title: Efficacy of standard therapies against Ureaplasma species and persistence among men with non-gonococcal urethritis enrolled in a randomised controlled trial.
abstract: OBJECTIVE
  Ureaplasma urealyticum biovar 2 (UU-2), but not Ureaplasma parvum (UP), has been associated with non-gonococcal urethritis (NGU), but little is known about species-specific responses to standard therapies. We examined species-specific treatment outcomes and followed men with treatment failure for 9 weeks.
  
  
  METHODS
  From May 2007 to July 2011, men aged ≥16 attending a sexually transmitted disease (STD) clinic in Seattle, Washington, with NGU (urethral discharge or urethral symptoms plus ≥5 polymorphonuclear leucocytes /high-powered field) enrolled in a double-blind, randomised trial. Participants received active azithromycin (1 g) + placebo doxycycline or active doxycycline (100 mg twice a day ×7 days) + placebo azithromycin. Ureaplasma were detected in culture followed by species-specific PCR. Outcomes were assessed at 3, 6 and 9 weeks. At 3 weeks, men with persistent Ureaplasma detection received 'reverse therapy' (e.g., active doxycycline if they first received active azithromycin). At 6 weeks, persistently positive men received moxifloxacin (400 mg×7 days).
  
  
  RESULTS
  Of 490 men, 107 (22%) and 60 (12%) were infected with UU-2 and UP, respectively, and returned at 3 weeks. Persistent detection was similar for UU-2-infected men initially treated with azithromycin or doxycycline (25% vs. 31%; p=0.53), but differed somewhat for men with UP (45% vs. 24%; p=0.11). At 6 weeks, 57% of UU-2-infected and 63% of UP-infected men who received both drugs had persistent detection. Failure after moxifloxacin occurred in 30% and 36%, respectively. Persistent detection of UU-2 or UP was not associated with signs/symptoms of NGU.
  
  
  CONCLUSIONS
  Persistent detection after treatment with doxycycline, azithromycin and moxifloxacin was common for UU and UP, but not associated with persistent urethritis.
  
  
  BACKGROUND
  NCT00358462.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Khosropour
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Manhart
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA Children's National Health System, Washington, DC, USA.
authors.forename: Catherine W
authors.initials: CW
authors.lastname: Gillespie
authors.affiliation: Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA.
authors.forename: M Sylvan
authors.initials: MS
authors.lastname: Lowens
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Golden
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Jensen
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: George E
authors.initials: GE
authors.lastname: Kenny
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Totten
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D004318:Doxycycline / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D016990:Ureaplasma urealyticum / Q000187:drug effects*; D014526:Urethritis / Q000188:drug therapy* / Q000382:microbiology; D014861:Washington / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline