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
Source: PubMed


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.

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    • "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 [17], 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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