Failure of cefoxitin and doxycycline to eradicate endometrial Mycoplasma genitalium and the consequence for clinical cure of pelvic inflammatory disease.
OBJECTIVE
As Mycoplasma genitalium is associated with pelvic inflammatory disease (PID), we examined the efficacy of a commonly used PID antimicrobial in treating M genitalium upper genital tract infection.


METHODS
In the PID Evaluation and Clinical Health study of inpatient versus outpatient treatment, 682 women treated with cefoxitin and doxycycline for clinically suspected PID had stored cervical and endometrial specimens available for analysis. In the current sub study, we compared baseline endometritis, short term treatment failure (continued endometritis and pelvic pain 30 days following treatment) and sequelae among women with and without M genitalium, identified using PCR.


RESULTS
Endometrial M genitalium was associated with baseline endometritis (adjusted OR 3.0, 95% CI 1.5 to 6.1). Among women with a positive baseline M genitalium test, 41% tested positive again 30 days following treatment. Women testing positive compared to those testing negative for M genitalium at baseline had an increased risk of short-term treatment failure (RR 4.6, 95% CI 1.1 to 20.1). Rates of sequelae, including infertility (22%), recurrent PID (31%) and chronic pelvic pain (42%), were high among women testing positive for endometrial M genitalium at baseline. There was a non-significant trend towards increased infertility, chronic pelvic pain and recurrent PID, and decreased pregnancy and live birth following M genitalium infection.


CONCLUSIONS
M genitalium is associated with endometritis and short-term PID treatment failure. Cefoxitin and doxycycline, a Centers for Disease Control and Prevention recommended PID treatment regimen, is ineffective for the treatment of M genitalium upper genital tract infection.
Haggerty
C L
CL
University of Pittsburgh, Department of Epidemiology, 130 DeSoto Street, 516B Parran Hall, Pittsburgh, PA 15261, USA. haggerty@pitt.edu
Totten
P A
PA
Astete
S G
SG
Lee
S
S
Hoferka
S L
SL
Kelsey
S F
SF
Ness
R B
RB
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002440:Cefoxitin / Q000627:therapeutic use*; D004318:Doxycycline / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004716:Endometritis / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000382:microbiology; D008875:Middle Aged; D009175:Mycoplasma Infections / Q000188:drug therapy*; D045704:Mycoplasma genitalium; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy / Q000382:microbiology; D012008:Recurrence; D012307:Risk Factors; D017211:Treatment Failure
D000900:Anti-Bacterial Agents; D002440:Cefoxitin; D004318:Doxycycline