu, China.
| | - Jason J Ong
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Català A, Hernández DG. AEDV Expert Recommendations on the Management of Suppurative Sexually Transmitted Infections. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00340-5. [PMID: 38663731 DOI: 10.1016/j.ad.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
The incidence of sexually transmitted infections (STIs) is increasing in Spain. Suppurative STIs are one of the most frequent reasons for consultation in specialized centers. The reason for suppurative STIs is multiple and their empirical treatment varies with the currently growing problem of antimicrobial resistance. Dermatologists are trained and prepared to treat these diseases, but their correct management requires active knowledge of national and international guidelines. The present document updates, reviews and summarizes the main expert recommendations on the management and treatment of these STIs.
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Affiliation(s)
- A Català
- Servicio de Dermatología y Venereología, Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología, España; Programa de Salud Sexual, Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, España; Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología,spaña.
| | - D García Hernández
- Programa de Salud Sexual, Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, España; Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología,spaña
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3
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Chromy D, Starossek L, Grabmeier-Pfistershammer K, Adamek S, Maischack F, Sammet S, Sadoghi B, Stary G, Willinger B, Weninger W, Esser S, Makristathis A, Bauer WM. High cure rates of Mycoplasma genitalium following empiric treatment with azithromycin alongside frequent detection of macrolide resistance in Austria. Infection 2024:10.1007/s15010-024-02261-6. [PMID: 38649669 DOI: 10.1007/s15010-024-02261-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, often harboring resistance-associated mutations to azithromycin (AZM). Global surveillance has been mandated to tackle the burden caused by MG, yet no data are available for Austria. Thus, we aimed to investigate the prevalence of MG, disease characteristics, and treatment outcomes at the largest Austrian HIV-and STI clinic. METHODS All MG test results at the Medical University of Vienna from 02/2019 to 03/2022 were evaluated. Azithromycin resistance testing was implemented in 03/2021. RESULTS Among 2671 MG tests, 199 distinct and mostly asymptomatic (68%; 135/199) MG infections were identified, affecting 10% (178/1775) of all individuals. This study included 83% (1479/1775) men, 53% (940/1775) men who have sex with men (MSM), 31% (540/1754) HIV+, and 15% (267/1775) who were using HIV pre-exposure prophylaxis (PrEP). In logistic regression analysis, 'MSM' (aOR 2.55 (95% CI 1.65-3.92)), 'use of PrEP' (aOR 2.29 (95% CI 1.58-3.32)), and 'history of syphilis' (aOR 1.57 (95% CI 1.01-2.24) were independent predictors for MG infections. Eighty-nine percent (178/199) received treatment: 11% (21/178) doxycycline (2 weeks), 52% (92/178) AZM (5 days), and 37% ( 65/178) moxifloxacin (7-10 days) and 60% (106/178) had follow-up data available showing negative tests in 63% (5/8), 76% (44/58) and 85% (34/40), respectively. AZM resistance analysis was available for 57% (114/199)) and detected in 68% (78/114). Resistance-guided therapy achieved a cure in 87% (53/61), yet, empiric AZM-treatment (prior to 03/2021) cleared 68% (26/38). CONCLUSIONS Mycoplasma genitalium was readily detected in this Austrian observational study, affected predominantly MSM and often presented as asymptomatic disease. We observed a worryingly high prevalence of AZM resistance mutations; however, empiric AZM treatment cleared twice as many MG infections as expected.
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Affiliation(s)
- David Chromy
- Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Dermatology and Venereology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lisa Starossek
- Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Sarah Adamek
- Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Felix Maischack
- Department of Dermatology and Venereology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stefanie Sammet
- Department of Dermatology and Venereology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Birgit Sadoghi
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weninger
- Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Esser
- Department of Dermatology and Venereology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Athanasios Makristathis
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Michael Bauer
- Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Obafemi OA, Rowan SE, Nishiyama M, Wendel KA. Mycoplasma genitalium: Key Information for the Primary Care Clinician. Med Clin North Am 2024; 108:297-310. [PMID: 38331481 DOI: 10.1016/j.mcna.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, which appears to be a cause of urethritis and cervicitis and has been associated with pelvic inflammatory disease (PID), epididymitis, proctitis, infertility, complications during pregnancy, and human immunodeficiency virus (HIV) transmission. Three Food and Drug Administration (FDA) approved tests are available. Testing should be focused to avoid inappropriate antibiotic use. The Center of Disease Control and Prevention (CDC) guidelines recommend testing for persistent male urethritis, cervicitis, and proctitis and state that testing should be considered in cases of PID. Testing is also recommended for sexual contacts of patients with MG. Testing is not recommended in asymptomatic patients, including pregnant patients, who do not have a history of MG exposure. Although resistance-guided therapy is recommended, there are currently no FDA approved tests for MG macrolide resistance, and tests are not widely available in the United States. The CDC recommends 2-step treatment with doxycycline followed by azithromycin or moxifloxacin. Moxifloxacin is recommended if resistance testing is unavailable or testing demonstrates macrolide resistance..
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Affiliation(s)
- Oluyomi A Obafemi
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Department of Family Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Sarah E Rowan
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Masayo Nishiyama
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA
| | - Karen A Wendel
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
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McNeil CJ, Barroso LF, Workowski K. Proctitis: An Approach to the Symptomatic Patient. Med Clin North Am 2024; 108:339-354. [PMID: 38331484 DOI: 10.1016/j.mcna.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Proctitis is an inflammatory condition of the distal rectum that can be associated with common sexually transmitted infections (STIs), such as gonorrhea, chlamydia, and syphilis. For persons presenting with ulcerative findings on examination, in addition to syphilis, Mpox, lymphogranuloma venereum, and herpes simplex virus should be in the differential. Providers should also be aware that there are evolving data to support a role for Mycoplasma genitalium in proctitis. Performing a comprehensive history, clinical evaluation including anoscopy, and rectal nucleic amplification STI testing may be useful in identifying the cause of proctitis and targeting treatment.
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Affiliation(s)
- Candice J McNeil
- Department of Medicine, Section on Infectious Diseases, Wake Forest University School of Medicine.
| | - Luis F Barroso
- Department of Medicine, Section on Infectious Diseases, Wake Forest University School of Medicine
| | - Kimberly Workowski
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
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Ando N, Mizushima D, Shimizu Y, Uemura Y, Takano M, Mitobe M, Kobayashi K, Kubota H, Miyake H, Suzuki J, Sadamasu K, Nakamoto T, Aoki T, Watanabe K, Oka S, Gatanaga H. Sitafloxacin- Versus Moxifloxacin-Based Sequential Treatment for Mycoplasma Genitalium Infections: Protocol for a Multicenter, Open-Label Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e52565. [PMID: 37962941 PMCID: PMC10685287 DOI: 10.2196/52565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Mycoplasma genitalium is an emerging sexually transmitted pathogen associated with increasing antibiotic resistance. The current treatment guidelines recommend moxifloxacin-sequential therapy for macrolide-resistant Mgenitalium or strains with unknown resistance profiles. However, it is unclear whether sitafloxacin, a 4th-generation fluoroquinolone antibiotic, is effective against resistant strains. OBJECTIVE This study aims to assess and compare the efficacy and safety of sitafloxacin- and moxifloxacin-based treatment regimens for managing Mgenitalium infections. METHODS We will conduct this randomized controlled trial at multiple centers in Japan. Eligible participants include adults aged 18 years or older with a confirmed Mgenitalium infection, as determined through the nucleic acid amplification test. Patients will be randomly assigned using a stratified approach based on the treatment facility and infection site. The interventions comprise oral sitafloxacin (200 mg) daily for 7 days (with optional pretreatment of oral doxycycline, 200 mg, daily for up to 7 days), with a control group receiving oral doxycycline (200 mg) daily for 7 days followed by moxifloxacin (400 mg) daily for another 7 days. The primary outcome is the treatment success rate with a superiority margin of 10%, as confirmed through the nucleic acid amplification test. Secondary outcomes encompass changes in the bacterial load at the urogenital or rectal sites and the emergence of posttreatment-resistant mutant strains. RESULTS Enrollment commenced in June 2023 and will conclude in December 2024, with findings anticipated by 2025. The expected success rates fall within the range of 80% for sitafloxacin and 42% for moxifloxacin against Mgenitalium carrying the G248T (S83I) mutation, based on previous studies. Accordingly, with a 5% significance level (2-sided) and 80% statistical power, we aim to recruit 50 participants per group, factoring in a 10% expected dropout rate. CONCLUSIONS This study will provide valuable insights into the efficacy and safety of sitafloxacin- versus moxifloxacin-based sequential therapy in treating Mgenitalium infections. These findings have the potential to influence clinical guidelines, favoring more effective therapeutic choices. The multicenter approach enhances the robustness of this study. However, a limitation is the potential insufficiency of statistical power to detect posttreatment-resistant mutant strains in each group, rendering posttreatment-resistance mutations a notable concern. In the future, we may need to increase the sample size to enhance power. TRIAL REGISTRATION Japan Registry of Clinical Trials (jRCTs031230111); https://jrct.niph.go.jp/en-latest-detail/jRCTs031230111. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52565.
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Affiliation(s)
- Naokatsu Ando
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Daisuke Mizushima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yosuke Shimizu
- Biostatistics Section, Department of Data Science, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Section, Department of Data Science, National Center for Global Health and Medicine, Tokyo, Japan
| | - Misao Takano
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Morika Mitobe
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Kai Kobayashi
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Hiroaki Kubota
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Hirofumi Miyake
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Jun Suzuki
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Kenji Sadamasu
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Takato Nakamoto
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takahiro Aoki
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Watanabe
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
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Berti V, Blondel J, Spindler L, de Parades V, Aubert M, Le Monnier A, Lourtet-Hascoet J. Infective anoproctitis in men having sex with men: Don't forget Mycoplasma genitalium. Infect Dis Now 2023; 53:104771. [PMID: 37598775 DOI: 10.1016/j.idnow.2023.104771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES The aim was to describe the clinical characteristics of symptomatic anoproctitis and the occurrence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG) infections in a prospective cohort of MSM patients. METHODS From February 2018 to January 2020, all consecutive patients presenting at the Leopold Bellan Proctology Institute of Saint-Joseph Hospital, Paris, France with symptoms of anoproctitis were tested on rectal samples for C. trachomatis (CT), N. gonorrhoeae (NG), M. genitalium (MG). Clinical, microbiological, biological data, STI risk factors, medical history and treatments were collected. RESULTS Three hundred and sixty-five patients were included for suspected infective anoproctitis. CT was detected in 84/365 (23%) patients, NG in 45/365 (12%) and MG in 46/315 patients (15%), associated with macrolide resistance in 28/46 MG strains (61%). The most frequent symptoms were rectal pains, rectal bleeding, purulent discharge in 253 (79%), 191 (60%), and 164 (51%) of cases respectively. In comparison with MG infections, ulcerations, erythematous proctitis, rectorragia and false needs were more frequently described in CT infections, while purulent proctitis, functional pain and purulent discharge were more often observed in NG and CT anoproctitis. CONCLUSION We found a high prevalence rate of STIs due to CT, NG, while MG detection was associated with a high rate of macrolide resistance in a cohort of MSM patients. Our results confirm that in cases of symptomatic anoproctitis, MG should be tested in association with other STI pathogens.
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Affiliation(s)
- V Berti
- Clinical Microbiology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - J Blondel
- Clinical Microbiology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - L Spindler
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | - V de Parades
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | - M Aubert
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | - A Le Monnier
- Clinical Microbiology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France; Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France; Micalis Institute, Université Paris-Saclay, INRAE, AgroParisTech, Jouy-en-Josas, France
| | - J Lourtet-Hascoet
- Clinical Microbiology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
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Ong JJ, Lim A, Bradshaw C, Taylor-Robinson D, Unemo M, Horner PJ, Vickerman P, Zhang L. Cost-effectiveness of testing for Mycoplasma genitalium among men who have sex with men in Australia. Sex Transm Infect 2023; 99:398-403. [PMID: 36958826 DOI: 10.1136/sextrans-2022-055611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/23/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES Mycoplasma genitalium (MG) disproportionately affects men who have sex with men (MSM). We determined the cost-effectiveness of different testing strategies for MG in MSM, taking a healthcare provider perspective. METHODS We used inputs from a dynamic transmission model of MG among MSM living in Australia in a decision tree model to evaluate the impact of four testing scenarios on MG incidence: (1) no one tested; (2) symptomatic MSM; (3) symptomatic and high-risk asymptomatic MSM; (4) all MSM. We calculated the incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $A30 000 per quality-adjusted life year (QALY) gained. We explored the impact of adding an antimicrobial resistance (AMR) tax (ie, additional cost per antibiotic consumed) to identify the threshold, whereby any testing for MG is no longer cost-effective. RESULTS Testing only symptomatic MSM is the most cost-effective (ICER $3677 per QALY gained) approach. Offering testing to all MSM is dominated (ie, higher costs and lower QALYs gained compared with other strategies). When the AMR tax per antibiotic given was above $150, any testing for MG was no longer cost-effective. CONCLUSION Testing only symptomatic MSM is the most cost-effective option, even when the potential costs associated with AMR are accounted for (up to $150 additional cost per antibiotic given). For pathogens like MG, where there are anticipated future costs related to AMR, we recommend models that test the impact of incorporating an AMR tax as they can change the results and conclusions of cost-effectiveness studies.
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Affiliation(s)
- Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- London School of Hygiene and Tropical Medicine, London, UK
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Aaron Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Catriona Bradshaw
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Orebro, Sweden
- Institute for Global Health, University College London, London, UK
| | - Paddy J Horner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lei Zhang
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
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9
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Ando N, Mizushima D, Takano M, Mitobe M, Kobayashi K, Kubota H, Miyake H, Suzuki J, Sadamasu K, Aoki T, Watanabe K, Uemura H, Yanagawa Y, Gatanaga H, Oka S. Effectiveness of sitafloxacin monotherapy for quinolone-resistant rectal and urogenital Mycoplasma genitalium infections: a prospective cohort study. J Antimicrob Chemother 2023:dkad208. [PMID: 37376970 PMCID: PMC10393875 DOI: 10.1093/jac/dkad208] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Mycoplasma genitalium has a tendency to develop macrolide and quinolone resistance. OBJECTIVES We investigated the microbiological cure rate of a 7 day course of sitafloxacin for the treatment of rectal and urogenital infections in MSM. PATIENTS AND METHODS This open-label, prospective cohort study was conducted at the National Center for Global Health and Medicine, Tokyo, Japan from January 2019 to August 2022. Patients with M. genitalium urogenital or rectal infections were included. The patients were treated with sitafloxacin 200 mg daily for 7 days. M. genitalium isolates were tested for parC, gyrA and 23S rRNA resistance-associated mutations. RESULTS In total, 180 patients (median age, 35 years) were included in this study, of whom 77.0% (97/126) harboured parC mutations, including 71.4% (90/126) with G248T(S83I) in parC, and 22.5% (27/120) harboured gyrA mutations. The median time to test of cure was 21 days. The overall microbiological cure rate was 87.8%. The cure rate was 100% for microbes harbouring parC and gyrA WTs, 92.9% for microbes harbouring parC G248T(S83I) and gyrA WT, and 41.7% for microbes harbouring parC G248T(S83I) and gyrA with mutations. The cure rate did not differ significantly between urogenital and rectal infection (P = 0.359). CONCLUSIONS Sitafloxacin monotherapy was highly effective against infection caused by M. genitalium, except strains with combined parC and gyrA mutations. Sitafloxacin monotherapy can be used as a first-line treatment for M. genitalium infections in settings with a high prevalence of parC mutations and a low prevalence of gyrA mutations.
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Affiliation(s)
- Naokatsu Ando
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Daisuke Mizushima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Misao Takano
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Morika Mitobe
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Kai Kobayashi
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Hiroaki Kubota
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Hirofumi Miyake
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Jun Suzuki
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Kenji Sadamasu
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Takahiro Aoki
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Watanabe
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Haruka Uemura
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuaki Yanagawa
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
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Wood GE, Bradshaw CS, Manhart LE. Update in Epidemiology and Management of Mycoplasma genitalium Infections. Infect Dis Clin North Am 2023; 37:311-333. [PMID: 37105645 DOI: 10.1016/j.idc.2023.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Mycoplasma genitalium is a frequent cause of urogenital syndromes in men and women and is associated with adverse sequelae in women. M genitalium also infects the rectum, and may cause proctitis, but rarely infects the pharynx. Diagnosis requires nucleic acid amplification testing. Antibiotic resistance is widespread: more than half of infections are resistant to macrolides and fluoroquinolone resistance is increasing. Resistance-guided therapy is recommended for symptomatic patients, involving initial treatment with doxycycline to reduce organism load followed by azithromycin for macrolide-sensitive infections or moxifloxacin for macrolide-resistant infections. Neither screening nor tests of cure are recommended in asymptomatic persons.
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Affiliation(s)
- Gwendolyn E Wood
- Division of Infectious Diseases, University of Washington, Center for AIDS and STD, Box 359779, 325 9th Avenue, Seattle, WA 98104, USA.
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Center for AIDS and STD, Box 359931, 325 9th Avenue, Seattle, WA 98104, USA
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11
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Lee TF, Lin KY, Chang SY, Huang YT, Hsueh PR. Performance of two commercial multiplex polymerase chain reaction assays for the etiological diagnosis of sexually transmitted infections among men who have sex with men. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:104-110. [PMID: 36050217 DOI: 10.1016/j.jmii.2022.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the etiologies of sexually transmitted infections (STIs) among men who have sex with men (MSM) in Taiwan. METHODS Two commercial assays, the BD MAX Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and Trichomonas vaginalis (TV) panel and the Allplex™ STI Essential assay (CT, GC, Mycoplasma genitalium [MG], Mycoplasma hominis [MH], Ureaplasma urealyticum [UU], Ureaplasma parvum [UP], and TV) were evaluated. During the first stage, urine and rectal swab samples from 168 patients were evaluated using the BD MAX assay, and the multiplex RT-PCR Allplex™ STI Essential assay was applied only to the patients with positive results on the BD MAX asay (n = 49). During the second stage, urine and rectal swab samples from 90 patients were evaluated using the BD MAX assay and the Allplex™ qPCR. RESULTS The Allplex qPCR identified all CT, missed one and additionally one TV from the positive samples (n = 49) by the BD MAX assay in the first stage. At the second stage, both commercial assays showed similar detection rate of CT, NG or CT/NG coinfection (11.1%, 1.1% and 4.4% by the BD MAX assay; 10.0%, 1.1% and 2.2% by the Allplex qPCR). The positivity rates of MG, MH, and UU by the Allplex qPCR were 4.4%, 2.2%, and 12.2%, respectively, for urine samples and 10%, 13.3%, and 22.2%, respectively, for anal swab samples. CONCLUSIONS High rates of STI-associated etiologies were observed in MSM. The positive rates were higher in rectal swabs than in urine samples.
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Affiliation(s)
- Tai-Fen Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Yin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Sui-Yuan Chang
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Clinical Laboratory Science and Medical Biotechnology College of Medicine, Taipei, Taiwan
| | - Yu-Tsung Huang
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
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12
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Kumbhakar R, Barbee LA, Berzkalns A, Herrmann S, Ramchandani MS, Golden MR, Dombrowski JC. Etiologies of Proctitis at a Sexual Health Clinic in Seattle, Washington From 2011 to 2021. Sex Transm Dis 2022; 49:860-862. [PMID: 35969837 PMCID: PMC10538061 DOI: 10.1097/olq.0000000000001696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We analyzed microbiologic etiologies of proctitis among patients seen in an urban sexual health clinic during 2011 to 2021. Among 759 cases, 179 (24%) tested positive for Neisseria gonorrhoeae , 171 (23%) for Chlamydia trachomatis , 21 (3%) for herpes simplex virus, 30 (4%) for syphilis, and 73 (10%) for multiple pathogens; no pathogen was identified in 425 (56%).
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Affiliation(s)
- Raaka Kumbhakar
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Lindley A. Barbee
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Anna Berzkalns
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Susannah Herrmann
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Meena S. Ramchandani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Matthew R. Golden
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Julia C. Dombrowski
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
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13
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Chua TP, Bodiyabadu K, Machalek DA, Garland SM, Bradshaw CS, Plummer EL, Danielewski J, Vodstrcil LA, Doyle ML, Murray GL. Prevalence of Mycoplasma genitalium fluoroquinolone-resistance markers, and dual-class-resistance markers, in asymptomatic men who have sex with men. J Med Microbiol 2021; 70. [PMID: 34590993 PMCID: PMC8697509 DOI: 10.1099/jmm.0.001429] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Failure of fluoroquinolones, the principal treatment option for macrolide-resistant Mycoplasma genitalium infections, has recently emerged. This is of particular concern for men who have sex with men (MSM), who have high proportions of macrolide-resistant M. genitalium infections. Treatment failure with moxifloxacin is likely the result of single nucleotide polymorphisms (SNPs) in parC, whilst concurrent gyrA mutations may play a role.Gap Statement. The levels of fluoroquinolone resistance and dual-class (i.e. macrolide and fluoroquinolone) resistance in M. genitalium among asymptomatic MSM is unknown.Aim. To (i) determine the proportion of fluoroquinolone resistance and dual-class resistance in M. genitalium infections among asymptomatic MSM, (ii) explore any clinical and behavioural associations with fluoroquinolone resistance, and (iii) determine the distribution of antibiotic resistance among M. genitalium mgpB sequence types (STs).Methodology. M. genitalium positive samples (N=94) were obtained from 1001 asymptomatic MSM enrolled in a study at Melbourne Sexual Health Centre (Carlton, Australia) between August 2016 and September 2017. Sanger sequencing was performed to determine the proportion of M. genitalium infections with SNPs in parC that have previously been associated with failure of moxifloxacin (corresponding to amino changes S83I, D83R, D87Y and D87N) and in gyrA (corresponding to amino acid changes M95I, D99N, D99Y and D99G). Associations between clinical/behavioural factors and parC SNPs were examined. Strain typing was performed by sequencing a portion of the mgpB gene.Results. The proportion of MSM with infections harbouring parC and gyrA SNPs was 13.0 % [95 % confidence interval (CI): 6.8-23.2 %] and 4.7 % (95 % CI: 1.1-13.4 %), respectively; dual-class resistance was 13.0 %. No significant clinical/behavioural associations were found. Antibiotic resistance was not restricted to specific mgpB STs.Conclusion. One in eight (13 %) of asymptomatic MSM with M. genitalium had an infection with dual-class-resistance mutations. Typing by mgpB sequence suggested fluoroquinolone resistance is arising from independent mutation events. This study illustrates that asymptomatic MSM may act as a reservoir for antibiotic-resistant M. genitalium.
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Affiliation(s)
- Teck-Phui Chua
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Kaveesha Bodiyabadu
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Dorothy A Machalek
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,Kirby Institute, University of New South Wales, Kensington, Sydney, New South Wales, Australia
| | - Suzanne M Garland
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Erica L Plummer
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Danielewski
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michelle L Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Gerald L Murray
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
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14
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 793] [Impact Index Per Article: 264.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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15
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Shedko ED, Goloveshkina EN, Akimkin VG. Molecular epidemiology and antimicrobials resistance mechanism of Mycoplasma genitlaium. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Currently, infections caused by Mycoplasma genitalium are ones the most common sexually transmitted infections. Their prevalence is varied from 1.3% to 15.9%. Infections caused by M.genitalium may lead to urethritis in men and a wide spectrum of diseases in women. Antibiotic resistance now is one of the most emerging problems both in the scientific and in the healthcare fields. The usage of antimicrobials inhibiting cell wall synthesis for the treatment of M.genitalium is ineffective, and resistance to macrolides and fluoroquinolones is increasing rapidly. M.genitalium infections diagnostics is complicated due to specific conditions and duration of culture methods. The usage of nucleic acid amplification techniques is the most relevant for laboratory diagnostics, and is used in existing assays. This review compiles current data on the prevalence, molecular mechanisms of pathogenesis and antibiotic resistance, as well as diagnostics methods of M.genitalium.
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16
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Zhang XH, Zhao PZ, Ke WJ, Wang LY, Tso LS, Chen ZY, Liao YY, Liang CM, Chen HR, Ren XQ, Huang JM, Ong JJ, Yang F, Yang LG. Prevalence and correlates of Mycoplasma genitalium infection among patients attending a sexually transmitted infection clinic in Guangdong, China: a cross-sectional study. BMC Infect Dis 2021; 21:649. [PMID: 34225661 PMCID: PMC8256639 DOI: 10.1186/s12879-021-06349-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Mycoplasma genitalium (MG) causes urogenital tract infections and is associated with reproductive morbidity. Although MG has been reported across many regions and population groups, it is not yet routinely tested for in China. Our study contributes to current research by reporting the prevalence and correlates of MG infection in patients attending a sexually transmitted infection (STI) clinic in Guangdong from Jan 2017-May 2018. Methods Urethral (from 489 men) and endo-cervical (from 189 women) samples, blood samples, and patient histories (via questionnaires) were collected. Doctors clinically diagnosed anogenital warts (GW) during the examination (n = 678). The presence of MG was evaluated using an in-house via polymerase chain reaction protocol. We also tested all participants for herpes simplex virus-2 (HSV-2), Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), syphilis and HIV. Univariate and multivariate logistic regression were used to evaluate factors associated with MG. Results MG was detected in 7.2% (49/678) of the patients (men, 7.4%; women, 6.9%). The MG positivity rate was 14.2% among symptomatic patients, and 5.6% for asymptomatic patients, respectively. Only 36.7% (18/49) Mg positive patients were symptomatic. Among the MG-infected patients, 10.2% were co-infected with CT, 6.1% with NG, 8.2% with HSV-2, 4.1% with syphilis and 22.4% with GW. Presentation with clinical symptoms was significantly associated with MG infection [OR = 2.52 (2.03–3.13)]. In our analysis, MG was not associated with other STIs. Conclusions MG is a relatively common infection among individuals attending an STI clinic in Guangdong Province. Routine testing of symptomatic patients may be necessary, and more epidemiological studies are needed to provide evidence for future testing guidelines.
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Affiliation(s)
- Xiao-Hui Zhang
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
| | - Pei-Zhen Zhao
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
| | - Wu-Jian Ke
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
| | - Liu-Yuan Wang
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
| | - Lai Sze Tso
- Department of Culture Studies and Oriental Languages, University of Oslo, Oslo, Norway.,Anthropology, Massachusetts Institute of Technology, Cambridge, MA, USA.,Center for Health and Human Development Studies, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zheng-Yu Chen
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
| | - Yu-Ying Liao
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
| | - Chun-Mei Liang
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
| | - Hui-Ru Chen
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
| | - Xu-Qi Ren
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
| | - Jin-Mei Huang
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
| | - Jason J Ong
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Melbourne, Australia
| | - Fan Yang
- University of North Carolina, UNC Project-China, Guangzhou, China
| | - Li-Gang Yang
- Dermatology Hospital, Southern Medical University, Guangdong Province, Guangzhou, China. .,Guangdong Provincial Dermatology Hospital, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China.
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17
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de Vries HJC, Nori AV, Kiellberg Larsen H, Kreuter A, Padovese V, Pallawela S, Vall-Mayans M, Ross J. 2021 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. J Eur Acad Dermatol Venereol 2021; 35:1434-1443. [PMID: 34057249 DOI: 10.1111/jdv.17269] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/24/2021] [Indexed: 12/14/2022]
Abstract
This guideline intents to offer guidance on the diagnosis and management of patients with gastrointestinal symptoms and a suspected sexually transmitted cause. Proctitis is defined as an inflammatory syndrome of the anal canal and/or the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via digital contact and toys. Neisseria gonorrhoeae, Chlamydia trachomatis (including lymphogranuloma venereum), Treponema pallidum and herpes simplex virus are the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), women having anal intercourse may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, tenesmus, bleeding, constipation and discharge in and around the anal canal. The majority of rectal chlamydia and gonococcal infections are asymptomatic and can only be detected by laboratory tests. Therefore, especially when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from STIs, which are often spread without penile penetration. New in this updated guideline is: (i) lymphogranuloma venereum proctitis is increasingly found in HIV-negative MSM, (ii) anorectal Mycoplasma genitalium infection should be considered in patients with symptomatic proctitis after exclusion of other common causations such N. gonorrhoeae, C. trachomatis, syphilis and herpes, (iii) intestinal spirochetosis incidentally found in colonic biopsies should not be confused with syphilis, and (iv) traumatic causes of proctitis should be considered in sexually active patients.
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Affiliation(s)
- H J C de Vries
- STI Outpatient Clinic, Cluster Infectious Diseases, Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A V Nori
- Department of Sexual & Reproductive Health and HIV Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H Kiellberg Larsen
- Department of Dermatology and Venereology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten-Herdecke, Oberhausen, Germany
| | - V Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - S Pallawela
- The Florey Unit, Royal Berkshire Hospital, Reading, UK
| | - M Vall-Mayans
- Infectious Diseases Department, Fight AIDS Foundation, Hospital Germans Trias Pujol, Badalona, Spain
| | - J Ross
- Department of Sexual Health and HIV, Birmingham University Hospitals NHS Foundation Trust, Birmingham, UK
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18
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Han Y, Yin YP, Liu JW, Chen K, Zhu BY, Zhou K, Shi MQ, Xu WQ, Jhaveri TA, Chen XS. Rectal Mycoplasma genitalium in Patients Attending Sexually Transmitted Disease Clinics in China: An Infection That Cannot Be Ignored. Infect Drug Resist 2021; 14:2509-2515. [PMID: 34234478 PMCID: PMC8255646 DOI: 10.2147/idr.s314775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies have investigated rectal Mycoplasma genitalium (MG) in men who have sex with men (MSM), while little is known about the prevalence of rectal MG infection in individuals attending sexually transmitted disease (STD) clinics in China. We aimed to estimate the prevalence of rectal MG infection in this population and identified the potential risk factors for rectal MG infection. Methods A cross-sectional study was conducted among individuals attending STD clinics located in China from June 2018 to August 2020. Univariate and multivariate logistic regression analyses were conducted to explore the association of different risk factors for rectal MG infection. Results A total of 1,382 patients were included in the final analyses. A total of 30 of 1377 rectal swabs (2.2%) and 77 of 1374 urogenital samples (5.6%) were positive for MG. In Guangxi, 18 of 47 patients (38.3%) infected with urogenital MG and 5 of 19 patients (26.3%) infected with rectal MG received the recommended treatment. Factors found to be significantly associated with rectal MG infection included: male (adjusted odds ratio (AOR) 0.232, [95% CI: 0.072–0.745]) compared to female, homosexual or bisexual (AOR 40.427, [95% CI: 3.880–421.196]) compared to heterosexual, and those infected with urogenital MG (AOR 7.215, [95% CI: 2.898–17.965]) compared to those who did not get infected with urogenital MG. Conclusion Rectal MG infection should be thought of not only in MSM population but also in STD clinic patients, especially females who have urogenital MG infection. Appropriate strategy for rectal MG screening and treatment needs to be developed for these patients in China.
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Affiliation(s)
- Yan Han
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Yue-Ping Yin
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Jing-Wei Liu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Kai Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Bang-Yong Zhu
- Institute of Dermatology, Guangxi Autonomous Region, Nanning, People's Republic of China
| | - Ke Zhou
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Mei-Qin Shi
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Wen-Qi Xu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Tulip A Jhaveri
- Division of Medical Microbiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, People's Republic of China
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19
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Ong JJ, Ruan L, Lim AG, Bradshaw CS, Taylor-Robinson D, Unemo M, Horner PJ, Vickerman P, Zhang L. Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical model. EClinicalMedicine 2021; 33:100779. [PMID: 33842867 PMCID: PMC8020166 DOI: 10.1016/j.eclinm.2021.100779] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) causes a sexually transmitted infection (STI) with a rising rate of antimicrobial resistance. Currently, guidelines do not recommend screening asymptomatic men who have sex with men (MSM). We developed a mathematical model of MG transmission to examine the impact of various screening strategies on the incidence and prevalence of MG among MSM attending a sexual health clinic. METHODS A compartmental mathematical model of MG transmission among MSM was constructed and calibrated using data from the Melbourne Sexual Health center, where resistance-guided therapy provides high treatment effectiveness (92-95%). The model stratified men by symptom status, sexual risk behaviours and whether or not they had MG with macrolide resistance. We simulated the impact on endemic steady-state MG prevalence and incidence of the following screening scenarios, namely screening: 1) no MSM; 2) only symptomatic MSM (the current recommendation); 3) all symptomatic and high-risk asymptomatic MSM; and 4) all MSM. Our base case analysis assumed a treatment effectiveness of 92-95% using resistance-guided therapy. We also examined the impact of treatment effectiveness (i.e. the proportion of detected MG that were cured) and screening coverage (i.e. testing rate) on MG prevalence. FINDINGS The model predicts that the overall endemic MG prevalence is 9.1% (95% CI: 7.9-10.0) in the current situation where screening is only offered to symptomatic MSM (base-case). This would increase to 11·4% (95% confidence intervals (CI): 10.2-13.7) if no MSM are offered screening, but would decrease to 7.3% (95% CI: 5.7-8.4) if all symptomatic and high-risk asymptomatic MSM were offered screening and 6.4% (95% CI: 4.7-7·7) if all MSM were offered screening. Increasing coverage of MSM screening strategies shows a similar effect on decreasing endemic MG incidence. When evaluating the simultaneous impact of treatment effectiveness and screening coverage, we found that offering screening to more MSM may reduce the overall prevalence but leads to a higher proportion of macrolide-resistant MG, particularly when using treatment regimens with lower effectiveness. INTERPRETATION Based on the available treatment options, offering screening for MG to other MSM (beyond the currently recommended group of symptomatic MSM) could slightly reduce the prevalence and incidence of MG. However, further increasing screening coverage must be weighed against the impact of lower treatment effectiveness (i.e. when not using resistance-guided therapy), increasing the selection of macrolide resistance, and other negative consequences related to AMR and management (e.g. unnecessary psychological morbidity from infections that do not need treatment).
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Affiliation(s)
- Jason J. Ong
- Central Clinical School, Monash University, Victoria, Melbourne, Australia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
- Corresponding authors.
| | - Luanqi Ruan
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
- Research Base of Key Laboratory of Surveillance and Early Warning on Infectious Disease, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Aaron G. Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University, Örebro, Sweden
| | - Patrick J. Horner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lei Zhang
- Central Clinical School, Monash University, Victoria, Melbourne, Australia
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Corresponding authors.
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20
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Peel J, Aung E, Bond S, Bradshaw C. Recent advances in understanding and combatting Mycoplasma genitalium. Fac Rev 2020; 9:3. [PMID: 33659935 PMCID: PMC7886083 DOI: 10.12703/b/9-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mycoplasma genitalium has emerged over the last 30 years as a sexually transmitted infection (STI). As data have accumulated, our understanding of this pathogen and its role in disease continues to evolve. This in turn creates new challenges and complexities. Questions remain regarding the natural history of M. genitalium, its contribution to disease and long-term sequelae. A decline in cure rates for first-line anti-microbials has been observed. This is likely in part due to high usage of single-dose azithromycin in the sexual health field but also due to the intrinsic ability of M. genitalium to rapidly acquire anti-microbial resistance. Consequently, the term 'the new STI superbug' is not infrequently used by the media to describe this pathogen. Currently available antibiotics have side effects that, though rare, are potentially serious. This leads to inherent questions regarding the benefit of testing for and treating M. genitalium, particularly in asymptomatic individuals or in genital syndromes where the benefit of treatment is not well established. In this review, we summarize the most recent evidence and literature regarding M. genitalium and explore areas of research where disparities exist. We discuss the contribution of M. genitalium to genital syndromes, particularly those where data are conflicting, in order to inform indications for testing and treatment. Avoidance of increasing anti-microbial resistance with astute anti-microbial stewardship is paramount if we are to successfully manage M. genitalium infection. We examine the state of play regarding anti-microbial resistance and how to combat this, including currently available anti-microbials, resistance-guided therapy and novel therapeutic approaches. We aim to provide an overview of the current understanding of M. genitalium and the implications for current clinical practise and suggestions for future research.
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Affiliation(s)
- Joanne Peel
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Ei Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Stephanie Bond
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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21
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Shipitsyna E, Unemo M. A profile of the FDA-approved and CE/IVD-marked Aptima Mycoplasma genitalium assay (Hologic) and key priorities in the management of M. genitalium infections. Expert Rev Mol Diagn 2020; 20:1063-1074. [PMID: 33095669 DOI: 10.1080/14737159.2020.1842198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Mycoplasma genitalium (MG) causes frequently asymptomatic STIs. MG prevalence figures are lacking and management is complicated by the lack of etiological diagnostics and high antimicrobial resistance in many countries. Appropriately validated, quality-assured, and FDA-approved MG diagnostic assays have been lacking. AREAS COVERED The clinical and analytical performance characteristics of the Aptima® MG assay, the first FDA-approved MG nucleic acid amplification test (NAAT), are summarized. Key priorities in the management and control of MG infections are also discussed. EXPERT OPINION Highly sensitive, specific, and quality-assured MG NAATs, e.g. the Aptima MG assay on the automated and flexible Panther® platform, are imperative to improve the management and control of MG infections internationally. This testing, combined with macrolide-resistance testing (not yet available on the Panther platform), offers a rapid, high-throughput, and appropriate diagnosis of MG. Macrolide resistance-guided sequential treatment needs to be implemented for MG infections. Dual antimicrobial therapy, novel antimicrobials and, ideally, a vaccine may become essential.
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Affiliation(s)
- Elena Shipitsyna
- Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , St. Petersburg, Russia
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
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22
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Richardson D, Lewis DA, Jeoffreys NJ, Couldwell DL. Mycoplasma genitalium coinfection in men with symptomatic gonococcal urethritis. Sex Transm Infect 2020; 97:363-367. [PMID: 32912933 DOI: 10.1136/sextrans-2020-054529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/23/2020] [Accepted: 07/12/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES International guidelines recommend Mycoplasma genitalium testing, preferably using an assay to detect macrolide resistance-associated mutations, for men presenting with non-gonococcal urethritis, but there is no specific guidance on such testing for men with gonococcal urethritis. METHODS This study aimed to estimate the proportion of men with gonococcal urethritis who have coinfection with M. genitalium through a retrospective analysis of cases of symptomatic urethral gonorrhoea at Western Sydney Sexual Health Centre in 2017 and 2018. RESULTS Fourteen of 184 (7.6%, 95% CI 3.7 to 11.5) men with gonococcal urethritis had M. genitalium detected in the urine at the time of presentation. No demographic or behavioural factors predicted M. genitalium coinfection. Coinfection with urethral Chlamydia trachomatis was detected in 29 of 184 (15.8%, 95% CI 10.5 to 21.1). All five men with macrolide-resistant M. genitalium detected returned for treatment with moxifloxacin at a median of 8 days (range 5-16 days) after presentation and treatment of gonorrhoea; three of five were documented to remain symptomatic at this visit. CONCLUSION Although M. genitalium coinfection is less common than chlamydia among men with symptomatic gonococcal urethritis, M. genitalium testing, using an assay to detect macrolide resistance, will potentially reduce symptom duration particularly for men with macrolide-resistant infections, but may not be justifiable on cost-benefit analysis.
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Affiliation(s)
- Daniel Richardson
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity and Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
| | - Neisha J Jeoffreys
- Department of Microbiology, Institute of Clinical Pathology and Medical Research, Westmead, New South Wales, Australia
| | - Deborah L Couldwell
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity and Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
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23
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Latimer RL, Shilling HS, Vodstrcil LA, Machalek DA, Fairley CK, Chow EPF, Read TR, Bradshaw CS. Prevalence of Mycoplasma genitalium by anatomical site in men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect 2020; 96:563-570. [PMID: 32341023 DOI: 10.1136/sextrans-2019-054310] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To systematically review and appraise published data, to determine the prevalence of Mycoplasma genitalium (MG) in men who have sex with men (MSM) tested at each anatomical site, that is, at the urethra, rectum and/or pharynx. DESIGN Systematic review and meta-analysis. DATA SOURCES Ovid Medline, PubMed, Embase were searched for articles from 1st January 1981 (the year MG was first identified) to 1st June 2018. REVIEW METHODS Studies were eligible for inclusion if they reported MG prevalence in MSM tested at the urethra, rectum and/or pharynx, in at least 50 MSM, using nucleic acid amplification testing. Data were extracted by anatomical site, symptom and HIV status. Summary estimates (95% CIs) were calculated using random-effects meta-analysis. Subgroup analyses were performed to assess heterogeneity between studies. RESULTS Forty-six studies met inclusion criteria, with 34 reporting estimates of MG prevalence at the urethra (13 753 samples), 25 at the rectum (8629 samples) and 7 at the pharynx (1871 samples). MG prevalence was 5.0% (95% CI 3.5 to 6.8; I2=94.0) at the urethra; 6.2% (95% CI 4.6 to 8.1; I2=88.1) at the rectum and 1.0% (95% CI 0.0 to 5.1; I2=96.0) at the pharynx. The prevalence of MG was significantly higher at urethral and rectal sites in symptomatic versus asymptomatic MSM (7.1% vs 2.2%, p<0.001; and 16.1% vs 7.5%, p=0.039, respectively). MG prevalence at the urethra was significantly higher in HIV-positive compared with HIV-negative MSM (7.0% vs 3.4%, p=0.006). CONCLUSION MG was common in MSM, particularly at urethral and rectal sites (5% to 6%). MG was more commonly detected in symptomatic men at both sites, and more common in HIV-positive men at the urethra. MG was uncommonly detected in the pharynx. Site-specific estimates are similar to those for chlamydia and will be helpful in informing testing practices in MSM. PROSPERO REGISTRATION NUMBER CRD42017058326.
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Affiliation(s)
- Rosie L Latimer
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia .,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Hannah S Shilling
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Dorothy A Machalek
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tim Rh Read
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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24
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Spornraft-Ragaller P, Dumke R. Prevalence and antibiotic resistance of rectal Mollicutes in HIV-infected men who have sex with men at the University Hospital of Dresden, Germany. Infection 2020; 48:259-265. [PMID: 31993971 PMCID: PMC7292812 DOI: 10.1007/s15010-019-01386-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rectal sexually transmitted infections (STI) are common in men having sex with men (MSM). Mycoplasma genitalium is increasingly being reported in this localization, but due to frequent lack of symptoms at this site, clinical significance is still unclear. Rectal prevalence of Mycoplasma hominis and Ureaplasma species is not well studied so far. We aimed to investigate the prevalence and antibiotic sensitivity of rectal Mollicutes in our HIV-cohort. METHODS In 227 MSM presenting for annual STI-screening, 317 anorectal swabs were collected from January 2017 to December 2018. PCR was performed for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, M. genitalium and also culture for M. hominis and Ureaplasma spec. RESULTS Prevalence for M. genitalium, M. hominis, Ureaplasma spec., C. trachomatis and N. gonorrhoeae was 8.2%, 7.3%, 12.0%, 5.1% and 1.9%, respectively. Patients were asymptomatic with few exceptions. Seroprevalence of syphilis in 227 MSM was 41.9%. In 20 strains of M. genitalium, resistance-associated mutations to macrolides and quinolones were found in 60% and 30%, respectively; in five strains (25%) to both. M. hominis and Ureaplasma spec. frequently occurred combined, mostly in significant quantity consistent with infection. M. hominis and Ureaplasma spec. regularly showed sensitivity to tetracycline. CONCLUSION At screening, rectal colonization with Mollicutes was common in our patients, but rarely caused symptoms. Due to rising antibiotic resistance of M. genitalium against quinolones, therapeutic options are increasingly limited. Treatment should be guided by antibiotic resistance testing including quinolones. In persisting anorectal symptoms, M. hominis and Ureaplasma spec. should also be taken into account.
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Affiliation(s)
- Petra Spornraft-Ragaller
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Roger Dumke
- Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden, Dresden, Germany
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25
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Bradley I, Varma R, Knight V, Iliakis D, McNally L, Jalocon D, Jeoffreys N, Chen S, McNulty A. Prevalence of rectal Mycoplasma genitalium and macrolide resistance in men who have sex with men attending Sydney Sexual Health Centre. Sex Health 2020; 17:114-120. [PMID: 31969248 DOI: 10.1071/sh18221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 07/10/2019] [Indexed: 01/19/2023]
Abstract
Background Sexually transmissible infections (STIs) have been increasing in men who have sex with men (MSM) in recent years; however, few studies have investigated the prevalence or antimicrobial resistance in rectal Mycoplasma genitalium in this group. This study aimed to determine the prevalence and predictors of rectal M. genitalium in MSM attending an urban sexual health service in Sydney, Australia, namely the Sydney Sexual Health Centre (SSHC), as well as estimate the rate of macrolide resistance. METHODS A prospective cross-sectional analysis was conducted of rectally asymptomatic MSM having a rectal swab collected as part of their routine care. Participants self-collected a rectal swab to be tested for M. genitalium and completed a 14-item questionnaire that provided information on behavioural risk factors. The prevalence of rectal M. genitalium was determined and multivariate analysis was performed to assess the associations for this infection. Positive specimens then underwent testing for macrolide-resistant mutations (MRMs) using the ResistancePlus MG assay (SpeeDx, Eveleigh, NSW, Australia). RESULTS In all, 742 patients were consecutively enrolled in the study. The median age was 31 years (interquartile range 27-39 years), with 43.0% born in Australia. Overall, 19.0% of men were bisexual, 22.9% were taking pre-exposure prophylaxis (PrEP) and 4.3% were HIV positive. The prevalence of rectal M. genitalium was 7.0% (95% confidence interval (CI) 5.3-9.1) overall and 11.8% in those taking PrEP. On multivariate analysis, PrEP use was significantly associated with having rectal M. genitalium (odds ratio 2.01; 95% CI 1.09-3.73; P = 0.01). MRMs were detected in 75.0% (36/48; 95% CI 60.4-86.4%) of infections. CONCLUSION Rates of rectal M. genitalium infection were high among asymptomatic MSM attending SSHC and MRMs were detected in 75% of infections. PrEP use was found to be significantly associated with rectal M. genitalium infection. These data contribute to the evidence base for screening guidelines in MSM.
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Affiliation(s)
- Isabella Bradley
- Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Rick Varma
- Sydney Sexual Health Centre, Sydney, NSW 2000, Australia
| | - Vickie Knight
- Sydney Sexual Health Centre, Sydney, NSW 2000, Australia
| | - Dimitra Iliakis
- Serology and Virology Division, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Leon McNally
- Molecular Diagnostic Medicine Laboratory, SydPath St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Dean Jalocon
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Neisha Jeoffreys
- Institute for Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Sharon Chen
- Institute for Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW 2000, Australia; and Corresponding author.
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26
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Kato Y, Kawaguchi S, Shigehara K, Yaegashi H, Nakashima K, Nakagawa T, Sakamoto J, Itoda I, Ueda M, Izumi K, Kadono Y, Mizokami A. Prevalence of N. gonorrhoeae, C. trachomatis, M. genitalium, M. hominis and Ureaplasma spp. in the anus and urine among Japanese HIV-infected men who have sex with men. J Infect Chemother 2019; 26:403-406. [PMID: 31882383 DOI: 10.1016/j.jiac.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 11/18/2022]
Abstract
The present study investigated the prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, M. hominis, and Ureaplasma spp. (biovars 1 and 2) in Japanese HIV-positive men who have sex with men (MSM). One-hundred-and-six Japanese HIV-infected MSM patients were enrolled. Anal and urine samples were collected and DNA testing for each microorganism was performed. Questionnaires regarding lifestyle habits and sexual behavior were administered. The prevalence of N. gonorrhoeae, C. trachomatis, M. genitalium, M. hominis, and Ureaplasma spp. in the anus was 5.6%, 8.9%, 4.4%, 5.6%, and 8.9%, respectively. A history of genital warts was an independent risk factor for detection of Mycoplasma spp. and Ureaplasma spp. The prevalence of these microorganisms in the anus of asymptomatic Japanese HIV-positive MSM was relatively high in agreement with previous reports from other countries.
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Affiliation(s)
- Yuki Kato
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazufumi Nakashima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomomi Nakagawa
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Jiro Sakamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | | | - Mikio Ueda
- Department of Internal Medicine, Keijyu Kanazawa Hospital, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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27
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Read TRH, Murray GL, Danielewski JA, Fairley CK, Doyle M, Worthington K, Su J, Mokany E, Tan LT, Lee D, Vodstrcil LA, Chow EPF, Garland SM, Chen MY, Bradshaw CS. Symptoms, Sites, and Significance of Mycoplasma genitalium in Men Who Have Sex with Men. Emerg Infect Dis 2019; 25:719-727. [PMID: 30882306 PMCID: PMC6433010 DOI: 10.3201/eid2504.181258] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During 2016-2017, we tested asymptomatic men who have sex with men (MSM) in Melbourne, Australia, for Mycoplasma genitalium and macrolide resistance mutations in urine and anorectal swab specimens by using PCR. We compared M. genitalium detection rates for those asymptomatic men to those for MSM with proctitis and nongonococcal urethritis (NGU) over the same period. Of 1,001 asymptomatic MSM, 95 had M. genitalium; 84.2% were macrolide resistant, and 17% were co-infected with Neisseria gonorrhoeae or Chlamydia trachomatis. Rectal positivity for M. genitalium was 7.0% and urine positivity was 2.7%. M. genitalium was not more commonly detected in the rectums of MSM (n = 355, 5.6%) with symptoms of proctitis over the same period but was more commonly detected in MSM (n = 1,019, 8.1%) with NGU. M. genitalium is common and predominantly macrolide-resistant in asymptomatic MSM. M. genitalium is not associated with proctitis in this population.
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Prevalence of Mycoplasma genitalium and Azithromycin-resistant Infections Among Remnant Clinical Specimens, Los Angeles. Sex Transm Dis 2019; 45:632-635. [PMID: 29509566 DOI: 10.1097/olq.0000000000000829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mycoplasma genitalium is an important cause of bacterial sexually transmitted diseases. Diagnosis and susceptibility testing of M. genitalium are limited by the fastidious nature of the organism. Therefore, the prevalence of infection and azithromycin resistance are poorly studied. METHODS We conducted an exploratory study on remnant clinical specimens. We collected remnant DNA from consecutive urine samples and clinical swabs (cervical/vaginal, rectal, and pharyngeal) previously tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the Cobas 4800 CT/NG assay (Roche Molecular Systems, Pleasanton, CA) between March-April 2017 from across the University of California, Los Angeles Health System. We then retrospectively tested all specimens with the ResistancePlus MG (550) kit, a molecular assay for the detection of M. genitalium and genetic mutations associated with azithromycin resistance. RESULTS Among 500 specimens, the prevalence of M. genitalium was 1.1% (95% confidence interval [CI], 0.04%-3.0%) in urine samples (n = 362), 17.4% (95% CI, 5.7%-39.6%) in rectal swabs (n = 23), and 1.9% (95% CI, 0.3%-7.3%) in cervical/vaginal swabs (n = 106). The prevalence of N. gonorrhoeae was 0.6% in urine samples and 4.3% in rectal swabs, whereas the prevalence of C. trachomatis was 2.2% in urine samples, 4.3% in rectal swabs and 3.8% in cervical/vaginal swabs. Of the 10 M. genitalium positive specimens, 8 (80.0%) had a mutation associated with azithromycin resistance. CONCLUSIONS The prevalence of M. genitalium infection in our population varied by anatomic site of infection. Most M. genitalium infections had at least 1 mutation associated with azithromycin resistance.
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Isabel Lázaro-Simó A, Esperalba-Esquerra J, Vall-Mayans M. A case report of proctitis associated with Mycoplasma genitalium in a man who has sex with men. Int J STD AIDS 2019; 30:623-625. [PMID: 30722752 DOI: 10.1177/0956462419825896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mycoplasma genitalium is an infection of increasing concern due to its potential to cause sequelae in the reproductive tract and the development of antimicrobial resistance. Its role as a cause of proctitis in people with high-risk sexual behaviour has not been properly defined yet but it seems to be less symptomatic than proctitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae. We present a case of a man who has sex with men with proctitis associated with M. genitalium after excluding other infections known to cause STI proctitis.
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Affiliation(s)
| | | | - Martí Vall-Mayans
- 3 STI Unit Vall d'Hebron - Drassanes, Infectious Diseases Department, Hospital Vall d'Hebron, Barcelona, Spain
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