Abstract
ObjectivesTo evaluate therapy for Mycoplasma genitalium infection with doxycycline or azithromycin 1 g compared to five days of azithromycin (total dose 1.5 g).MethodsA retrospective case study was performed among patients attending the STD-clinic in Falun, Sweden 1998–2005. All patients with a positive PCR test for M. genitalium were routinely offered a test of cure (toc). Response to doxycycline for 9 days, azithromycin 1 g single dose and extended azithromycin (500 mg on day 1 followed by 250 mg o.d. for 4 days) was determined. In patients with treatment failure after azithromycin, macrolide resistance was monitored before and after treatment. Furthermore, the rate of macrolide resistance was monitored for positive specimens available from 2006–2011.ResultsThe eradication rate after doxycycline was 43% (48% for women and 38% for men), for azithromycin 1 g 91% (96% for women and 88% for men) and for extended azithromycin 99% (100% for women and 93% for men). Macrolide resistance developed in 7/7 examined (100%) of those testing positive after azithromycin 1 g, but in none of those treated with extended azithromycin. Macrolide resistance before treatment increased from 0% in 2006 and 2007 to 18% in 2011.ConclusionsThese findings confirm the results from other studies showing that doxycycline is inefficient in eradicating M. genitalium. Although azithromycin 1 g was not significantly less efficient than extended dosage, it was associated with selection of macrolide resistant M. genitalium strains and should not be used as first line therapy for M. genitalium. Monitoring of M. genitalium macrolide resistance should be encouraged.
Highlights
IntroductionMycoplasma genitalium has become a well-established sexually transmitted infection (recently reviewed in [1]) and the main focus is on therapy and complications
Mycoplasma genitalium has become a well-established sexually transmitted infection and the main focus is on therapy and complications
Study design This study was performed as a retrospective case-study of patients attending the Department of Venereology, Central Hospital, Falun, Sweden with a diagnosis of M. genitalium infection confirmed by polymerase chain reaction (PCR)
Summary
Mycoplasma genitalium has become a well-established sexually transmitted infection (recently reviewed in [1]) and the main focus is on therapy and complications. It was first isolated in 1980 from two of 13 men with non-gonococcal urethritis (NGU) [2,3]. In comparison with other sexually transmitted infections there is less information about the global prevalence of M. genitalium. The prevalence of M. genitalium in men with non-chlamydial NGU (NCNGU) ranges from 10% to 45% [1] and in the general population from 1% to 3,3% [10,11]
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