Time to eradication of Mycoplasma genitalium after antibiotic treatment in men and women.
OBJECTIVE
The objectives of this study were to evaluate the time to a Mycoplasma genitalium-negative test after start of treatment and to monitor if and when antibiotic resistance developed.


METHODS
Sexually transmitted disease (STD) clinic attendees with suspected or verified M. genitalium infection were treated with azithromycin (5 days, 1.5 g; n = 85) or moxifloxacin (n = 5). Subjects with symptomatic urethritis or cervicitis of unknown aetiology were randomized to either doxycycline (n = 49) or 1 g of azithromycin as a single dose (n = 51). Women collected vaginal specimens and men collected first-catch urine 12 times during 4 weeks. Specimens were tested for M. genitalium with a quantitative MgPa PCR and for macrolide resistance-mediating mutations with a PCR targeting 23S rRNA.


BACKGROUND
NCT01661985.


RESULTS
Ninety M. genitalium cases were enrolled. Of 56 patients with macrolide-susceptible strains before treatment with azithromycin (1.5 g, n = 46; 1 g single oral dose, n = 10), 54 (96%) had a negative PCR test within 8 days. In four patients, M. genitalium converted from macrolide susceptible to resistant after a 10 day lag time with negative tests (azithromycin 1.5 g, n = 3; 1 g single oral dose, n = 1). Moxifloxacin-treated subjects (n = 4) were PCR negative within 1 week. Six of eight (75%) remained positive despite doxycycline treatment.


CONCLUSIONS
PCR for M. genitalium rapidly became negative after azithromycin treatment. Macrolide-resistant strains were detected after initially negative tests. Test of cure should be recommended no earlier than 3-4 weeks.
Department of Dermatology and Venereology, Region Östergötland, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden R&D Department of Local Health Care, Region Östergötland, SE-581 85 Linköping, Sweden lars.falk@regionostergotland.se.
Lars
L
Falk
Department of Dermatology and Venereology, Västervik Hospital, SE-593 81 Västervik, Sweden.
Martin
M
Enger
Microbiology and Infection Control, Sexually Transmitted Infections, Research and Development, Statens Serum Institut, Copenhagen, DK-2300 København S, Denmark.
Jørgen Skov
JS
Jensen
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D017963:Azithromycin / Q000008:administration & dosage / Q000494:pharmacology; D004269:DNA, Bacterial / Q000235:genetics; D004275:DNA, Ribosomal / Q000235:genetics; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D008137:Longitudinal Studies; D018942:Macrolides / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D009175:Mycoplasma Infections / Q000188:drug therapy*; D045704:Mycoplasma genitalium / Q000187:drug effects / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012338:RNA, Ribosomal, 23S / Q000235:genetics; D013997:Time Factors; D016896:Treatment Outcome; D014556:Urine / Q000382:microbiology; D014621:Vagina / Q000382:microbiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D024841:Fluoroquinolones; D018942:Macrolides; D012338:RNA, Ribosomal, 23S; D017963:Azithromycin; D000077266:Moxifloxacin