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Johnson K, Buluwela E, McDonald G, Golden J, Dickinson M, Jones R, Girometti N, Jagjitsingh G, Rayment M. Mycoplasma genitalium treatment outcomes among a cohort failing macrolide resistance-guided treatment across three London sexual health clinics. Sex Transm Infect 2024:sextrans-2023-056093. [PMID: 39089882 DOI: 10.1136/sextrans-2023-056093] [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: 12/15/2023] [Accepted: 07/17/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE British guidelines advise treatment of Mycoplasma genitalium (Mgen) infection using the results of macrolide resistance-associated mutation (MRAM) assays. Limited data informs management when patients fail MRAM-guided treatment. This study evaluates current management strategies employed for cases of Mgen infection with MRAM-guided treatment failure. DESIGN This retrospective analysis reviewed laboratory and clinical data pertaining to all positive Mgen results between 28 May 2020 and 05 November 2022 across three London sexual health clinics. Treatment failure was defined as microbiological or clinical failure, despite appropriate MRAM-guided treatment with full compliance and no re-infection risk. Where MRAM status was unable to be determined, samples were excluded. RESULTS 340 samples were included from mostly male (74.4%) patients with a mean age of 30 years. The majority of tests were sent for urethritis (63.8%), and most infections were present without concurrent STIs (83.5%). 183 (53.8%) samples were MRAM positive; 157 (46.1%) were wild type. 152/183 (83.1%) received MRAM-guided treatment. 49/152 (32.2%) cases of MRAM-guided treatment failure were identified. 32/49 (65.3%) achieved either microbiological or clinical cure through a variety of treatment regimens. 66.6% of nine patients who received pristinamycin achieved microbiological cure; two patients were cured by minocycline. Many patients received multiple courses of moxifloxacin despite previous failures. CONCLUSION Whilst high compliance with recommended MRAM-guided therapy was identified, there were also high rates of quinolone therapy failure (32.2%). Barriers to appropriate treatment include a lack of quinolone resistance assays and the non-availability of sitafloxacin in Europe, along with the limited availability of pristinamycin and minocycline in the UK during the study dates. We recommend developing a standardised management pathway for treatment resistant cases.
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Affiliation(s)
- Kate Johnson
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ella Buluwela
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Gemma McDonald
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - John Golden
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Molly Dickinson
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Rachael Jones
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicolo Girometti
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Gurmit Jagjitsingh
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Michael Rayment
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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McKnight U, Farsides B, Soni S, Will C. Treating Mycoplasma genitalium (in pregnancy): a social and reproductive justice concern. Monash Bioeth Rev 2024:10.1007/s40592-024-00200-7. [PMID: 38990510 DOI: 10.1007/s40592-024-00200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/12/2024]
Abstract
Antimicrobial Resistance is a threat to individual and to population health and to future generations, requiring "collective sacrifices" in order to preserve antibiotic efficacy. 'Who should make the sacrifices?' and 'Who will most likely make them?' are ethical concerns posited as potentially manageable through Antimicrobial Stewardship. Antimicrobial stewardship almost inevitably involves a form of clinical cost-benefit analysis that assesses the possible effects of antibiotics to treat a diagnosed infection in a particular patient. However, this process rarely accounts properly for patients - above and beyond assessments of potential (non)compliance or adherence to care regimes. Drawing on a vignette of a pregnant woman of colour and migrant diagnosed with Mycoplasma genitalium, a sexually transmissible bacterium, this article draws out some of the ethical, speculative, and practical tensions and complexities involved in Antimicrobial Stewardship. We argue that patients also engage in a form of cost-benefit analysis influenced by experiences of reproductive and social (in)justice and comprising speculative variables - to anticipate future possibilities. These processes have the potential to have effects above and beyond the specific infection antimicrobial stewardship was activated to address. We contend that efforts to practice and research antimicrobial stewardship should accommodate and incorporate these variables and acknowledge the structures they emerge with(in), even if their components remain unknown. This would involve recognising that antimicrobial stewardship is intricately connected to other social justice issues such as immigration policy, economic justice, access to appropriate medical care, racism, etc.
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Affiliation(s)
- Ulla McKnight
- The Sociology and Criminology Department, University of Sussex, Freeman Building G30, Falmer Brighton, BN1 9QE, UK.
| | | | - Suneeta Soni
- Consultant in Sexual Health and HIV, University Hospitals Sussex, Honorary Clinical Senior Lecturer, Brighton and Sussex Medical School, Falmer, UK
| | - Catherine Will
- The Sociology and Criminology Department, University of Sussex, Freeman Building G30, Falmer Brighton, BN1 9QE, UK
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3
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Azrad M, Saleh N, Zur IY, Becker D, Shiloah N, Habib S, Peretz A. Mycoplasma genitalium's Antibiotic Resistance in Sexually Transmitted Infections Clinics in Israel. J Low Genit Tract Dis 2024:00128360-990000000-00125. [PMID: 38980157 DOI: 10.1097/lgt.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To determine the prevalence of antibiotic resistance rate in Mycoplasma genitalium, and distribution of mutations associated with this resistance, among patients that attended sexually transmitted infections (STI) investigation clinics. MATERIALS AND METHODS This cross-sectional study included M. genitalium-positive samples (urine, vaginal, rectal, and pharyngeal swabs) collected from 170 patients attending two STI investigation clinics, which were subjected to macrolide and quinolone resistance mutations analyses. Data regarding patient age, sex, and material/anatomical site of testing were collected. RESULTS Macrolide-resistance mutations were identified in 48.8% of samples and were more common among males (p < .0001) and in rectal samples (p < .05). A2059C was the most prevalent macrolide-resistance mutation (18.2%). Quinolone resistance was detected in 23% of the samples, with S83I being the most common (17.1%) mutation. Rate of co-resistance to macrolides and quinolones was 21.2%. CONCLUSIONS The high rate of antibiotic resistance found in the current study, especially to macrolides, underscores the importance of antibiotic resistance monitoring in M. genitalium isolates in cases of persistent or recurrent urethritis/cervicitis, in cases of treatment failure and among specific populations. Such surveillance will improve treatment regimens and cure rates.
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Affiliation(s)
- Maya Azrad
- The Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Tiberias, Israel, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Nora Saleh
- The Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Tiberias, Israel, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | | | | | - Sonia Habib
- Haifa District, Ministry of Health, Haifa, Israel
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4
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Jensen JS, Unemo M. Antimicrobial treatment and resistance in sexually transmitted bacterial infections. Nat Rev Microbiol 2024; 22:435-450. [PMID: 38509173 DOI: 10.1038/s41579-024-01023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/22/2024]
Abstract
Sexually transmitted infections (STIs) have been part of human life since ancient times, and their symptoms affect quality of life, and sequelae are common. Socioeconomic and behavioural trends affect the prevalence of STIs, but the discovery of antimicrobials gave hope for treatment, control of the spread of infection and lower rates of sequelae. This has to some extent been achieved, but increasing antimicrobial resistance and increasing transmission in high-risk sexual networks threaten this progress. For Neisseria gonorrhoeae, the only remaining first-line treatment (with ceftriaxone) is at risk of becoming ineffective, and for Mycoplasma genitalium, for which fewer alternative antimicrobial classes are available, incurable infections have already been reported. For Chlamydia trachomatis, in vitro resistance to first-line tetracyclines and macrolides has never been confirmed despite decades of treatment of this highly prevalent STI. Similarly, Treponema pallidum, the cause of syphilis, has remained susceptible to first-line penicillin.
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Affiliation(s)
- Jorgen S Jensen
- Department of Bacteria, Parasites and Fungi, Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark.
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London, London, UK
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5
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Sandoval-Garcés M, Wang A, Martin-Gorgojo A. Comparative Study of Clinical Practice Guidelines on the Management of Venereal Infection: Different Periodic Screenings, Therapeutic Approaches, and Follow-up Care After Treatment Across the CDC, IUSTI and BASHH Guidelines on the Most Frequent STIs. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:639-645. [PMID: 38387644 DOI: 10.1016/j.ad.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
- M Sandoval-Garcés
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas. Ayuntamiento de Madrid, Madrid, España; Departamento de Dermatología, Facultad de Medicina. Universidad de Chile, Santiago de Chile, Chile
| | - A Wang
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas. Ayuntamiento de Madrid, Madrid, España; Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Martin-Gorgojo
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas. Ayuntamiento de Madrid, Madrid, España.
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Sandoval-Garcés M, Wang A, Martin-Gorgojo A. [Translated article] Comparative Study of Clinical Practice Guidelines on the Management of Venereal Infection: Different Periodic Screenings, Therapeutic Approaches, and Follow-up Care After Treatment Across the CDC, IUSTI and BASHH Guidelines on the Most Frequent STIs. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T639-T645. [PMID: 38648928 DOI: 10.1016/j.ad.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 02/06/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- M Sandoval-Garcés
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas, Ayuntamiento de Madrid, Madrid, Spain; Departamento de Dermatología, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile.
| | - A Wang
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas, Ayuntamiento de Madrid, Madrid, Spain; Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Martin-Gorgojo
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas, Ayuntamiento de Madrid, Madrid, Spain
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Pitt-Kendall R, Sun S, Hughes S, Merrick R, Donaldson H, Rayment M, Ivanov Z, Day M, Bari A, Rebec M, Callan E, Mohammed H, Sinka K, Cole M, Fifer H. Investigating the cause of increased tetracycline-resistant Neisseria gonorrhoeae in England, 2016-20. J Antimicrob Chemother 2024; 79:1060-1068. [PMID: 38517444 PMCID: PMC11062939 DOI: 10.1093/jac/dkae073] [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: 12/06/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Antimicrobial resistance in Neisseria gonorrhoeae is a global public health concern. Tetracycline resistance (TetR) increased from 39.4% to 75.2% between 2016 and 2021 in N. gonorrhoeae isolates collected through national surveillance in England, despite the absence of use of tetracyclines for the treatment of gonorrhoea. OBJECTIVES We investigated whether there was correlation between bacterial sexually transmitted infection (STI) tests performed and treatment with antimicrobials, with increased TetR in N. gonorrhoeae. METHODS We examined correlations between bacterial STI tests, antimicrobial treatment and TetR in N. gonorrhoeae, using national surveillance data from three large sexual health services (SHS) in London during 2016-20. Doxycycline prescribing data and antibiograms of a non-STI pathogen from distinct patient groups (sexual health, obstetric and paediatric), at a large London hospital, were analysed to identify if doxycycline use in SHS was associated with resistance in a non-STI organism. RESULTS A substantial increase in TetR was observed, particularly in isolates from gay, bisexual and other MSM (GBMSM). Strong positive correlations were observed exclusively in GBMSM between N. gonorrhoeae TetR and both bacterial STI tests (r = 0.97, P = 0.01) and antimicrobial treatment (r = 0.87, P = 0.05). Doxycycline prescribing increased dramatically during the study period in SHS. Prevalence of TetR in Staphylococcus aureus was higher in isolates sourced from SHS attendees than those from other settings. CONCLUSIONS Frequent screening of GBMSM at higher risk of STIs, such as those on pre-exposure prophylaxis (PrEP) leading to/and increased use of doxycycline for the treatment of diagnosed infections, may account for the increase in TetR in N. gonorrhoeae.
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Affiliation(s)
| | - Suzy Sun
- UK Health Security Agency, London, UK
| | | | | | | | - Michael Rayment
- Chelsea & Westminster NHS Foundation Trust, London, UK
- Imperial College London, 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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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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Dias BDC, Sekgele W, Nhlapo D, Mahlangu MP, Venter JME, Maseko DV, Müller EE, Greeves M, Botha P, Radebe F, Kufa T, Kularatne RS. Extragenital Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men in Johannesburg, South Africa. Sex Transm Dis 2024; 51:245-250. [PMID: 38534082 DOI: 10.1097/olq.0000000000001927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND In South Africa, extragenital etiological sexually transmitted infection (STI) screening among men who have sex with men (MSM) is not routinely available. We aimed to determine the prevalence of STI pathogens at rectal and pharyngeal sites, syphilis seroprevalence, and associated risk factors among a selection of high-risk MSM without symptomatic urethritis attending a men's health clinic in Johannesburg, South Africa. METHODS A cross-sectional study was conducted in 2022. Enrolled clients self-reported demographic, sexual behavioral risks, and clinical information. Client or clinician-collected rectal and pharyngeal swabs were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. C. trachomatis-positive rectal samples were reflex tested for lymphogranuloma venereum. Blood specimens were screened for syphilis. Univariate and multivariate regression models were used to determine factors independently associated with the presence of an extragenital STI or syphilis. RESULTS Among the 97 participants (median age, 29 years), 24.7% had an extragenital STI and 9.4% had high nontreponemal antibody titers (rapid plasma reagin ≥1:16). Rectal STIs were detected in 26.4% participants: N. gonorrhoeae (14.3%), C. trachomatis (9.9%), and M. genitalium (5.5%). Pharyngeal STIs were less prevalent (4.1%). Overall, the prevalence of any STI was 41%. Sex under the influence of drugs (adjusted odds ratio, 4.94; 95% confidence interval, 1.56-15.69) and engaging in condomless receptive anal intercourse with a casual partner (adjusted odds ratio, 8.36; 95% confidence interval, 1.73-40.28) were independent risk factors for having an extragenital STI. CONCLUSIONS The high burden of extragenital STIs and active syphilis in asymptomatic MSM underscores the importance of routine etiological screening in this key population, as the syndromic approach would not enable detection or treatment of these infections.
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Affiliation(s)
| | - Windy Sekgele
- South African Field Epidemiology Training Programme (SAFETP), National Institute for Communicable Diseases
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Belagal P. Current alternative therapies for treating drug-resistant Neisseria gonorrhoeae causing ophthalmia neonatorum. Future Microbiol 2024; 19:631-647. [PMID: 38512111 PMCID: PMC11229588 DOI: 10.2217/fmb-2023-0251] [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: 11/12/2023] [Accepted: 01/03/2024] [Indexed: 03/22/2024] Open
Abstract
Ophthalmia neonatorum is a microbial contraction, damaging eyesight, occurring largely among neonates. Infants are particularly vulnerable to bacterial infections acquired during birth from infected mothers, especially from Neisseria gonorrhoeae and Chlamydia trachomatis. Over the decades, N. gonorrhoeae is alarmingly developing a resistance to most antibiotics currently prescribed. To counter this challenge, it is imperative to find potent and cost-effective therapeutic agents for prophylaxis and treatment, to which the N. gonorrhoeae cannot easily develop resistance. This review showcases alternate therapies such as antimicrobial-fatty acids, -peptides, -nano-formulations etc., currently evident against N. gonorrhoeae-mediated ophthalmia neonatorum, which remains a major cause of ocular morbidity, blindness and even death among neonates in developing countries.
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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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Russell A, Siddiq M, Fitzpatrick C, Richardson D. Anorectal Mpox in men who have sex with men associated with sexually transmitted co-infections: a case series. Sex Transm Infect 2024; 100:52-53. [PMID: 37833058 DOI: 10.1136/sextrans-2023-055906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- Annie Russell
- Sexual Health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Mohammed Siddiq
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Colin Fitzpatrick
- Sexual Health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Daniel Richardson
- Sexual Health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
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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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Mitjà O, Suñer C, Giacani L, Vall-Mayans M, Tiplica GS, Ross JD, Bradshaw CS. Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100737. [PMID: 37927440 PMCID: PMC10625009 DOI: 10.1016/j.lanepe.2023.100737] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/09/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
This review explores the therapeutic challenges of sexually transmitted infections (STI) in Europe, which include increasing antimicrobial resistance and limited progress in drug discovery. We primarily focus on gonorrhoea, Mycoplasma genitalium, and syphilis infections. For gonorrhoea with escalating resistance rates we explore the possibility of combining ceftriaxone with another antibiotic or using alternative antibiotics to mitigate resistance emergence, and we provide insights on the ongoing evaluation of new antimicrobials, like gepotidacin and zoliflodacin. In the case of M. genitalium, which exhibits high resistance rates to first and second-line treatments, we emphasize the importance of resistance-guided therapy in regions with elevated resistance levels, and highlight the limited alternative options, such as pristinamycin and minocycline. Furthermore, we address the challenges posed by syphilis, where the primary treatment consists of penicillin or doxycycline, with challenges arising in neurosyphilis, allergy, pregnancy, and supply shortages and discuss the ongoing evaluation of alternative antimicrobials (e.g., ceftriaxone, cefixime, linezolid). Our findings identify priority actions and provide concrete solutions for long-term effective management of STIs and antimicrobial resistance mitigation.
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Affiliation(s)
- Oriol Mitjà
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clara Suñer
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lorenzo Giacani
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Martí Vall-Mayans
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Badalona, Spain
| | - George-Sorin Tiplica
- Dermatology 2, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Jonathan D.C. Ross
- Sexual Health and HIV, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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16
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He W, Yuan Y, Liang J, Fan X, Li L, Pan X. Detection of macrolide and fluoroquinolone resistance-associated 23S rRNA and parC mutations in Mycoplasma genitalium by nested real-time PCR. Front Cell Infect Microbiol 2023; 13:1271392. [PMID: 37928183 PMCID: PMC10623348 DOI: 10.3389/fcimb.2023.1271392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
Background Traditional drug susceptibility testing cannot be performed in clinical laboratories due to the slow-growing characteristics of Mycoplasma genitalium when cultured in vitro. Sanger sequencing is the standard method for detecting drug resistance-associated mutations. It has been used in some laboratories to guide the choice of macrolide antibiotics for Mycoplasma genitalium infected patients. Furthermore, resistance to fluoroquinolone has become another emerging clinical challenge. Objective Sequencing analysis can detect unknown mutations, but it is time-consuming, requires professional analytical skills and the appropriate testing equipment. The main objective of this study was to establish a nested real-time PCR method for the simultaneous detection of 23S rRNA and parC genotypes in relation to the macrolide and fluoroquinolone resistance. Results 105 MG-positive samples and 27 samples containing other pathogens were used for validation. The limit of the nested real-time PCR detection was 500 copies/reaction and there was no cross-reaction with Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis, Neisseria gonorrhoeae, Human papillomavirus, Herpes simplex virus, Candida albicans and Ureaplasma parvum, but the 23S rRNA assay cross-reacted with Mycoplasma pneumoniae. Compared with sequencing results, the sensitivity of 23S rRNA was 100% (95% CI; 93.3 -100), the specificity was 94.3% (95% CI; 79.4 - 99.0), the overall consistency was 98% (95% CI; 92.5 - 99.7) and kappa value was 0.96 (P < 0.001); the sensitivity of parC was 100% (95% CI; 93.4 - 100), the specificity was 89.7% (95% CI; 71.5 - 97.3) and the overall consistency was 96.9% (95% CI; 90.7 - 99.2) with a kappa value of 0.92 (P < 0.001). Conclusions The results of this sensitive and rapid alternative for identifying resistant genotypes of Mycoplasma genitalium are intuitive and easy to interpret, especially for mixed MG populations. Although the relevant 23S rRNA primers need further adjustment, this reliable method would provide an effective diagnostic tool for the selection of antibiotics in clinical practice.
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Affiliation(s)
- Wenyin He
- Department of Clinical Laboratory, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ying Yuan
- Department of Clinical Laboratory, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junyu Liang
- Department of Clinical Laboratory, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuejiao Fan
- Department of Clinical Laboratory, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lei Li
- Department of Clinical Laboratory, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xingfei Pan
- Department of Infectious Diseases, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Lokken EM, Kabare E, Oyaro B, Nyaigero M, Kinuthia J, Jaoko W, Mandaliya K, McClelland RS, Manhart LE. A prospective preconception cohort study of the association between Mycoplasma genitalium and fecundability in Kenyan women trying to conceive. Hum Reprod 2023; 38:2020-2027. [PMID: 37634090 PMCID: PMC10546078 DOI: 10.1093/humrep/dead172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 08/04/2023] [Indexed: 08/28/2023] Open
Abstract
STUDY QUESTION Is Mycoplasma genitalium-infection associated with reduced fecundability? SUMMARY ANSWER Preconception M. genitalium-infection was associated with 27% lower fecundability though confidence intervals were wide, and the association between M. genitalium and fecundability may be dependent on concurrent bacterial vaginosis (BV). WHAT IS KNOWN ALREADY M. genitalium has been associated with cervicitis, pelvic inflammatory disease, infertility, and preterm birth, but the extent to which M. genitalium is causally related to adverse reproductive sequelae in women is debated. STUDY DESIGN, SIZE, DURATION Kenyan women enrolled in a prospective preconception cohort provided vaginal fluid specimens and underwent monthly pregnancy testing. Stored samples from 407 women who had been trying to conceive for ≤6 months were tested for M. genitalium using a nucleic acid amplification test. PARTICIPANTS/MATERIALS, SETTING, METHODS Data on first day of last menstrual period, sexual behavior, pregnancy status, and vaginal specimens were collected at monthly preconception visits. The association between M. genitalium detected at the visit prior to each pregnancy test and fecundability was estimated using discrete time proportional probabilities models. Secondary analyses explored the influence of concurrent BV on the association between M. genitalium and fecundability. MAIN RESULTS AND THE ROLE OF CHANCE The 407 participants experienced 1220 menstrual cycles and 213 pregnancies. The prevalence of M. genitalium at enrollment was 7.7%. After adjustment for age, frequency of condomless sex in the last 4 weeks, and study site, M. genitalium was associated with a 27% lower fecundability, but confidence intervals were wide (adjusted fecundability ratio (aFR) 0.73, 95% CI 0.44, 1.23). In secondary analyses, when compared to cycles without M. genitalium or BV at the visit prior, women with both M. genitalium and BV at the visit prior had a 51% lower fecundability (aFR = 0.49, 95% CI 0.22, 1.09) whereas there was no association of M. genitalium alone (aFR = 0.98 (95% CI 0.54, 1.76)), and a smaller reduction in fecundability for women with BV only (aFR = 0.80 (95% CI 0.60, 1.07)). LIMITATIONS, REASONS FOR CAUTION Results should be interpreted cautiously given the relatively low prevalence of M. genitalium and wide confidence intervals. WIDER IMPLICATIONS OF THE FINDINGS In this cohort of Kenyan women trying to conceive, the association between M. genitalium and fecundability was influenced by concurrent BV status, suggesting there may be a synergistic effect of M. genitalium and BV on fecundability. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-RSM). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were completed using REDCap electronic data capture tools hosted at the University of Washington's Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation and consulting fees from Lupin Pharmaceuticals. L.E.M. receives research funding and material for research studies, paid to the University of Washington, from Hologic Corporation and Nabriva Therapeutics, travel support from Hologic, and consulting fees from Health Advances. E.M.L.'s contributions to this study primarily occurred while affiliated with the University of Washington; at the time of submission, E.M.L. was an employee of and holds stock or stock grants for AbbVie, Inc. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Erica M Lokken
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Emmanuel Kabare
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Brenda Oyaro
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Maureen Nyaigero
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics & Gynaecology, Kenyatta National Hospital, Nairobi, Kenya
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | | | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lisa E Manhart
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Menezes ME, Silver EJ, Goldstein DY, Collins-Ogle MD, Fox AS, Coupey SM. Prevalence and Factors Associated With Mycoplasma genitalium Infection in At-Risk Female Adolescents in Bronx County, New York. Sex Transm Dis 2023; 50:635-641. [PMID: 37255234 DOI: 10.1097/olq.0000000000001840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Mycoplasma genitalium infection can adversely affect female reproductive health, but data are limited about prevalence and characteristics of the infection in female adolescents. We employed a sensitive assay to detect M. genitalium infection, and we describe its characteristics in a clinical sample of women younger than 21 years. METHODS We recruited females aged 13 to 20 years in children's hospital clinics whose clinicians were testing for chlamydia/gonorrhea. Participants completed a questionnaire providing demographics, sexual history, and current symptoms. Urine/endocervical samples were tested for chlamydia/gonorrhea and partitioned for M. genitalium testing using Aptima M. genitalium assay. We reviewed records for the clinic visit to document examination, diagnosis, and results of sexually transmitted infection (STI) testing. We compared prevalence of M. genitalium infection by demographics, sexual history, symptoms, and signs. RESULTS Of 153 participants mean age 18.07 ± 1.68 years, 58% self-identified as Hispanic, 27% Black, 64% straight/heterosexual, 27% bisexual, 1% gay/lesbian, 29% reported a prior STI diagnosis. Prevalence of M. genitalium was 11.1% (17/153), 13 of 17 were asymptomatic, 2 of 17 had pelvic inflammatory disease (PID), 3 of 17 coinfected with chlamydia or gonorrhea. Prevalence of chlamydia was 6.6% and of gonorrhea 2.6%. A logistic regression model indicated independent associations of bisexual orientation versus all other orientations (adjusted odds ratio [aOR], 4.80; 95% confidence interval [CI], 1.38-16.67), self-reported prior STI (aOR, 3.83; 95% CI, 1.10-13.37), and self-reported prior PID (aOR, 9.12; 95% CI, 1.02-81.72) with higher odds of M. genitalium infection. CONCLUSIONS Findings suggest that in at-risk female populations younger than 21 years, M. genitalium is a prevalent STI and symptomatic adolescents may warrant testing and treatment. Further study of harms and benefits of testing asymptomatic bisexual female adolescents or those with prior STI/PID is needed.
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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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Zhang S, Xu K, Liu SX, Ye XL, Huang P, Jiang HJ. Retrospective Analysis of Azithromycin-Resistant Ureaplasma urealyticum and Mycoplasma hominis Cervical Infection Among Pregnant Women. Infect Drug Resist 2023; 16:3541-3549. [PMID: 37305734 PMCID: PMC10255606 DOI: 10.2147/idr.s405286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose Ureaplasma urealyticum and Mycoplasma hominis began to show resistance to azithromycin, a macrolide antibiotic commonly used in pregnancy. Unfortunately, there are few effective and safe drugs in the clinic for genital mycoplasmas in pregnant women. In the present study, we investigated the prevalence of azithromycin-resistant U. urealyticum and M. hominis infections in pregnant women. The secondary research objects were possible influencing factors and consequences of insensitive Mycoplasma infection. Patients and methods A retrospective analysis was carried out in pregnant women who underwent cervical Mycoplasma culture between October 2020 and October 2021 at a large general hospital in eastern China. The sociological characteristics and clinical information of these women were collected and analyzed. Results A total of 375 pregnant women were enrolled, and 402 cultured mycoplasma specimens were collected. Overall, 186 (49.60%) patients tested positive cervical Mycoplasma infection, and 37 (9.87%) had infections caused by azithromycin-resistant Mycoplasma. In total, 39 mycoplasma samples were insensitive to azithromycin in vitro, also showing extremely high resistance to erythromycin, roxithromycin, and clarithromycin. Azithromycin was the only antibiotic used in women with Mycoplasma cervical infection, regardless of azithromycin resistance in vitro. Statistical results showed that azithromycin-resistant cervical Mycoplasma infection in pregnant women was unrelated to age, body mass index (BMI), gestational age, number of embryos, and assisted reproductive technology (ART) use, but led to a significantly increased incidence of adverse pregnancy outcomes (spontaneous abortion (SA), preterm birth (PTB), preterm prelabor rupture of membranes (PPROM), and stillbirth). Conclusion Azithromycin-resistant U. urealyticum and M. hominis cervical infections are relatively common during pregnancy, and can increase the risk of adverse pregnancy outcomes; however, there is currently a lack of safe and effective drug treatments. Herein, we show that azithromycin-resistant mycoplasma infection requires timely intervention.
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Affiliation(s)
- Su Zhang
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Ke Xu
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Su-Xiao Liu
- Center for Reproductive Medicine, Department of Obstetrics, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiao-Lan Ye
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Ping Huang
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Hong-Juan Jiang
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
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22
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Waites KB, Crabb DM, Ratliff AE, Geisler WM, Atkinson TP, Xiao L. Latest Advances in Laboratory Detection of Mycoplasma genitalium. J Clin Microbiol 2023; 61:e0079021. [PMID: 36598247 PMCID: PMC10035321 DOI: 10.1128/jcm.00790-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Mycoplasma genitalium is an important sexually transmitted pathogen affecting both men and women. Its extremely slow growth in vitro and very demanding culture requirements necessitate the use of molecular-based diagnostic tests for its detection in clinical specimens. The recent availability of U.S. Food and Drug Administration (FDA)-cleared commercial molecular-based assays has enabled diagnostic testing to become more widely available in the United States and no longer limited to specialized reference laboratories. Advances in the knowledge of the epidemiology and clinical significance of M. genitalium as a human pathogen made possible by the availability of molecular-based testing have led to updated guidelines for diagnostic testing and treatment that have been published in various countries. This review summarizes the importance of M. genitalium as an agent of human disease, explains the necessity of obtaining a microbiological diagnosis, describes currently available diagnostic methods, and discusses how the emergence of antimicrobial resistance has complicated treatment alternatives and influenced the development of diagnostic tests for resistance detection, with an emphasis on developments over the past few years.
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Affiliation(s)
- Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Donna M Crabb
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amy E Ratliff
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William M Geisler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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23
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Chlamydia trachomatis Coinfection Does Not Influence Mycoplasma genitalium Bacterial Load in Urogenital Samples. Sex Transm Dis 2023; 50:157-160. [PMID: 36729935 DOI: 10.1097/olq.0000000000001752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mycoplasma genitalium (MG) is associated with urethritis in men and weakly associated with pelvic inflammatory disease in women. Mycoplasma genitalium coinfections with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are commonly reported; however, little is known about their interaction. One study suggested that MG/NG coinfections might increase the bacterial load of NG, which has been shown to have a higher transmission potential. As even less is known about the impact of a simultaneous MG/CT infection, we assessed whether patients with urogenital MG/CT coinfections have a higher bacterial load than patients with a single infection. METHODS There were 1673 urogenital samples from patients from a population-based chlamydia study, and our sexually transmitted infection clinic tested for both CT and MG. When positive, the load was quantified. Nonparametric tests compared the CT and MG load, and linear regression analyses tested the association of the CT and MG load within a patient. RESULTS In 60 MG-positive patients, MG load ranged from 1.7 to 6.0 log10 copies/ml, similar to the CT load distribution. Only 6 patients were MG-positive and CT-negative, but the MG load distribution was similar to that of CT-positive patients (n.s.). The MG and CT load was unrelated in coinfected persons (n.s.). CONCLUSIONS We found no correlation between the CT and MG load in urogenital samples, and the MG load distribution was similar in CT-positive and CT-negative patients. These results could have implications for the transmission risk of these infections.
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24
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Li L, Yuan Y, He W, Zheng L, Wang Q. Emerging multidrug resistance contributes to treatment failure in Mycoplasma genitalium infected patients in China. Diagn Microbiol Infect Dis 2023; 105:115854. [PMID: 36436311 DOI: 10.1016/j.diagmicrobio.2022.115854] [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: 06/07/2022] [Revised: 09/21/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
The increased treatment failure in patients with sexually transmitted Mycoplasma genitalium infection is associated with antimicrobial resistance. We performed a retrospective survey of antimicrobial clinical outcomes in M. genitalium-infected patients. In addition, we detected macrolide, fluoroquinolone and tetracycline resistance-associated markers to determine their role in treatment failure. The overall incidence of treatment failure was 28.29%, regardless of the drug used. In the present study, the prevalence of macrolide resistance-associated mutations in the 23S rRNA gene was 64%; that of fluroquinolone resistance-associated S83/D87 substitutions in the parC gene was 67.5%; and that of the tetracycline resistance-associated C1192T mutation in the 16S rRNA gene was 22.5%. Furthermore, evidence of dual antimicrobial resistance was found in 46.4% of pretreatment samples, and triple antimicrobial resistance was identified in 9.9%. These findings regarding the emergence of multidrug-resistant strains of M. genitalium in China are concerning and emphasize the importance of guiding M. genitalium treatment with antimicrobial resistance assays.
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Affiliation(s)
- Lei Li
- Laboratory Medicine Center, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Clinical Laboratory, The Third Affiliated Hospital of Guangzhou Medical University, Guangzho, China
| | - Ying Yuan
- Department of Clinical Laboratory, The Third Affiliated Hospital of Guangzhou Medical University, Guangzho, China
| | - Wenyin He
- Department of Clinical Laboratory, The Third Affiliated Hospital of Guangzhou Medical University, Guangzho, China
| | - Lei Zheng
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Qian Wang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China; Center for Clinical Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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25
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Ong JJ, Bourne C, Dean JA, Ryder N, Cornelisse VJ, Murray S, Kenchington P, Moten A, Gibbs C, Maunsell S, Davis T, Michaels J, Medland NA. Australian sexually transmitted infection (STI) management guidelines for use in primary care 2022 update. Sex Health 2023; 20:1-8. [PMID: 36356948 DOI: 10.1071/sh22134] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/15/2022] [Indexed: 11/12/2022]
Abstract
The 'Australian Sexually Transmitted Infection (STI) Management Guidelines For Use In Primary Care' (www.sti.guidelines.org.au ) provide evidence-based, up-to-date guidance targeted at use in primary care settings. A major review of the guidelines was undertaken in 2020-22. All content was reviewed and updated by a multi-disciplinary group of clinical and non-clinical experts, and assessed for appropriateness of recommendations for key affected populations and organisational and jurisdictional suitability. The guidelines are divided into six main sections: (1) standard asymptomatic check-up; (2) sexual history; (3) contact tracing; (4) STIs and infections associated with sex; (5) STI syndromes; and (6) populations and situations. This paper highlights important aspects of the guidelines and provides the rationale for significant changes made during this major review process.
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Affiliation(s)
- Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Monash University, Melbourne, Vic., Australia; and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Bourne
- Centre for Population Health, New South Wales Health, Sydney, NSW, Australia; and Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Qld, Australia
| | - Nathan Ryder
- Centre for Population Health, New South Wales Health, Sydney, NSW, Australia; and HNE Sexual Health, Hunter New England Health District, New Lambton, NSW, Australia
| | - Vincent J Cornelisse
- Kirketon Road Centre, New South Wales Health, Sydney, NSW, Australia; and The Kirby Institute, University of New South Wales Sydney, Kensington, NSW, Australia
| | - Sally Murray
- South Terrace Clinic, Fremantle and Fiona Stanley Hospitals, Fremantle, WA, Australia
| | - Penny Kenchington
- Townsville Sexual Health Service, Queensland Health, Townsville, Qld, Australia
| | | | | | | | | | | | - Nicholas A Medland
- Central Clinical School, Monash University, Melbourne, Vic., Australia; and The Kirby Institute, University of New South Wales Sydney, Kensington, NSW, Australia
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26
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Goodfellow JJ, Hughes S, Smith J, Jones R, Moore LSP, Rayment M. Novel use of oral chloramphenicol for treatment-resistant Mycoplasma genitalium. Sex Transm Infect 2023; 99:208-210. [PMID: 36717253 DOI: 10.1136/sextrans-2022-055621] [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: 09/09/2022] [Accepted: 10/02/2022] [Indexed: 02/01/2023] Open
Abstract
We describe the novel use of oral chloramphenicol for treatment-resistant Mycoplasma genitalium (M. genitalium) infection in a 20-year-old heterosexual cisgender male presenting with recurrent symptomatic non-gonococcal urethritis. M. genitalium urethritis is an increasingly common clinical conundrum in sexual health clinics and in cases of second-line treatment failure (such as moxifloxacin), UK and international guidelines struggle to make recommendations for third-line treatments. As shown in our case, the evidence base for third-line treatments is lacking, with poor success rates, and may be poorly tolerated. Here we demonstrate the novel use of a well-tolerated oral antimicrobial, chloramphenicol, resulting in rapid microbiological and clinical cure in treatment-resistant M. genitalium urethritis.
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Affiliation(s)
| | - Stephen Hughes
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jo Smith
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Rachael Jones
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Luke S P Moore
- Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Rayment
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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27
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Yu J, Zhou Y, Luo H, Su X, Gan T, Wang J, Ye Z, Deng Z, He J. Mycoplasma genitalium infection in the female reproductive system: Diseases and treatment. Front Microbiol 2023; 14:1098276. [PMID: 36896431 PMCID: PMC9989269 DOI: 10.3389/fmicb.2023.1098276] [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: 11/14/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Mycoplasma genitalium is a newly emerged sexually transmitted disease pathogen and an independent risk factor for female cervicitis and pelvic inflammatory disease. The clinical symptoms caused by M. genitalium infection are mild and easily ignored. If left untreated, M. genitalium can grow along the reproductive tract and cause salpingitis, leading to infertility and ectopic pregnancy. Additionally, M. genitalium infection in late pregnancy can increase the incidence of preterm birth. M. genitalium infections are often accompanied by co-infection with other sexually transmitted pathogens (Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis) and viral infections (Human Papilloma Virus and Human Immunodeficiency Virus). A recent study suggested that M. genitalium plays a role in tumor development in the female reproductive system. However, few studies endorsed this finding. In recent years, M. genitalium has evolved into a new "superbug" due to the emergence of macrolide-and fluoroquinolone-resistant strains leading to frequent therapy failures. This review summarizes the pathogenic characteristics of M. genitalium and the female reproductive diseases caused by M. genitalium (cervicitis, pelvic inflammatory disease, ectopic pregnancy, infertility, premature birth, co-infection, reproductive tumors, etc.), as well as its potential relationship with reproductive tumors and clinical treatment.
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Affiliation(s)
- Jianwei Yu
- Department of Public Health Laboratory Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yan Zhou
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Haodang Luo
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Xiaoling Su
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Tian Gan
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Jingyun Wang
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Zufeng Ye
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Zhongliang Deng
- Department of Public Health Laboratory Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jun He
- Department of Public Health Laboratory Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, China.,The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
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28
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Alamon-Reig F, Riera-Monroig J, González-Cordón A, Bosch J, Alsina M, Fuertes I. Mycoplasma genitalium: A descriptive study of 196 cases. Indian J Dermatol Venereol Leprol 2022; 88:873. [PMID: 35962503 DOI: 10.25259/ijdvl_217_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/01/2022] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Ana González-Cordón
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Bosch
- Department of Microbiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mercè Alsina
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Irene Fuertes
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona, Spain
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29
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Peters RP, Garrett N, Chandiwana N, Kularatne R, Brink AJ, Cohen K, Gill K, Chidarikire T, Wattrus C, Nel JS, Moosa MY, Bekker LG. Southern African HIV Clinicians Society 2022 guideline for the management of sexually transmitted infections: Moving towards best practice. South Afr J HIV Med 2022; 23:1450. [PMID: 36299557 PMCID: PMC9575338 DOI: 10.4102/sajhivmed.v23i1.1450] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Remco P.H. Peters
- Research Unit, Foundation for Professional Development, East London, South Africa,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa,Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Nomathemba Chandiwana
- Ezintsha, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Ranmini Kularatne
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adrian J. Brink
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Katherine Gill
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | - Camilla Wattrus
- Southern African HIV Clinicians Society (SAHCS), Johannesburg, South Africa
| | - Jeremy S. Nel
- Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Mahomed Y.S. Moosa
- Department of Infectious Disease, Division of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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30
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Soni S, Ison CA. Bacterial Special Interest Group activities. Sex Transm Infect 2022; 98:466. [PMID: 35995449 DOI: 10.1136/sextrans-2022-055568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Suneeta Soni
- Claude Nicol Centre, Brighton, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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31
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Herms F, Poizeau F, Anyfantakis V, Bonhomme P, Chaine-Sidibé B, Louison JB, Berçot B, Bagot M, Fouéré S. Mycoplasma genitalium screening in a specialized French unit: A retrospective study. Ann Dermatol Venereol 2022; 149:165-168. [PMID: 35690480 DOI: 10.1016/j.annder.2021.08.004] [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] [Received: 03/18/2021] [Revised: 06/23/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Mycoplasma genitalium (MG) infection accounts for 10-35% of non-gonococcal non-chlamydial (NGNC) urethritis. However, given that most people infected with MG do not develop symptoms and that antimicrobial resistance is increasing worldwide, there is no evidence of any benefits of screening asymptomatic individuals. We conducted this study to describe MG screening practices and outcomes at a French Sexually Transmitted Infections (STI) center in which MG testing was performed selectively and multiplex assays were not carried out [i.e., simultaneous screening for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and MG]. METHODS A retrospective, observational, single-center study was conducted at the STI unit of Saint-Louis Hospital in Paris. The records of all patients undergoing MG testing from January 1st, 2017, to December 31st, 2018, were reviewed. The primary aim of the study was to describe and evaluate the proportion of MG-positive (MG+) patients among those tested. Secondary objectives were determination of the prevalence of MG+ status among symptomatic patients, risk factors associated with MG infection, and therapeutic modalities and efficacy. RESULTS Two hundred and forty-nine patients underwent MG testing, 28 (11%) of whom were positive (MG+). The prevalence of MG+ status among symptomatic NGNC patients was 12%. HIV-positive (HIV+) status was significantly associated with MG+ status in univariate and multivariate analyses (Odds Ratio=7.3, 95% Confidence Interval 1.3-41.7; P=0.02). Twenty-three patients (85%) received antibiotics. Eighteen (67%) received azithromycin for 5 days, but 7 had clinical resistance. No quinolone resistance was reported. CONCLUSION Despite unavailability of multiplex testing at our facility, which led to targeted-only screening for MG, its relatively high local prevalence is in keeping with what is generally observed at similar facilities across the world, where use of multiplex tests enables systematic screening for MG alongside NG and CT. This reinforces the current recommendations in Europe, France and the US against systematic MG testing or treatment in asymptomatic patients.
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Affiliation(s)
- F Herms
- Department of Dermatology, Genital Diseases and STIs unit, Saint-Louis Hospital, 1, avenue Claude Vellefaux, 75010 Paris, France.
| | - F Poizeau
- EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), Rennes 1 University, 35000 Rennes, France; Department of Dermatology, CHU de Rennes, 35000 Rennes, France
| | - V Anyfantakis
- Department of Dermatology, Genital Diseases and STIs unit, Saint-Louis Hospital, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - P Bonhomme
- Department of Dermatology, Genital Diseases and STIs unit, Saint-Louis Hospital, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - B Chaine-Sidibé
- Department of Dermatology, Genital Diseases and STIs unit, Saint-Louis Hospital, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - J-B Louison
- Department of Dermatology, Genital Diseases and STIs unit, Saint-Louis Hospital, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - B Berçot
- Laboratory of Microbiology, Saint-Louis Hospital, 75010 Paris, France
| | - M Bagot
- Department of Dermatology, Genital Diseases and STIs unit, Saint-Louis Hospital, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - S Fouéré
- Department of Dermatology, Genital Diseases and STIs unit, Saint-Louis Hospital, 1, avenue Claude Vellefaux, 75010 Paris, France
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32
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Brown L, Chamula M, Weinberg S, Jbueen F, Rautemaa-Richardson R. Compliance with the Updated BASHH Recurrent Vulvovaginal Candidiasis Guidelines Improves Patient Outcomes. J Fungi (Basel) 2022; 8:jof8090924. [PMID: 36135648 PMCID: PMC9503580 DOI: 10.3390/jof8090924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/15/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
Recurrent vulvovaginal candidiasis (RVVC) is a debilitating, chronic condition that affects over 138 million (6%) women of reproductive age annually. We performed a retrospective audit of RVVC referrals to our tertiary care Candida clinic to evaluate the impact of the significantly updated British Association of Sexual Health and HIV (BASHH) 2019 vulvovaginal candidiasis guidelines on patient outcomes, the principles of which were implemented at our centre at the onset of the guideline revision process in 2017. A total of 78 women referred with suspected RVVC in 2017–2020 were included. Their mean symptom duration prior to referral was 6.7 years. RVVC was the definitive diagnosis in 73% of cases. In the 27% of patients without RVVC, the most common diagnoses were acute VVC (29%), vulval eczema (14%), dry skin (14%) and vulvodynia (10%). Of those with RVVC, 60% were diagnosed with an additional diagnosis, most commonly vulval eczema or vulvodynia. Only 12% of women had been counselled on appropriate vulval skin care, the mainstay of RVVC management. Long-term antifungal suppression was initiated in 68% of women. Azole-resistant Candida, for which there is no licensed treatment available in the UK, was identified in 23% of women with RVVC. In the follow-up, 82% of patients reported good control of symptoms using antifungal suppression therapy and recommended skin care, 16% had partial symptom control with some “flare-ups” responding to treatment, none reported poor control and for 2% this information was not available. RVVC-related morbidity can be reduced by following the principles outlined in the BASHH guidelines.
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Affiliation(s)
- Lottie Brown
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M23 9LT, UK
- Guys and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Mathilde Chamula
- Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
- Mycology Reference Centre Manchester, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | - Sharon Weinberg
- Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
- The Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - Frakinda Jbueen
- Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | - Riina Rautemaa-Richardson
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M23 9LT, UK
- Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
- Mycology Reference Centre Manchester, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
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33
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Pitt R, Boampong D, Day M, Jensen JS, Cole M. Challenges of in vitro propagation and antimicrobial susceptibility testing of Mycoplasma genitalium. J Antimicrob Chemother 2022; 77:2901-2907. [PMID: 35979812 DOI: 10.1093/jac/dkac281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The sexually transmitted bacterial pathogen Mycoplasma genitalium has proved a complex organism to work with in the laboratory setting. Exhibiting an extremely fastidious nature, successful in vitro propagation of M. genitalium has remained elusive for many researchers. Antimicrobial resistance to both first- and second-line recommended therapies (macrolides and fluoroquinolones, respectively) is commonly reported. However, phenotypic susceptibility testing is not routinely performed, due to the difficulties of in vitro growth. Instead, molecular detection of known resistance determinants is used to infer susceptibility/resistance. However, associations between determinant detection and clinical treatment failure are not always clear. Furthermore, molecular assays have limited use for detection of emerging resistance mechanisms. The present review collates and discusses the development of successful culture systems for initial isolation of this organism and current methodologies employed for phenotypic susceptibility testing to aid researchers in this field. As with Neisseria gonorrhoeae, future treatment options are extremely limited for M. genitalium and, if this sexually transmitted infection is to remain treatable, phenotypic susceptibility testing will play an invaluable role in evaluation of potential therapeutics. As such, retainment of these techniques is imperative.
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Affiliation(s)
- Rachel Pitt
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | | | - Michaela Day
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | | | - Michelle Cole
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
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34
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Molecular Typing Reveals Distinct Mycoplasma genitalium Transmission Networks among a Cohort of Men Who Have Sex with Men and a Cohort of Women in France. Microorganisms 2022; 10:microorganisms10081587. [PMID: 36014005 PMCID: PMC9413324 DOI: 10.3390/microorganisms10081587] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 02/05/2023] Open
Abstract
Mycoplasma genitalium causes sexually transmitted infecti.ons in men and women. Treatment failures to macrolides and fluoroquinolones have been reported worldwide. Although the mgpB typing method has often been used in M. genitalium-infected men who have sex with men (MSM), limited typing data are available for M. genitalium-infected women. In this study, we aimed to investigate the genetic relationship between M. genitalium strains and their antibiotic resistance profile in a cohort of MSM (86.2% on HIV preexposure prophylaxis [PrEP], 13.8% HIV positive) and a large cohort of women using mgpB/MG309 typing. The mgpB types were determined in 374 samples from 305 women and 65 MSM. Three MSM and one woman had two concurrent or subsequent samples. Macrolide and fluoroquinolone resistance-associated mutations were searched in the 23S rRNA as well as parC and gyrA genes. The mgpB phylogenetic construction revealed three large clusters that differed according to sexual practices and geographical origin of patients. The prevalence of macrolide and fluoroquinolone resistance was significantly higher in MSM compared with women (95.4% vs. 14.1% and 30.6% vs. 7.2%, p < 0.001, respectively). The macrolide resistance spread was polyclonal in both populations, but clonal diffusion of two dual-resistant types was observed in PrEP users in association with high antibiotic pressure and dense connectivity in this population.
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35
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Philipova I, Levterova V, Simeonovski I, Kantardjiev T. Azithromycin treatment failure and macrolide resistance in Mycoplasma genitalium infections in Sofia, Bulgaria. Folia Med (Plovdiv) 2022; 64:422-429. [PMID: 35856103 DOI: 10.3897/folmed.64.e63624] [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: 01/26/2021] [Accepted: 05/18/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Mycoplasmagenitalium is an established cause of sexually transmitted infections in men and women. Current guidelines recommend azithromycin and moxifloxacin as first- and second-line treatment, respectively. However, azithromycin treatment failure has been increasingly reported. The aim of this study was to determine the efficacy of azithromycin and alternative antibiotic regimens in a prospective cohort of M.genitalium-positive patients, and macrolide resistance mutations associated with azithromycin failure.
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Affiliation(s)
- Ivva Philipova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Ivan Simeonovski
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Todor Kantardjiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
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Ring A, Balakrishna S, Imkamp F, Burkard S, Triet F, Brunschweiler F, Grube C, Bodmer R, Kouyos RD, Günthard HF, Braun DL. High rates of asymptomatic Mycoplasma genitalium infections with high proportion of genotypic resistance to first-line macrolide treatment among men enrolled in the Zurich primary HIV infection study. Open Forum Infect Dis 2022; 9:ofac217. [PMID: 35783686 PMCID: PMC9246285 DOI: 10.1093/ofid/ofac217] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Mycoplasma genitalium (Mg) is an emerging sexually transmitted pathogen among men who have sex with men (MSM). Resistance to recommended antimicrobial agents are of public health concern. Few data exist on Mg infections in MSM diagnosed with human immunodeficiency virus (HIV) during primary HIV infection. Methods Participants of the Zurich Primary HIV Study (ClinicalTrials.gov Identifier NCT 00537966) were systematically offered screening for sexually transmitted infections (STIs) between April 2019 and September 2020. Screening was performed using an in-house polymerase chain reaction panel comprising Mg including genotypic resistance testing for macrolides and quinolones, Chlamydia trachomatis including serovars L1-L3, Neisseria gonorrhoeae, Treponema pallidum, and Hemophilus ducreyi. Results We screened 148 of 266 (55.6%) participants, with an overall total of 415 follow-up visits. Ninety-one percent were MSM. The incidence rate for all STIs was 47.0 (95% confidence interval [CI], 32.2–68.6) per 100 person-years. Mycoplasma genitalium was the most frequently detected pathogen: 30 participants (20%) presented with at least 1 Mg infection, corresponding to a period prevalence of 20.3% and incidence rate of 19.5 Mg infections (95% CI, 11.8–32.4). Most Mg infections (93%) were asymptomatic, and 9 (30%) participants showed spontaneous clearance. We detected high rates of antibiotic resistance: 73.3% to macrolides, 3.3% to quinolones, and 13.3% resistance to both antibiotics. Conclusions The high prevalence of mostly asymptomatic Mg infections and high rate of spontaneous clearance support cautious initiation for treatment. The high proportion of macrolide-resistant strains suggests that a genotypic determination of resistance should be standard of care. Moxifloxacin should be the preferred treatment option for symptomatic Mg infections among MSM if resistance testing is unavailable.
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Affiliation(s)
- Alexander Ring
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Suraj Balakrishna
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Frank Imkamp
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Sara Burkard
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Flurina Triet
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Flurina Brunschweiler
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Christina Grube
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Rebecca Bodmer
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Roger D. Kouyos
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Huldrych F. Günthard
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Dominique L. Braun
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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Melendez JH, Hardick J, Onzia A, Yu T, Kyambadde P, Parkes-Ratanshi R, Nakku-Joloba E, Kiragga A, Manabe YC, Hamill MM. Retrospective Analysis of Ugandan Men with Urethritis Reveals Mycoplasma genitalium and Associated Macrolide Resistance. Microbiol Spectr 2022; 10:e0230421. [PMID: 35412392 PMCID: PMC9045240 DOI: 10.1128/spectrum.02304-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/14/2022] [Indexed: 01/22/2023] Open
Abstract
The rising rates of antimicrobial resistance (AMR) in Mycoplasma genitalium globally and the association of this sexually transmitted infection (STI) with cervicitis, urethritis, and HIV are potentially of great public health concern. Data on the epidemiology of M. genitalium in men in sub-Saharan Africa are limited. We sought to determine the prevalence of M. genitalium and macrolide resistance in men with urethritis in Kampala, Uganda. Self-collected penile-meatal swabs and/or urine samples from men with symptomatic urethritis (n = 250) were retrospectively analyzed for the presence of M. genitalium and macrolide resistance markers with the Aptima M. genitalium and ResistancePlus M. genitalium assays. Additionally, demographic and STI coinfection data were used to investigate associations with M. genitalium infection. M. genitalium was detected in 12.8% (32/250) of individuals; 40.6% (n = 13) had M. genitalium monoinfection. Mutations associated with macrolide resistance were detected in 10.7% (3/28) of participants. Coinfection with Neisseria gonorrhoeae was common (41.0%), but M. genitalium was more prevalent in participants without N. gonorrhoeae coinfection (P = 0.001). M. genitalium is common in Ugandan men with urethritis both as a monoinfection and as a coinfection with other curable STIs. Macrolide resistance was present and warrants further research on treatment outcomes and the association between untreated M. genitalium and subsequent morbidity. IMPORTANCE Mycoplasma genitalium is a common sexually transmitted infection associated with urethritis in men. Little is known about M. genitalium infection in men with urethritis in Uganda. We report that 12% of participants in this study were positive for M. genitalium and that resistance to azithromycin, a macrolide antibiotic, is present. Furthermore, we show that either self-collected penile-meatal swabs or urine can be used for detection of M. genitalium.
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Affiliation(s)
- Johan H. Melendez
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Justin Hardick
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Annet Onzia
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Tong Yu
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Peter Kyambadde
- Ministry of Health, National Sexually Transmitted Infections Control Program, Kampala, Uganda
| | | | - Edith Nakku-Joloba
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Yukari C. Manabe
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Matthew M. Hamill
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Impact of 16S rRNA Single Nucleotide Polymorphisms on Mycoplasma genitalium Organism Load with Doxycycline Treatment. Antimicrob Agents Chemother 2022; 66:e0024322. [PMID: 35420491 DOI: 10.1128/aac.00243-22] [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: 11/20/2022] Open
Abstract
Doxycycline targets the 16S rRNA and is widely used for the treatment of sexually transmitted infections. While it is not highly effective at eradicating Mycoplasma genitalium infections, it can reduce organism load. The aim of this study was to investigate the association between single nucleotide polymorphisms (SNPs) in the 16S rRNA gene of M. genitalium and change in organism load. M. genitalium samples were collected from 56 men prior to commencing doxycycline and at a median of 13 of 14 doses. These were sequenced for the 16S rRNA, and the association between 16S rRNA SNPs and change in organism load was determined. 16S rRNA sequences were available for 52/56 (92.9%) M. genitalium-infected men, of which 20 (38.5%) had an undetectable load, 26 (50.0%) had a decrease in M. genitalium load (median change of 105-fold), and 6 (11.5%) had an increase in load (median change of 5-fold). The most common SNPs identified were A742G (10/52 [19.2%]), GG960-961TT/C (7/52 [13.5%]), and C1435T (28/52 [53.8%]) (M. genitalium numbering). None were associated with a change in organism load (P = 0.76, 0.16, and 0.98, respectively). Using pooled published data from 28 isolates, no clear relationship between the SNPs and doxycycline MIC was identified. In conclusion, the low efficacy of doxycycline against M. genitalium does not appear to be due to variation in the 16S rRNA gene.
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Khastgir J. Advances in the antibiotic management of epididymitis. Expert Opin Pharmacother 2022; 23:1103-1113. [PMID: 35380486 DOI: 10.1080/14656566.2022.2062228] [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: 11/04/2022]
Abstract
INTRODUCTION Acute epididymitis is commonly encountered and typically presents acutely within a wide clinical spectrum. Most cases of acute epididymitis are caused by bacterial infection, most often by sexually transmitted organisms and urinary pathogens. Current treatment regimens remain empirical, although recent advances using modern diagnostic techniques support a change in the management paradigm. AREAS COVERED The choice of the initial antibiotic regimen is empirical and based on the most likely causative pathogen, whether sexually transmitted, enteric or other. Adherence of clinical practice remains short of available guidance, which may be improved by thorough clinical and microbiologic assessment, supported by a knowledge of the commonly associated pathogenic organisms, and the appropriate choice of tests required for their identification. Use of advanced microbiology techniques and studies of current practice provide new insights that have challenged traditional management paradigms. The authors discuss these points in and provide their expert perspectives on its treatment and future developments. EXPERT OPINION Relatively sparse direct trial data exists on antimicrobial treatments for acute epididymitis. Much of the presently available guidance is derived from previous guidance recommendations, knowledge of antimicrobial activities of specific agents, and treatment outcomes in uncomplicated infections. Identification of specific pathogens and prescribing accuracy is dependent on the extent to which cases are investigated and is therefore variable.
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Affiliation(s)
- Jay Khastgir
- Princess of Wales Hospital, Cwm Taff Bro Morgannwg NHS University Health Board & Swansea University School of Medicine, Swansea
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Detection and Prevalence of Macrolide and Fluoroquinolone Resistance in Mycoplasma genitalium in Badalona, Spain. Antibiotics (Basel) 2022; 11:antibiotics11040485. [PMID: 35453236 PMCID: PMC9025937 DOI: 10.3390/antibiotics11040485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 12/04/2022] Open
Abstract
Macrolide and fluoroquinolone resistance (MLr/FQr) in Mycoplasma genitalium (MG) infections is concerning worldwide. Current guidelines recommend performing MLr detection in MG-positive cases to adjust antimicrobial therapy. We aimed to evaluate the usefulness of PCR followed by pyrosequencing for MLr detection in comparison with a one-step commercial assay and to assess the prevalence of MLr and FQr in Badalona, Spain. A total of 415 MG-positive samples by Allplex STI-7 (Seegene) were analyzed for MLr detection by pyrosequencing. From those, 179 samples were further analyzed for MG and MLr by ResistancePlus® MG kit (SpeeDx) and 100 of them also for fluoroquinolone resistance (FQr) by sequencing the parC gene. Regarding MG detection, Allplex and Resistance Plus® showed an overall agreement of 87%, but this value rose to 95.4% if we compare them for MLr detection. Prevalence of MLr was 23.1% in Badalona, but this rate increased to 73.7% in the HIV-positive patients cohort. FQr detection showed 3% of resistant strains. Pyrosequencing is a convenient and cheap technique for MLr detection, but one-step tools should be considered in high-throughput laboratories. Despite the fact that MLr remained moderate and FQr was low in our study, simultaneous MG and MLr detection would improve patient’s management applying resistance-guided treatment strategies.
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Individualised treatment of Mycoplasma genitalium infection—incorporation of fluoroquinolone resistance testing into clinical care. THE LANCET INFECTIOUS DISEASES 2022; 22:e267-e270. [DOI: 10.1016/s1473-3099(21)00629-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 01/12/2023]
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Stahl JP, Castan B, Bonnet E, Bru JP, Cohen R, Diamantis S, Faye A, Hitoto H, Issa N, Lesprit P, Maulin L, Poitrenaud D, Raymond J, Strady C, Varon E, Verdon R, Vuotto F, Welker Y, Gauzit R. Utilization of macrolides: State of the art 2022 Spilf and GPIP. Infect Dis Now 2022; 52:252-266. [DOI: 10.1016/j.idnow.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Simos P, Stewart AG. Sexually acquired reactive arthritis secondary to macrolide‐resistant
Mycoplasma genitalium
urethritis. Intern Med J 2022; 52:332-333. [DOI: 10.1111/imj.15684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Peter Simos
- Infection Management Services Princess Alexandra Hospital Brisbane Queensland Australia
| | - Adam G. Stewart
- Centre for Clinical Research, Faculty of Medicine The University of Queensland, Royal Brisbane and Women's Hospital Campus Brisbane Queensland Australia
- Department of Infectious Diseases Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Central Microbiology, Pathology Queensland Royal Brisbane and Women's Hospital Brisbane Queensland Australia
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Jensen JS, Cusini M, Gomberg M, Moi H, Wilson J, Unemo M. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 2022; 36:641-650. [PMID: 35182080 DOI: 10.1111/jdv.17972] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022]
Abstract
Mycoplasma genitalium infection contributes to 10-35% of non-chlamydial non-gonococcal urethritis in men. In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID) in 10-25%. Transmission of M. genitalium occurs through direct mucosal contact. CLINICAL FEATURES AND DIAGNOSTIC TESTS Asymptomatic infections are frequent. In men, urethritis, dysuria and discharge predominate. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. Symptoms are the main indication for diagnostic testing. Diagnosis is achievable only through nucleic acid amplification testing and must include investigation for macrolide resistance mutations. THERAPY Therapy for M .genitalium is indicated if M. genitalium is detected. Doxycycline has a cure rate of 30-40%, but resistance is not increasing. Azithromycin has a cure rate of 85-95% in macrolide-susceptible infections. An extended course of azithromycin appears to have a higher cure rate, and pre-treatment with doxycycline may decrease organism load and the risk of macrolide resistance selection. Moxifloxacin can be used as second-line therapy but resistance is increasing. RECOMMENDED TREATMENT Uncomplicated M. genitalium infection without macrolide resistance mutations or resistance testing: Azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral). Second-line treatment and treatment for uncomplicated macrolide-resistant M. genitalium infection: Moxifloxacin 400 mg od for 7 days (oral). Third-line treatment for persistent M. genitalium infection after azithromycin and moxifloxacin: Doxycycline or minocycline 100 mg bid for 14 days (oral) may cure 40-70%. Pristinamycin 1 g qid for 10 days (oral) has a cure rate of around 75%. Complicated M. genitalium infection (PID, epididymitis): Moxifloxacin 400 mg od for 14 days. MAIN CHANGES FROM THE 2016 EUROPEAN M. GENITALIUM GUIDELINE Due to increasing antimicrobial resistance and warnings against moxifloxacin use, indications for testing and treatment have been narrowed to primarily involve symptomatic patients. The importance of macrolide resistance-guided therapy is emphasised.
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Affiliation(s)
- J S Jensen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - M Cusini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Gomberg
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - H Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway
| | - J Wilson
- Genitourinary Medicine and HIV, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden
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De Baetselier I, Vuylsteke B, Reyniers T, Smet H, Van den Bossche D, Kenyon C, Crucitti T. Worryingly high prevalence of resistance-associated mutations to macrolides and fluoroquinolones in Mycoplasma genitalium among men who have sex with men with recurrent sexually transmitted infections. Int J STD AIDS 2022; 33:385-390. [DOI: 10.1177/09564624211070704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Men who have sex with men (MSM) using pre-exposure prophylaxis (PrEP) recurrently infected with STIs are playing a pivotal role in contemporary Sexually transmitted infections (STI) epidemics. Our aim was to assess whether these individuals had more Mycoplasma genitalium ( M. genitalium) infections and more resistance to macrolides and fluoroquinolones of M. genitalium compared to those who were not recurrently infected with STIs. Methods The study was performed on 179 Belgian MSM PrEP users that were followed up for 18 months. STIs including M. genitalium were detected quarterly. Detection of resistance-associated mutations (RAMs) to macrolides and fluoroquinolones was performed via Sanger sequencing of the 23S rRNA gene and parC gene (conferring mutations at position 83/87 in ParC). Differences in M. genitalium positivity rate and presence of RAMs between both groups were assessed using mixed-effects logistic regression. Results A total of 91 new M. genitalium infections were detected among 70 participants. MSM experiencing recurrent STIs have significantly more M. genitalium infections compared to those without (11.7% vs. 4.7% OR: 2.69). Importantly, the prevalence of RAMs to macrolides (95.2% vs. 77.4%) and fluoroquinolones (35.7% vs. 12.9%) was much higher among individuals with recurrent STIs. The difference was only statistically significant for macrolides (OR 5.83, p = .036). Conclusions MSM recurrently infected with STIs play a central role in the emergence of antimicrobial resistance in M. genitalium. The use of macrolides and fluoroquinolones should preferably be minimized in this population in order to avoid further emergence of multi-resistant M. genitalium.
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Affiliation(s)
- Irith De Baetselier
- Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bea Vuylsteke
- HIV/STI Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Thijs Reyniers
- HIV/STI Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Hilde Smet
- Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Dorien Van den Bossche
- Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Chris Kenyon
- STI Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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Zhou L, Lopez Rodas A, Llangarí LM, Romero Sandoval N, Cooper P, Sadiq ST. Single gene targeted nanopore sequencing enables simultaneous identification and antimicrobial resistance detection of sexually transmitted infections. PLoS One 2022; 17:e0262242. [PMID: 35061780 PMCID: PMC8782522 DOI: 10.1371/journal.pone.0262242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To develop a simple DNA sequencing test for simultaneous identification and antimicrobial resistance (AMR) detection of multiple sexually transmitted infections (STIs). METHODS Real-time PCR (qPCR) was initially performed to identify Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) infections among a total of 200 vulvo-vaginal swab samples from female sex workers in Ecuador. qPCR positive samples plus qPCR negative controls for these STIs were subjected to single gene targeted PCR MinION-nanopore sequencing using the smartphone operated MinIT. RESULTS Among 200 vulvo-vaginal swab samples 43 were qPCR positive for at least one of the STIs. Single gene targeted nanopore sequencing generally yielded higher pathogen specific read counts in qPCR positive samples than qPCR negative controls. Of the 26 CT, NG or MG infections identified by qPCR, 25 were clearly distinguishable from qPCR negative controls by read count. Discrimination of TV qPCR positives from qPCR negative controls was poorer as many had low pathogen loads (qPCR cycle threshold >35) which produced few specific reads. Real-time AMR profiling revealed that 3/3 NG samples identified had gyrA mutations associated with fluoroquinolone resistance, 2/10 of TV had mutations related to metronidazole resistance, while none of the MG samples possessed 23S rRNA gene mutations contributing to macrolide resistance. CONCLUSIONS Single gene targeted nanopore sequencing for diagnosing and simultaneously identifying key antimicrobial resistance markers for four common genital STIs shows promise. Further work to optimise accuracy, reduce costs and improve speed may allow sustainable approaches for managing STIs and emerging AMR in resource poor and laboratory limited settings.
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Affiliation(s)
- Liqing Zhou
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
| | - Andrea Lopez Rodas
- School of Medicine, Faculty of Health and Life Sciences, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Luz Marina Llangarí
- School of Medicine, Faculty of Health and Life Sciences, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Natalia Romero Sandoval
- School of Medicine, Faculty of Health and Life Sciences, Universidad Internacional del Ecuador, Quito, Ecuador
- Grups de Recerca d’Amèrica i Àfrica Llatines, GRAAL, Barcelona, Spain
| | - Philip Cooper
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- School of Medicine, Faculty of Health and Life Sciences, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Syed Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
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Abstract
IMPORTANCE Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes. OBSERVATIONS From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia, M genitalium, trichomoniasis, and symptomatic HSV-1 and HSV-2. Serology remains the recommended method to diagnose syphilis, typically using sequential testing to detect treponemal and nontreponemal (antiphospholipid) antibodies. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles, such as metronidazole, are effective treatments for gonorrhea, chlamydia, syphilis, M genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral treatment options for gonorrhea and M genitalium. No cure is available for genital herpes. Effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception. CONCLUSIONS AND RELEVANCE Approximately 1 in 5 adults in the US had an STI in 2018. Rates of gonorrhea, chlamydia, and syphilis in the US have increased, while rates of HSV-1 and HSV-2 have declined. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles are effective treatments for gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral therapies for gonorrhea and Mycoplasma genitalium, and no cure is available for genital herpes.
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Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew M Hamill
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Vodstrcil LA, Plummer EL, Doyle M, Murray GL, Bodiyabadu K, Jensen JS, Whiley D, Sweeney E, Williamson DA, Chow EPF, Fairley CK, Bradshaw CS. Combination therapy for Mycoplasma genitalium, and new insights into the utility of parC mutant detection to improve cure. Clin Infect Dis 2022; 75:813-823. [PMID: 34984438 DOI: 10.1093/cid/ciab1058] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) infection is challenging to cure due to rising antimicrobial resistance and limited treatment options. METHODS This was a prospective evaluation of the efficacy and tolerability of resistance-guided combination antimicrobial therapy for MG-treatment at Melbourne Sexual Health Centre (August 2019-December 2020). All patients received 7-days doxycycline prior to combination therapy based on the macrolide-resistant profile. Macrolide-susceptible infections received combination doxycycline+azithromycin (1g day-1, 500mg days-2-4) and macrolide-resistant infections combination doxycycline+moxifloxacin (400mg daily 7-days). Adherence and adverse effects were recorded at test-of-cure, recommended 14-28-days after antimicrobial completion. Sequencing was performed to determine the prevalence of single nucleotide polymorphisms (SNPs) in the parC gene and their association with moxifloxacin-treatment outcomes in macrolide-resistant infections. RESULTS Of 100 patients with macrolide-susceptible MG treated with doxycycline+azithromycin, 93 were cured (93.0%; 95%CI:86.1%-97.1%). Of 247 patients with macrolide-resistant MG receiving doxycycline+moxifloxacin, 210 were cured (85.0%; 95%CI:80.0%-89.2%). parC sequencing was available for 164 (66%) macrolide-resistant infections; 29% had SNPs at parC S83 or D87 (23% S83I). The absence of SNPs at parC S83/D87 was associated with 98.3% cure (95%CI:93.9-99.8%) following doxycycline+moxifloxacin. The presence of the parC S83I-SNP was associated with failure in 62.5% (95%CI:45.8-77.3%). Side-effects were common (40-46%) and predominantly mild and gastrointestinal. CONCLUSION Combination doxycycline+azithromycin achieved high cure for macrolide-susceptible infections. However, in the context of a high prevalence of the parC S83I mutation (23%) in macrolide-resistant infections, doxycycline+moxifloxacin cured only 85%Infections that were wildtype for S83/D87 experienced high cure following doxycycline+moxifloxacin, supporting the use of a parC-resistance/susceptibility testing strategy in clinical care.
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Affiliation(s)
- Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Erica L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Gerald L Murray
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Kaveesha Bodiyabadu
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Jorgen S Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - David Whiley
- The University of Queensland Centre for Clinical Research (UQ-CCR), Queensland, Australia.,Pathology Queensland Central Laboratory, Queensland, Australia
| | - Emma Sweeney
- The University of Queensland Centre for Clinical Research (UQ-CCR), Queensland, Australia
| | - Deborah A Williamson
- Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia.,Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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49
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Dhawan B, Raj JS, Rawre J, Dhawan N, Khanna N. Mycoplasma genitalium: A new superbug. Indian J Sex Transm Dis AIDS 2022; 43:1-12. [PMID: 35846530 PMCID: PMC9282694 DOI: 10.4103/ijstd.ijstd_103_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Mycoplasma genitalium (MG) is an emerging sexually transmitted pathogen. It is an important cause of nongonococcal urethritis in men and is associated with cervicitis and pelvic inflammatory disease in women, putting them at risk of infertility. Multiple factors that aid pathogenesis of MG include its ability of adhesion, gliding motility, and intracellular invasion by means of the tip organelle. Through intracellular localization and antigenic variation, MG could result in treatment-resistant chronic infection. There are limited data on the prevalence of MG in Indian patients with urogenital syndromes. Recently, a high prevalence of extra genital infection with MG has been reported. Molecular assays are the major diagnostic techniques of MG infection. Antimicrobial agents such as macrolides, along with fluoroquinolones, are the treatment of choice for MG infections. The issue of drug resistance to azithromycin and fluoroquinolones in MG is rising globally. As molecular tests are becoming available for MG, both for the diagnosis and the detection of antimicrobial resistance, any patient with MG infection should then be tested for antimicrobial resistance. Consideration of MG as a cause of sexually transmitted disease in the Indian population is crucial in diagnostic algorithms and treatment strategies. The purpose of this review is to understand the prevalence of MG in different clinical scenarios, molecular mechanisms of pathogenesis, current status of antimicrobial resistance, and its impact on MG treatment.
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50
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Gossé M, Nordbø SA, Pukstad B. Evaluation of treatment with two weeks of doxycycline on macrolide-resistant strains of Mycoplasma genitalium: a retrospective observational study. BMC Infect Dis 2021; 21:1225. [PMID: 34876039 PMCID: PMC8650379 DOI: 10.1186/s12879-021-06910-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/25/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Increasing macrolide resistance makes treatment of Mycoplasma genitalium infections challenging. The second-line treatment is moxifloxacin, an antibiotic drug best avoided due to the potential of severe side effects and interactions. This study evaluates the effects of treatment with doxycycline 100 mg twice daily for 2 weeks as an alternative to moxifloxacin. METHODS This retrospective observational study examined the medical records of patients testing positive for macrolide resistant Mycoplasma genitalium from January 1st, 2016 to September 1st, 2019 in Trondheim, Norway. Information regarding symptoms as well as clinical and microbiological cure was collected. RESULTS 263 infections from 259 patients (161 females/98 males) were examined. 155 (58.9%) had a negative test of cure following treatment. 34.7% of symptomatic patients not achieving microbiological cure experienced symptom relief or clearance. There was no statistical difference between bacterial loads in symptomatic versus asymptomatic patients. The mean difference was 1.6 × 105 copies/ml (95% CI - 1.4 × 105-4.8 × 105, p = 0.30) for women and 1.4 × 106 copies/ml (95% CI -4.0 × 105-3.2 × 106, p = 0.12) for men. CONCLUSIONS The cure rate of doxycycline in this study is higher than previously reported. This adds support to doxycycline's role in treatment before initiating treatment with less favorable drugs such as moxifloxacin.
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Affiliation(s)
- M Gossé
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.
| | - S A Nordbø
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway
- Department of Medical Microbiology, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - B Pukstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway
- Department of Dermatology, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway
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