Abstract
BackgroundAzithromycin has been widely used for Mycoplasma genitalium treatment internationally. However, the eradication efficacy has substantially declined recent decade. In Russia, josamycin (another macrolide) is the recommended first-line treatment for M. genitalium infections, however, no data regarding treatment efficacy with josamycin and resistance in M. genitalium infections have been internationally published. We examined the M. genitalium prevalence in males attending an STI clinic in Moscow, Russia from December 2006 to January 2008, investigated treatment efficacy with josamycin in male urethritis, and monitored the M. genitalium DNA eradication dynamics and selection of macrolide resistance in M. genitalium during this treatment.MethodsMicroscopy and real-time PCRs were used to diagnose urethritis and non-viral STIs, respectively, in males (n = 320). M. genitalium positive patients were treated with recommended josamycin regimen and treatment efficacy was monitored using quantitative real-time PCR. Macrolide resistance mutations were identified using sequencing of the 23S rRNA gene.ResultsForty-seven (14.7%) males were positive for M. genitalium only and most (85.1%) of these had symptoms and signs of urethritis. Forty-six (97.9%) males agreed to participate in the treatment efficacy monitoring. All the pre-treatment M. genitalium specimens had wild-type 23S rRNA. The elimination of M. genitalium DNA was substantially faster in patients with lower pre-treatment M. genitalium load, and the total eradication rate was 43/46 (93.5%). Of the six patients with high pre-treatment M. genitalium load, three (50%) remained positive post-treatment and these positive specimens contained macrolide resistance mutations in the 23S rRNA gene, i.e., A2059G (n = 2) and A2062G (n = 1).ConclusionsM. genitalium was a frequent cause of male urethritis in Moscow, Russia. The pre-treatment M. genitalium load might be an effective predictor of eradication efficacy with macrolides (and possibly additional antimicrobials) and selection of macrolide resistance. Additional in vivo and in vitro data are crucial to support the recommendation of using josamycin as first-line treatment for M. genitalium infections in Russia. It would be valuable to develop international M. genitalium management guidelines, and quantitative diagnostic PCRs determining also M. genitalium load and resistance mutations (for macrolides and ideally also moxifloxacin) should ideally be recommended.
Highlights
Azithromycin has been widely used for Mycoplasma genitalium treatment internationally
In the present study, it was shown that M. genitalium is a frequent cause of male urethritis in Moscow, Russia and that the M. genitalium eradication rate in 2006-2008 was 93.5% with the recommended first-line treatment in Russia, that is, josamycin 500 mg three times daily, 10 days [21]
All the three verified treatment failures had a high pre-treatment M. genitalium load and cells with mutations in the macrolide resistance region of 23S rRNA were selected during treatment
Summary
Azithromycin has been widely used for Mycoplasma genitalium treatment internationally. In Russia, josamycin (another macrolide) is the recommended first-line treatment for M. genitalium infections, no data regarding treatment efficacy with josamycin and resistance in M. genitalium infections have been internationally published. Despite being effective in vitro tetracyclines have shown a low eradication rate for M. genitalium clinically [1,10,11,12,13]. The eradication rate of M. genitalium after azithromycin 1 g therapy has substantially declined during the last decade [1,10,12,13,14,16]. It was reported that azithromycin 1 g therapy was associated with selection of azithromycin resistance in M. genitalium [14]. The side-effects, cost, and the risk of selection of resistance limit the moxifloxacin use [1,13,15,19,20]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
