Management Of Non-gonococcal Urethritis Research Articles

Mycoplasma genitalium Macrolide and Fluoroquinolone Resistance: Prevalence and Risk Factors Among a 2013–2014 Cohort of Patients in Barcelona, Spain

Macrolide and fluoroquinolone resistance is alarmingly emerging in M. genitalium worldwide. This article provides the first estimates of the current prevalence of macrolide and fluoroquinolone resistance-mediating mutations in Barcelona, Spain, and identifies risk factors associated with the acquisition of these resistances. The study was conducted retrospectively with specimens submitted between February 2013 and March 2014 to the microbiology department of the Vall d'Hebron Hospital, Barcelona, where M. genitalium was detected using nucleic acid amplification methods. DNA sequencing of 23S ribosomal RNA gene and parC was performed in the Statens Serum Institut, Copenhagen, to detect genotypic macrolide and fluoroquinolone resistance markers, respectively. Macrolide resistance-mediating mutations were detected in 35% (95% confidence interval, 24%-47%) of the M. genitalium-positive episodes, whereas 8% (95% confidence interval, 3%-17%) carried fluoroquinolone resistance mutations. Of them, three cases harbored multidrug resistance to both classes of antibiotics. Men who had sex with men (P = 0.002) and treatment with azithromycin within the previous 12 months (P = 0.006) were strongly associated with macrolide resistance. The widespread appearance of resistances, also in Spain, makes imperative the implementation of combined diagnostic-resistance detection assays for M. genitalium to facilitate the optimization of antibiotic treatment in the management of nongonococcal urethritis and potentially reduce the transmission of resistances.

P086 An audit of the management of persistent and recurrent non-gonococcal urethritis (pNGU) in a large London teaching hospital

Background/introduction The British Association of Sexual Health and HIV (BASHH) released a new national guideline on the management of non-gonococcal urethritis (NGU) in 2015. This audit was completed to assess compliance and identify areas for service improvement. Aim(s)/objectives To compare the management of pNGU against national guidelines. Methods A retrospective case note review was performed for all patients having two or more NGU code (C4N) over a 12-month period from 1 st April 2014. We collected demographic details, presenting symptoms, signs, investigations, management and number of visits. Results 130 patients were identified from three different clinics within the same Trust. A total of 282 visits were recorded. 35.4% of visits were diagnosed as NGU and 66.2% as pNGU. We achieved 100% compliance with all four of BASHH auditable out comes (i.e. screening for C. trachomatis (CT) and gonorrhoea, documented offer of written information, delivery of first-line therapy and partner notification). Only one patient was diagnosed with CT. In recurrent visits, only 31.0% of further investigations were done and 12.6% of them were treated as pNGU according to the guideline. 55.2% of the patients had 4 or more visits. Discussion/conclusion We demonstrated high levels of compliance with national guidelines for managing NGU. However, management of patients with pNGU was sub-optimal with a lack of appropriate investigations and incorrect treatment regimes. Low levels of CT positivity in this cohort demonstrate the importance of further investigations. Correct pNGU treatment may also lead to fewer visits and reduced burden on the service.

HIV-1 Shedding and Chlamydial Urethritis

To the Editor. —Drs Schmid and Fontanarosa1thoroughly discussed the causes and management of nongonococcal urethritis. However, they did not emphasize the link between treatment of sexually transmitted diseases and prevention of human immunodeficiency virus (HIV).2We collected ejaculate from a 32-year-old white man with HIV-1 disease and a CD4 cell count of 0.11×109/L who was taking no antiretroviral therapy. The patient had chlamydial urethritis at the time the sample was obtained, with dysuria but without discharge. We performed quantitative HIV-1 culture on his seminal cell fraction, using a modification of the AIDS Clinical Trials Group quantitative cell culture protocol. We had previously performed 32 quantitative cultures for HIV-1 using seminal cells from 25 HIV-1—infected individuals; the range of excretion was

The management of nongonococcal urethritis in males

(1979). The management of nongonococcal urethritis in males. Issues in Health Care of Women: Vol. 1, No. 5, pp. 9-15.