Joyce F. Braam1, firstname.lastname@example.org
Alje P. van Dam1,2, email@example.com
Sylvia M. Bruisten1,2, firstname.lastname@example.org
Maarten F. Schim van der Loeff1,3, email@example.com
Martijn S. van Rooijen1, firstname.lastname@example.org
Henry de Vries1,2, email@example.com
Clarissa E. Vergunst1,4, firstname.lastname@example.org
1 Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Amsterdam, the Netherlands;
2 Department of Medical Microbiology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands;
3 Department of Internal Medicine, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands;
4 Department of Dermatology NWZ Den Helder, the Netherlands
Mycoplasma genitalium (MG) is associated with urethritis in men. Treatment of urethritis with azithromycin is expected to be less effective in patients infected with MG due to an increase in macrolide resistance in MG. We examined the clinical improvement in men treated presumptively for urethritis and correlated this to MG positivity and macrolide resistance.
From 15th May 2018 until 4th September 2019 urine samples of all men (2033) with 2181 episodes of urethritis were tested for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and MG using TMA assays (Aptima, Hologic). Non-gonococcal urethritis (NGU) was defined as urethritis complaints plus the presence of >10 leucocytes per high power field in a Gram stain of a urethral smear. Additional presence of intracellular gram-negative diplococci defined gonococcal urethritis. Presumptive therapy for gonococcal urethritis was 1000 mg ceftriaxone IM and for NGU 1000 mg azithromycin PO. Macrolide resistance-associated mutations in MG were detected by qPCR. Clinical improvement was inquired in a text message two weeks after therapy.
Of all urethritis episodes, 584/2181 (27%) patients had NG, 666/2181 (31%) CT, and 497/2181 (23%) MG. MG was successfully typed in 350 (70%) samples of which 259 (74%) were macrolide resistant. Of the 640 (31%) text message responders 509 (80%) indicated that their symptoms were reduced or gone. The improvement percentage was lower for patients infected with MG (95/143, 66%) compared to those without MG infection (414/497, 83%) (p<0.001). Patients with macrolide resistant MG (46/79, 58%) reported less often improvement compared to patients with macrolide sensitive MG (20/24, 83%) (p=0.025) especially in patients with resistant MG without CT or NG co-infection (26/53, 49%).
Patients with urethritis and macrolide resistant MG had a worse clinical outcome after standard treatment compared to patients with macrolide sensitive MG or without MG infection. The clinical use of testing for MG and macrolide resistance among men with urethritis should be evaluated.
34 IUSTI Congress - European Congres on Sexually transmitted Infections and HIV/AIDS
TAMING THE TIDE of STIs & HIV
Bucharest, September 3-5,