Abstract
ABSTRACTMycoplasma genitalium is a sexually transmitted bacterium associated with nongonococcal urethritis (NGU) in men and cervicitis, endometritis, and pelvic inflammatory disease in women. Effective treatment is challenging due to the inherent, and increasingly acquired, antibiotic resistance in this pathogen. In our treatment trial conducted from 2007 to 2011 in Seattle, WA, we demonstrated poor efficacy of azithromycin (AZM) and doxycycline (DOX) against M. genitalium among men with NGU. In the present study, we cultured M. genitalium from 74 of 80 (92.5%) PCR-positive men at enrollment (V-1) and defined the MICs of AZM (N = 56 isolates) of DOX (N = 62 isolates). Susceptibility to AZM was bimodal; MICs were >8 μg/ml (44.6%) and <0.004 μg/ml (55.4%) for these isolates. The association of MIC with treatment efficacy was determined for men initially treated with either AZM (N = 30) or DOX (N = 24). Men treated with AZM were more likely to experience microbiologic treatment failure (P < 0.001) if infected with isolates that had AZM MICs of >8 μg/ml (18/18 men) than those with isolates that had AZM MICs of <0.004 μg/ml (1/12 men). Clinical treatment failure also was more likely to occur (P = 0.002) with AZM MICs of >8 μg/ml (12/18 men) than with AZM MICs of <0.004 μg/ml (1/12 men). In contrast, DOX MICs ranged from <0.125 to 2 μg/ml and were not correlated with microbiologic (P = 0.71) or clinical treatment (P = 0.41) failure, demonstrating no relationship between DOX MICs and treatment efficacy. Given the rapid spread of AZM resistance and the emergence of quinolone resistance, the current second-line therapy, monitoring MICs and evaluating other potential treatments for M. genitalium will be critical.
Highlights
Mycoplasma genitalium is a sexually transmitted bacterium associated with nongonococcal urethritis (NGU) in men and cervicitis, endometritis, and pelvic inflammatory disease in women
Mycoplasma genitalium is a reproductive tract pathogen for which culture is complicated and effective treatment regimens are challenging. This cell wall-less bacterium has been implicated in the etiology of nongonococcal urethritis (NGU) in men [1, 2] and cervicitis [3], endometritis [4], and pelvic inflammatory disease [5] in women
The difficulty of culturing M. genitalium from clinical specimens precluded the characterization of additional strains until Jensen and Hamasuna et al [17, 18] developed a Vero cell coculture technique in which growth is detected by an increase in genomes over time by quantitative PCR
Summary
Mycoplasma genitalium is a sexually transmitted bacterium associated with nongonococcal urethritis (NGU) in men and cervicitis, endometritis, and pelvic inflammatory disease in women. Mycoplasma genitalium is a reproductive tract pathogen for which culture is complicated and effective treatment regimens are challenging This cell wall-less bacterium has been implicated in the etiology of nongonococcal urethritis (NGU) in men [1, 2] and cervicitis [3], endometritis [4], and pelvic inflammatory disease [5] in women (reviewed in references 6 and 7). We cultured the M. genitalium strains infecting these men, assessed diversity by strain typing, determined in vitro susceptibility to AZM and DOX, and correlated these MICs with treatment efficacy. This collection may be useful for future studies assessing the efficacy of other potential treatments for this reproductive tract pathogen
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