Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis Infections in Men With Nongonococcal Urethritis: Predictors and Persistence After Therapy
Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. The Journal of Infectious Diseases
(Impact Factor: 6).
05/2012; 206(3):357-65. DOI: 10.1093/infdis/jis356
Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) are sexually transmitted infections (STIs) associated with nongonococcal urethritis (NGU). We assessed their predictors and persistence after treatment.
We analyzed data from an NGU treatment trial among symptomatic heterosexual men aged 16-45 years from STI clinics. Nucleic acid amplification tests detected CT, MG, and TV at baseline and at 1 and 4 weeks after therapy. Associations between variables and STI detection were investigated.
Among 293 participants, 44% had CT, 31% had MG, and 13% had TV at baseline. In multivariate analysis, CT infection was associated with young age and STI contact. Young age was also associated with MG, and having ≥ 1 new partner was negatively associated with TV. We detected persistent CT in 12% and MG in 44% of participants at 4 weeks after therapy, which were associated with signs and symptoms of NGU. Persistent CT was detected in 23% of participants after azithromycin treatment vs 5% after doxycycline treatment (P = .011); persistent MG was detected in 68% of participants after doxycycline vs 33% after azithromycin (P = .001). All but 1 TV infection cleared after tinidazole.
Persistent CT and MG after treatment of NGU are common, and were associated with clinical findings and drug regimen.
Available from: Shin Ito
- "Therefore, it could be recommended that such patients be re-treated with antibiotics with high activity against M. genitalium irrespective of the presence or absence of symptoms. We are fully aware that the limitations of the present study include the small number of subjects, the fact that we did not take into consideration differences in antimicrobial activity against M. genitalium among the antibiotics administered to the patients, which could influence their clinical courses after treatment , and the absence of data regarding clinical courses of patients with M. genitalium-negative non-chlamydial NGU treated with antibiotics . It remains unclear whether our present finding that, a leukocyte count of 10 leukocytes/ml or more in FVU in the period of Days 18e24 could be a helpful predictor of treatment failure for M. genitalium-positive NGU, is valid even in cases of other types of non-chlamydial NGU, including U. urealyticum-positive NGU. "
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ABSTRACT: Mycoplasma genitalium is regarded as another pathogen of male non-gonococcal urethritis (NGU). Failure to eradicate this mycoplasma is associated with persistent or recurrent NGU, but this mycoplasma is not routinely examined in clinical practice. In cases of M. genitalium-positive NGU, therefore, some criteria are needed to assess the success or failure of antimicrobial chemotherapy other than microbiological outcomes. We enrolled 49 men with M. genitalium-positive non-chlamydial NGU. At successive visits after treatment, we inquired about their symptoms, observed their urethral meatus for urethral discharge, and examined their first-void urine (FVU) for quantification of leukocytes and for the persistence of M. genitalium. M. genitalium was eradicated in 34 patients after treatment, whereas the mycoplasma persisted in 15. Urethritis symptoms and urethral discharges were not found to be predictors of the persistence of M. genitalium up to the 25th day after the start of treatment. Leukocyte counts in FVU from the patients with persistence of M. genitalium were significantly higher than those from the patients with eradication of the mycoplasma. Leukocyte counts of 10 leukocytes/μl or more between the 18th and 24th day after the start of treatment were most significantly associated with the persistence of M. genitalium. Quantification of leukocytes in FVU would appear to be crucial to judge the outcome of treatment in patients with non-chlamydial NGU and could be helpful to predict the persistence of M. genitalium after treatment when M. genitalium is not routinely examined in clinical specimens in clinical practice.
Journal of Infection and Chemotherapy 02/2014; 20(5-6). DOI:10.1016/j.jiac.2014.01.002 · 1.49 Impact Factor
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ABSTRACT: Ten articles published in 2012 and of interest for the practice of ambulatory general internal medicine are reviewed in this paper. Topics of public health issues, such as the association between sleep disorders and prediabetes, the association between prediabetes and stroke, and the harmful effects of prolonged sitting are tackled. Other focuses include hepatitis C screening, abdominal aortic aneurysm screening and prostatic cancer screening. Therapeutic aspects are reviewed, such as the management of nongonococcal urethritis, the treatment of iron deficiency without anemia and the substitution of subclinical hypothyroidism. Finally a new study about aspirin and cancer prevention is discussed.
Revue médicale suisse 01/2013; 9(370):182-5.
Annals of internal medicine 02/2013; 158(3):ITC2-1. DOI:10.7326/0003-4819-158-3-20130205-01002 · 17.81 Impact Factor
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