Efficacy of Doxycycline-Sitafloxacin Sequential Therapy for Urogenital Mycoplasma genitalium Infection in Nanjing, China.

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The aim of this study was to evaluate the efficacy of doxycycline-sitafloxacin sequential therapy in the treatment of Mycoplasma genitalium (Mg) urogenital infections in Nanjing, China. Potential subjects were tested initially for Mg infection by nucleic acid amplification testing and again at least 21 days after completion of doxycycline (100 mg twice daily for 7 days)-sitafloxacin (100 mg twice daily for 7 days) sequential therapy. The presence of macrolide and quinolone resistance-associated mutations in 23S rRNA, parC, gyrA, and gyrB genes in Mg was examined at baseline and upon retesting of specimens from subjects that did not clear Mg. A total of 218 patients were screened for Mg, of whom 65 were positive for Mg; 63 Mg-infected patients were enrolled. Twenty-two (35%) Mg-infected subjects (16 heterosexual men, 5 women, and 1 man who had sex with men [MSM]) were successfully evaluated with a test of cure; 20 (91%) cleared Mg infection. In pretreatment specimens, mutations in 23S rRNA, parC (G248T [S83I]), gyrA (G277T [G93C]), and gyrB genes were present in 100% (19 of 19), 61.1% (11 of 18), 6.7% (1 of 15), and 7.1% (1 of 14), respectively. Mg clearance rates were 4 of 4 in infected subjects that possessed both wild-type parC and gyrA genes, and 9 of 10 when a parC G248T mutation and an otherwise wild-type gyrA gene were identified. Two subjects (9%) reported mild adverse events. Doxycycline-sitafloxacin sequential therapy was well tolerated and effective against most urogenital Mg infections in Nanjing and may provide an option for treatment.