Non-gonococcal Urethritis Research Articles

Comparison of Current Standard of Care Versus the Australian Guidelines for Management of Mycoplasma Genitalium Infections Among Men Being Treated for Non-gonococcal Urethritis

Comparison of Current Standard of Care Versus the Australian Guidelines for Management of Mycoplasma Genitalium Infections Among Men Being Treated for Non-gonococcal Urethritis

Classification of non-gonococcal urethritis: a review.

Non-gonococcal urethritis (NGU) is the most common disease of the genital tract in men. Recent studies have recommended avoiding the empiric antibiotic administrations that constitute the classical treatment approach in NGU and to aim toward treatment of causative pathogens. However, the classification of NGU agents remains controversial. In addition, the relevance of the commensalism of Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, and Gardnerella vaginalis, which are among the opportunistic pathogens found in the urethral flora, has yet to be determined. Furthermore, there are certain pathogens on which sufficient studies have not been conducted, although they are known to be NGU pathogens, and their statuses should be updated. In this review, the classification of NGU pathogens is summarized in the light of the current literature.

Detection of ureaplasmas and bacterial vaginosis associated bacteria and their association with non-gonococcal urethritis in men.

No aetiology is found in up to 40% of men with symptomatic urethritis. Male partners of women with bacterial vaginosis (BV) may be at higher risk of non-gonococcal urethritis (NGU). The aim of this study was to examine the role of BV associated bacteria in first-void urine (FVU) in 97 asymptomatic men without urethritis (controls) and 44 men (cases) with NGU including 20 men with idiopathic urethritis (IU) attending a Swedish STD-clinic between January and October 2010. BV-associated bacteria and ureaplasmas were detected by quantitative PCR assays. All BV associated bacteria, except Megasphaera-like type 1, were strongly positively correlated with U. urealyticum p<0.005 and even stronger with the combined U. urealyticum and U. parvum load (p<0.0005) suggesting that ureaplasma induced elevated pH may stimulate the growth of BV associated bacteria. No statistically significant differences were found between IU cases and controls in the prevalence or load of BV associated bacteria or ureaplasmas. In multiple logistic regression, Megasphaera-like type 1 was associated with IU (p = 0.03), but most positive FVU samples contained very few bacteria and the finding may not be clinically relevant.

Symptoms, Sites, and Significance of Mycoplasma genitalium in Men Who Have Sex with Men.

During 2016–2017, we tested asymptomatic men who have sex with men (MSM) in Melbourne, Australia, for Mycoplasma genitalium and macrolide resistance mutations in urine and anorectal swab specimens by using PCR. We compared M. genitalium detection rates for those asymptomatic men to those for MSM with proctitis and nongonococcal urethritis (NGU) over the same period. Of 1,001 asymptomatic MSM, 95 had M. genitalium; 84.2% were macrolide resistant, and 17% were co-infected with Neisseria gonorrhoeae or Chlamydia trachomatis. Rectal positivity for M. genitalium was 7.0% and urine positivity was 2.7%. M. genitalium was not more commonly detected in the rectums of MSM (n = 355, 5.6%) with symptoms of proctitis over the same period but was more commonly detected in MSM (n = 1,019, 8.1%) with NGU. M. genitalium is common and predominantly macrolide-resistant in asymptomatic MSM. M. genitalium is not associated with proctitis in this population.

Detection of Rectal Chlamydia trachomatis in Heterosexual Men Who Report Cunnilingus.

Rectal infection with Chlamydia trachomatis (CT) is frequent in women who deny receptive anal sex and is thought to arise from autoinoculation of the rectum from vaginal secretions. An alternate hypothesis is that oral sex inoculates and establishes gastrointestinal tract infection. Distinguishing these hypotheses is difficult in women. In men, autoinoculation is unlikely and heterosexual men frequently perform oral sex, but rarely participate in receptive anal exposure behaviors. We enrolled high-risk men with and without nongonococcal urethritis who presented to a sexually transmitted infection clinic in Indianapolis, Indiana. Urine and rectal swabs were collected and tested for urogenital and rectal CT, Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG). Men completed surveys concerning symptoms, sexual orientation, and detailed recent and lifetime oral and anal sexual behaviors. Rectal CT was detected in 2/84 (2.4%) heterosexual men who reported cunnilingus, but no lifetime receptive anal behaviors. All of the men who denied receptive anal behaviors were negative for rectal NG and MG. In homosexual and bisexual men, rectal CT prevalence was high (9.7%), and rectal NG (4.8%) and MG (4.8%) were also detected. We detected rectal CT infections in heterosexual men who reported cunnilingus but denied receptive anal behaviors. Oral sex may be a risk factor for rectal CT infection via oral inoculation of the gastrointestinal tract.

Infectious human adenoviruses are shed in urine even after disappearance of urethral symptoms.

BackgroundUrethritis is a common sexually transmitted disease, and human adenoviruses (HAdVs) have been found to be associated with nonchlamydial nongonococcal urethritis. However, the level and viability of HAdV in the urine of patients with urethritis remain unclear.MethodsMale patients with urethritis and an asymptomatic group were screened using their First-void urine (FVU) for urethritis-related pathogens to identify those with HAdV DNA. FVU and gargle fluid were collected from all patients including from those in the asymptomatic group. A swab of eye discharge was also collected from patients with eye symptoms. The pharyngeal and/ or ocular fluid was also screened only in cases in which FVU was positive for HAdV DNA. HAdVs were isolated using A549 cell lines and typed by sequencing, and viral shedding during 2 years was quantified using real-time PCR. The prevalence of HAdV was assessed in the urethritis and asymptomatic groups, and viral load, isolated HAdV types, and urethral symptoms were compared between the groups.ResultsThe positive detection rate of HAdV DNA was significantly higher in the urethritis group than in the asymptomatic group. Of 398 patients with urethritis, HAdV was isolated in all 32 cases (23 cases in which only HAdV DNA was detected with a mean of 2 × 109 copies/mL in urine samples). Of 124 control cases, one had HAdV monoinfection. The most frequently detected HAdV type was 56, followed by types 37 and 64. Regarding the relationship between symptoms and isolated HAdVs, the virus was isolated for up to 12 days after urethritis symptoms disappeared.ConclusionsHAdVs were significantly detected and isolated from the FVU of patients with urethritis. Furthermore, high levels of infectious HAdVs are excreted in urine for a long period even after urethritis symptoms disappear.

Prevalence of ureaplasma urealyticum, mycoplasma hominis and human papillomavirus coinfection in people attending a sexually transmitted infections (STI)/HIV reference centre in Salvador, Bahia, Brazil

Introduction: Ureaplasma urealyticum and Mycoplasma hominis are frequently found at many women’s and men’s urogenital tract, and have been associated with non-gonococcal urethritis, cervicitis, infertility, chorioaminionitis and adverse pregnancy outcomes. Some studies show high prevalence of human papillomavirus (HPV) in patients with non-gonococcal urethritis, while also presenting high frequency of Ureaplasma urealyticum infection in women with cervicalcytology abnormalities and men with genital warts. Objectives: To evaluate the prevalence of Ureaplasma urealyticum, Mycoplasma hominis and HPV coinfection in people attending a sexually transmitted infections (STI)/HIV reference centre and to identify the risk factors associated. Methods: A cross-sectional study with patients aged &gt;18 years, carried out for Ureaplasma urealyticum and Mycoplasma hominis from July 1st to December 31, 2015, in a STI/HIV reference centre from the State of Bahia, Brazil. Sociodemographic and clinical data were obtained from secondary data from patients’ charts and laboratory findings, and analyzed using SPSS 20.0. Pearson’s χ2 test or Fisher’s exact test was used to evaluate categorical variables. HPV clinical diagnosis was considered positive as the presence of genital warts. Results: In this study, 849 patients were included — 196 men and 653 women. Of the sample, 51.4% was diagnosed with at least one of the two bacteria. The prevalence of Mycoplasma hominis infection was higher in coinfection (16.7%) than in isolated infection (2.2%). The prevalence of Ureaplasma urealyticum isolated infection was 32.4%. A strong association was found between the presence of genital warts and Ureaplasma urealyticum infection, with an estimated risk of 1.230 (p=0.014). Conclusion: Our findings suggest the need for further investigation for Ureaplasma urealyticum infection in patients presenting genital warts on physical examination. In addition, in this context, greater attention should be given to women and pregnant women.

Haemophilus Species Isolated in Urethral Exudates as a Possible Causative Agent in Acute Urethritis: A Study of 38 Cases

IntroductionThe incidence of urethritis due to Haemophilus species is increasing. The main aim of this study was to describe the clinical and microbiological characteristics of patients with this form of urethritis. A secondary aim was to discuss the adequacy of treatments in patients with different types of antibiotic resistance. Material and methodsWe studied patients with a microbiologically confirmed diagnosis of urethritis seen at the Sexually Transmitted Infections Unit of our hospital between July 2015 and July 2018. We selected all patients in whom Haemophilus species were isolated on chocolate agar. Antibiotic resistance was tested using the disk-diffusion method. Cross-sectional data were collected prospectively during outpatient visits. ResultsHaemophilus species were isolated in 33.6% of cases. The most common clinical manifestation was urethral discharge (57.6%); 60% of the patients were men who have sex with men and in this subgroup Haemophilus species were significantly more common than either Neisseria or Chlamydia species. Haemophilus species were found in isolation in 39.5% of patients and the most common one was Haemophilus parainfluenzae (isolated in 84.2% of cases). In total, 34.2% of patients were resistant to azithromycin and 26.3% were resistant to both azithromycin and tetracycline. Empirical treatment achieved clinical and microbiologic cure in 11 of the patients who were not lost to follow-up (n=17; 44.7%). The remaining 6 patients required treatment with a new antibiotic. ConclusionsHaemophilus species are a new cause of nongonococcal urethritis, whose incidence is rising, particularly in men who have sex with men who engage in unprotected oral sex. The clinical manifestations are similar to those seen in gonococcal urethritis. Eradication of infection must be confirmed due to the high rate of antibiotic resistance associated with Haemophilus species.

Sexually Transmitted Infection Trends among Clinic Attendees of a Secondary Health Care Facility in Lagos, Nigeria: A 12-month Retrospective Review

Background: Sexually transmitted infections (STIs) constitute major health problems and can have serious reproductive health consequences. Understanding the patterns of STI and their associated risk factors in a particular region is necessary for proper planning and implementation of targeted interventions. Aims: To determine the pattern of STI and their associated risk factors in a secondary health facility in Lagos, Nigeria. Materials and Methods: A hospital based, retrospective study of data collected from the clinical records of 31 patients who attended STI clinic of the General Hospital, Lagos over a period of 12 months. The diagnosis was made based on history, clinical examination and microbiological investigations. Data analysis was done by SPSS version 23. Results: Gonococcal urethritis 8(25.8%) was the commonest STI followed by 7(22.6%) trichomoniasis, 6(19.4%) genital warts, 6(19.4%) herpes genitalis 3(9.7%) non-gonococcal urethritis and 1(3.2%) person had chancroid and was HIV positive. Majority of the patients had 26 (83.9%) multiple sex partners, 18(58.9%) never used condom and 17(54.8%) had previous history of STI. Occasional use of condom (X2 = 6.482, df = 1, P- value = 0.039) and previous history of STI (X 2 = 4.644, df= 1, P- value =0.031) were statistically associated with Gonococcal urethritis. Dyspareunia (X2 = 15.708, df =1, P- value =0.000) was also statistically associated with Trichomoniasis. Conclusion: Bacterial STI still constitute a major burden of STI in our clinic which is contrary to the recent trends of viral STI constituting a major burden of STI in some parts of the world. Poor condom usage observed from this study might be partly responsible for it. Bearing in mind by Clinicians that bacterial STI is still rampant and Condom use promotion will go a long way to reduce the burden of STI in the community.

The role of adhesive and cytokine signaling systems in the pathogenesis of persistent post-eradication urethritis in men, induced by c. trachomatis, u. urealyticum, m. genitalium

The purpose of the study was to investigate the role of soluble intercellular adhesion molecules (ICAM-1, VCAM) in the pathogenesis of persistent non-gonococcal urethritis in men induced by C.trachomatis, U.urealyticum, M. genitalium and to determine their possible association with the content of cytokines in urethral cytokines (IL -6, IL-8). Conclusions: Cytokines with chemokine activity (IL-6, IL-8) and soluble intercellular adhesion molecules (ICAM-1, VCAM) are key factors in the pathogenesis of persistent post-eradication urethritis, which is confirmed by statistically significant differences in the median concentrations of these mediators between patients with persistence Symptoms and clinical cure. Cytokines (IL-6, IL-8) and adhesive molecules (ICAM-1, VCAM) have synergistic effects that promote the recruitment and deposition of immunocompetent cells, as indicated by the presence of a correlation between the concentrations of these mediators. Further studies should be aimed at establishing mechanisms for the development of specific symptoms and ways to correct them.

1491. Mycoplasma genitalium: A Concordance Study in Heterosexual Partnerships at Risk for Chlamydial Infection

Background Mycoplasma genitalium (MG) causes symptomatic nonchlamydial, nongonococcal urethritis in men, and cervicitis, pelvic inflammatory disease and infertility in women. We aimed to determine: prevalence and concordance of MG infection within heterosexual partnerships; MG detection by sample site in infected subjects; symptom association with MG infection; frequency of co-infection with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV); and risk factors associated with MG infection and concordance.MethodsData from two partnership studies were combined; both enrolled sexually active heterosexual couples between the ages of 14–24 years who were at high risk for CT, between April 10, 2000 and September 29, 2003 at a sexually transmitted infection (STI) clinic in Indianapolis, IN. MG was detected by nucleic acid amplification from specimens stored at −70°C for up to 48 months. MG was sought in urine and urethra in men and urine, vagina, and cervix in women. Symptoms evaluated were dysuria, discharge in men and discharge, dysuria, abdominal pain in women. Symptom association with MG infection was analyzed by Chi-square test and logistic regression was used for associations of demographic, behavioral and biologic factors with MG concordance.ResultsMicrobiologic data were available from 200 men and 217 women, and demographic information from 188 men and 201 women in partnerships. 43/217 dyads contained an individual with MG infection, and both individuals were infected in 11/43 (26%) partnerships (concordant). In men and women MG detection was highest in urine (10%, 9%) specimens. Prevalence of MG was 14% in women and10% in men. Most infected men (79%) and women (62%) were African American. Mean age at first sex was 14 years for both genders. CT was the most frequent co-infection in both MG infected men (32%) and women (52%). MG infection without co-infection was associated with penile discharge in men (57%) P = 0.18. No symptoms in women were indicative of MG infection, and no demographic, behavioral or biologic factors were statistically associated with MG concordance.ConclusionThe prevalence of MG was substantial. Concordance in partnerships was 26%, less than observed with CT (~70%) in this study. Our study is limited due to small numbers of subjects with MG infection.Disclosures All authors: No reported disclosures.

Aislamiento de Haemophilus spp. en exudados uretrales como posible agente etiológico de uretritis aguda: estudio de 38 casos

IntroductionThe incidence of urethritis due to Haemophilus species is increasing. The main aim of this study was to describe the clinical and microbiological characteristics of patients with this form of urethritis. A secondary aim was to discuss the adequacy of treatments in patients with different types of antibiotic resistance. Material and methodsWe studied patients with a microbiologically confirmed diagnosis of urethritis seen at the Sexually Transmitted Infections Unit of our hospital between July 2015 and July 2018. We selected all patients in whom Haemophilus species were isolated on chocolate agar. Antibiotic resistance was tested using the disk-diffusion method. Cross-sectional data were collected prospectively during outpatient visits. ResultsHaemophilus species were isolated in 33.6% of cases. The most common clinical manifestation was urethral discharge (57.6%); 60% of the patients were men who have sex with men and in this subgroup Haemophilus species were significantly more common than either Neisseria or Chlamydia species. Haemophilus species were found in isolation in 39.5% of patients and the most common one was Haemophilus parainfluenzae (isolated in 84.2% of cases). In total, 34.2% of patients were resistant to azithromycin and 26.3% were resistant to both azithromycin and tetracycline. Empirical treatment achieved clinical and microbiologic cure in 11 of the patients who were not lost to follow-up (n=17; 44.7%). The remaining 6 patients required treatment with a new antibiotic. ConclusionsHaemophilus species are a new cause of nongonococcal urethritis, whose incidence is rising, particularly in men who have sex with men who engage in unprotected oral sex. The clinical manifestations are similar to those seen in gonococcal urethritis. Eradication of infection must be confirmed due to the high rate of antibiotic resistance associated with Haemophilus species.

Male urethritis with or without discharge: a clinico aetiological study in Hi-tech Medical College and Hospital Bhubaneswar, Odisha

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Urethritis or inflammation of the urethra is a multifactorial condition. Urethritis is called gonococcal urethritis (GU) when Neisseria gonorrhoeae is detected in urethral smear of the patient and nongonococcal urethritis (NGU) when this organism cannot be visualized.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Urethritis cases were identified from the dermatology OPD record. A retrospective analysis of data of patients diagnosed as GU and NGU for a period of 5 years (from August 2012-July 2017) was made. We have included only male patients more than 10 year.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Neisseria gonorrhoeae (61.42%) and Chlamydia trachomatis (45.9%) were the most common causative organism among urethritis and nongonococcal urethritis (NGU) respectively. Chlamydia urethritis had been confirmed by demonstrating ≥5 polymorphonuclear lymphocytes (PMNLs) from the anterior urethra using a Gram stained urethral smear. Acute condition (7-14 days) more common in GU. Dysuria and purulent urethral discharge (68.6%) was more common in GU. In urine specimen pus cells count were more than 10. The most common age group was 21-30 year (42.86%). Most patients were from low socio-economic status (62.85%). Sexual exposure was more common in unmarried patients (94.74%). Heterosexual exposure (93.75%) was more common. Urethritis was also associated with other infection in 18 patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Urethritis is inflammation of urethra which is manifested by dysuria with or without urethral discharge. Though there is increased incidence of Chlamydia infections, still now Gonococcal infection is the most common cause of urethritis.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Long Duration of Asymptomatic Mycoplasma genitalium Infection After Syndromic Treatment for Nongonococcal Urethritis.

Although Mycoplasma genitalium (MG) is an acknowledged cause of nongonococcal urethritis (NGU), access to diagnostic testing is limited. Syndromic management is common, yet little is known about natural history. Between August 2014 and April 2016, 13 heterosexual men aged ≥16 years with MG were identified within a cohort study of men with and without NGU attending an urban sexually transmitted diseases clinic. Men had 6-7 monthly visits. NGU was defined as ≥5 polymorphonuclear leukocytes per high-power field on urethral Gram stain plus either visible urethral discharge or urethral symptoms. Men with NGU received 1 g of azithromycin. Men with persistent NGU received moxifloxacin 400 mg for 14 days. First-void urine was retrospectively tested for MG using transcription-mediated amplification. Resistance-associated mutations were detected by polymerase chain reaction (PCR) and sequencing. Organism load was determined by quantitative PCR. Sixty-two percent of MG-positive men had macrolide resistance-mediating mutations (MRMM) at enrollment; 31% had parC mutations (all outside the quinolone resistance-determining region). MG persisted after azithromycin in 7 men, 6 of whom had MRMM. The median duration of persistence in the absence of curative therapy was 143 days (range, 21-228). Five men experienced symptom resolution after azithromycin, but MG persisted for another 89-186 days before moxifloxacin. Organism load was somewhat lower in MRMM than wild-type infections (P = .16). The high prevalence of macrolide resistance and long duration of infection after symptom resolution highlights the need for diagnostic MG testing of men with NGU to direct therapy.

Microscopy of Gram-stained urethral smear in the diagnosis of urethritis: Which threshold value should be selected?

The aim of this study was to investigate the sensitivity of GSS in the diagnosis of urethritis in patients who present to the outpatient clinic with symptoms of urethritis. Sixty-three male patients who presented to our outpatient clinic with symptoms of urethritis between January and March 2018 were evaluated. Urethral smear samples obtained from patients were evaluated both by GSS examination and by Real-time Multiplex Polymerase Chain Reaction (rt-MPCR) assay. The sensitivity and specificity of GSS in detecting gonococcal urethritis (GU) and nongonococcal urethritis (NGU) were calculated for threshold values of ≥5 and ≥2 PMNL/HPF. The mean age was 33.2±7.1years. According to the rt-MPCR results, 14 patients had GU and 27 patients had NGU. A threshold value of ≥5 PMNL/HPF in the GSS demonstrated 92.9% sensitivity in the diagnosis of GU and 55.6% sensitivity in the diagnosis of NGU. A threshold value of ≥2 PMNL/HPF reached 100% sensitivity for GU and 92.6% sensitivity for NGU. A cut-off value of ≥5 PMNL/HPF in the GSS has low sensitivity in the diagnosis of NGU. On the other hand, a threshold value of ≥2 PMNL/HPF seems to have higher sensitivity in the diagnosis of both GU and NGU.

Mycoplasma genitalium in the Far North Queensland backpacker population: An observational study of prevalence and azithromycin resistance.

BackgroundMycoplasma genitalium is a sexually transmitted infection (STI), and a common cause of non-gonococcal urethritis (NGU). There is concern regarding the rise in prevalence of M. genitalium and rates of resistance to macrolide antibiotics. International backpackers represent a unique population that may be at an increased risk of STIs. The purpose of this study was to determine the prevalence of M. genitalium and antibiotic resistance in international backpackers.MethodsFirst void urine samples were obtained utilising opportunistic sampling from 294 non-treatment-seeking international backpackers at a variety of hostels in Cairns, Queensland Australia. Participants also answered a fixed-answer survey regarding sociodemographic characteristics and sexual risk behaviours. Samples were tested for M. genitalium, Chlamydia trachomatis and Neisseria gonorrhoeae using polymerase chain reaction (PCR). Samples positive for M. genitalium were investigated for macrolide resistance-associated mutations in the 23S rRNA genome at positions A2058G, A2058C, A2058T, A2059G and A2059C (Escherichia coli numbering).ResultsOf the 294 samples, 23 failed the internal control. The prevalence of M. genitalium was 1.8% (5/271, 95% confidence interval [CI] ± 1.58), C. trachomatis was 4.1% (11/271, 95% CI ± 2.36) and N. gonorrhoeae was not detected. Macrolide resistance-associated mutations were identified in 40% (2/5) of M. genitalium-positive samples. M. genitalium infection was associated with reporting symptoms (odds ratio [OR] 14.36, 95% CI 2.17–94.94, p < 0.05).ConclusionsM. genitalium and C. trachomatis are relatively common amongst non-treatment seeking international backpackers, but may not differ from Australian population prevalence. This article provides evidence to further support the increased utilisation of M. genitalium PCR in the diagnosis of NGU, and for macrolide resistance testing for all identified M. genitalium infections.

Мікоплазма геніталіум – таємний руйнівник

Mycoplasma genitalium is a common cause of cervicitis and non-gonococcal urethritis. Today, this causative agent is already associated with inflammatory diseases of the pelvic organs and sexually acquired reactive arthritis. The only diagnostic method is a nucleic acid amplification (NAAT) test that detects specific DNA (PCR) or M. genitalium RNA. Several treatment regimens are proposed, depending on the uncomplicated or complicated course of M. genitalium infection and the determination of macrolide resistance. Key words: Mycoplasma genitalium, sexually transmitted infections, inflammatory diseases of the pelvic organs, cervicitis, non-gonococcal urethritis.

Antimicrobial susceptibility of Mycoplasma genitalium isolates from Pretoria, South Africa in 2012 and 2016

Background: Mycoplasma genitalium is a sexually transmitted pathogen associated with non-gonococcal urethritis and cervicitis. Azithromycin regimens have been considered first-line treatment for M. genitalium infections, with fluoroquinolone regimens effective as second-line treatments. However, the proportion of M. genitalium harbouring macrolide or fluoroquinolone resistance-associated mutations has been increasing worldwide. This study was done to compare the genotypic macrolide and fluoroquinolone resistance of M. genitalium strains obtained from women attending a termination of pregnancy clinic five years apart.Methods: M. genitalium was detected by PCR in vaginal swab samples from 100 and 104 termination of pregnancy attendees at a tertiary hospital in Pretoria, South Africa during 2012 and 2016 respectively. Genes associated with macrolide and fluoroquinolone resistance in the M. genitalium isolates were sequenced and analysed.Results: The prevalence of M. genitalium was 6.0% (6/100) in 2012 and 7.7% (8/104) in 2016. No resistance-associated mutations were seen in the 2012 isolates. Among the 2016 M. genitalium isolates, two (25%) harboured a macrolide-associated resistance mutation and one (12.5%) a fluoroquinolone resistance-associated mutation in the parC gene.Conclusions: There is an increase in macrolide and fluoroquinolone resistance among local M. genitalium strains. This highlights the need for improved surveillance.

A Case of Reiters Syndrome in a Young Patient Presenting to the ED

Introduction: In 1916, Hans Reiter described the classic triad of arthritis, nongonococcal urethritis, and conjunctivitis (Reiters syndrome) in a Prussian soldier with diarrhea, during the first world war. Reiter’s syndrome is defined as a complication of non gonococcal urethritis in which there is arthritis (mainly knees, ankles and feet), conjunctivitis, rashes, cardiac and neurological problems. Other features include; iritis, keratoderma blenorrhagicum, circinate balanitis, plantar fasciitis, Achilles tendonitis, aortic incompetence. RS is triggered by bacterial infection that enters via mucosal surfaces usually, (but not always) associated with human leukocyte antigen (HLA)- B27. Nongonococcal venereal disease (most often Chlamydia) and infectious diarrhea usually precede reiter’s syndrome. These include infections with: Shigella flexneri, Shigella dysenteriae, Salmonella typhimurium, Salmonella enteritidis, Streptococcus viridans, Mycoplasma pneumonia, Cyclospora, Chlamydia trachomatis, Yersinia enterocolitica, and Yersinia pseudotuberculosis. Campylobacter jejuni . Others include Chlamydia pneumoniæ and Ureaplasma urealiticum.

Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation.

Rising macrolide and quinolone resistance in Mycoplasma genitalium necessitate new treatment approaches. We evaluated outcomes of sequential antimicrobial therapy for M. genitalium guided by a macrolide-resistance assay. In mid-2016, Melbourne Sexual Health Centre switched from azithromycin to doxycycline (100 mg twice daily for 7 days) for nongonococcal urethritis, cervicitis, and proctitis. Cases were tested for M. genitalium and macrolide-resistance mutations (MRMs) by polymerase chain reaction. Directly after doxycycline, MRM-negative infections received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and MRM-positive infections received sitafloxacin (100 mg twice daily for 7 days). Assessment of test of cure and reinfection risk occurred 14-90 days after the second antibiotic. Of 244 evaluable M. genitalium infections (52 women, 68 heterosexual men, 124 men who have sex with men) diagnosed from 20 June 2016 to 15 May 2017, MRMs were detected in 167 (68.4% [95% confidence interval {CI}, 62.2%-74.2%]). Treatment with doxycycline decreased bacterial load by a mean 2.60 log10 (n = 56; P < .0001). Microbiologic cure occurred in 73 of 77 MRM-negative infections (94.8% [95% CI, 87.2%-98.6%]) and in 154 of 167 MRM-positive infections (92.2% [95% CI, 87.1%-95.8%]). Selection of macrolide resistance occurred in only 2 of 76 (2.6% [95% CI, .3%-9.2%]) macrolide-susceptible infections. In the context of high levels of antimicrobial resistance, switching from azithromycin to doxycycline for presumptive treatment of M. genitalium, followed by resistance-guided therapy, cured ≥92% of infections, with infrequent selection of macrolide resistance.