zithromax and Sexually-Transmitted-Diseases--Bacterial

Mycoplasma genitalium is a sexually transmitted urogenital pathogen, and infection can result in serious symptoms. As M. genitalium is rather difficult to culture, infections are usually detected by molecular methods. Unfortunately, there has recently been a significant increase in resistance to azithromycin and moxifloxacin used for the treatment of M. genitalium infections. The increased resistance to (often empirically prescribed) M. genitalium treatments has resulted in frequent therapy failures and stresses the need for routine detection of antimicrobial resistance. In M. genitalium, antimicrobial resistance is almost always the result of DNA mutations and thus can easily be detected by molecular techniques. Regrettably, many microbiology laboratories do not use molecular techniques for the detection of bacterial antimicrobial resistance. As molecular tests are becoming available for M. genitalium, both for the establishment of infection and the detection of antimicrobial resistance, it is now more important to ensure that knowledge on the resistance mechanisms is transferred from the laboratory to the clinician. This review will provide a brief summary of the current status of antimicrobial resistance, its molecular mechanisms and the impact on the current status of M. genitalium treatment.

Topics: Anti-Bacterial Agents; Azithromycin; Doxycycline; Drug Resistance, Bacterial; Female; Female Urogenital Diseases; Humans; Male; Male Urogenital Diseases; Microbial Sensitivity Tests; Moxifloxacin; Mycoplasma genitalium; Mycoplasma Infections; Polymorphism, Single Nucleotide; Sexually Transmitted Diseases, Bacterial

Mycoplasma genitalium is now recognised as an important bacterial sexually transmitted infection. We summarised data from studies of mutations associated with macrolide and fluoroquinolone resistance in M genitalium to establish the prevalence of resistance. We also investigated temporal trends in resistance and aimed to establish the association between resistance and geographical location.. In this systematic review and meta-analysis, we searched PubMed, Embase, and MEDLINE for studies that included data for the prevalence of mutations associated with macrolide and fluoroquinolone resistance in M genitalium published in any language up to Jan 7, 2019. We defined prevalence as the proportion of M genitalium samples positive for key mutations associated with azithromycin resistance (23S rRNA gene, position 2058 or 2059) or moxifloxacin resistance (S83R, S83I, D87N, or D87Y in parC), or both, among all M genitalium samples that were successfully characterised. We used random-effects meta-analyses to calculate summary estimates of prevalence. Subgroup and meta-regression analyses by WHO region and time period were done. This study was registered with PROSPERO, number CRD42016050370.. Overall, 59 studies from 21 countries met the inclusion criteria for our study: 57 studies of macrolide resistance (8966 samples), 25 of fluoroquinolone resistance (4003 samples), and 22 of dual resistance to macrolides and fluoroquinolones (3280 samples). The summary prevalence of mutations associated with macrolide resistance among M genitalium samples was 35·5% (95% CI 28·8-42·5); prevalence increased from 10·0% (95% CI 2·6-20·1%) before 2010, to 51·4% (40·3-62·4%) in 2016-17 (p<0·0001). Prevalence of mutations associated with macrolide resistance was significantly greater in samples in the WHO Western Pacific and Americas regions than in those from the WHO European region. The overall prevalence of mutations associated with fluoroquinolone resistance in M genitalium samples was 7·7% (95% CI 4·5-11·4%). Prevalence did not change significantly over time, but was significantly higher in the Western Pacific region than in the European region. Overall, the prevalence of both mutations associated with macrolide resistance and those associated with fluoroquinolone resistance among M genitalium samples was 2·8% (1·3-4·7%). The prevalence of dual resistance did not change significantly over time, and did not vary significantly by geographical region.. Global surveillance and measures to optimise the efficacy of treatments-including resistance-guided strategies, new antimicrobials, and antimicrobial combination approaches-are urgently needed to ensure cure in a high proportion of M genitalium infections and to prevent further spread of resistant strains.. Australian National Health and Medical Research Council.

Topics: Anti-Bacterial Agents; Azithromycin; Carrier Proteins; Drug Resistance, Bacterial; Female; Humans; Male; Moxifloxacin; Mutation; Mycoplasma genitalium; Mycoplasma Infections; Polymorphism, Single Nucleotide; Prevalence; RNA, Ribosomal, 23S; Sexually Transmitted Diseases, Bacterial; Transferases

Rates of bacterial sexually transmitted infections (STIs) continue to rise, demanding treatments to be highly effective. However, curing infections faces significant challenges due to antimicrobial resistance in Neisseria gonorrhoeae and Mycoplasma genitalium and especially treating STIs at extragenital sites, particularly rectal chlamydia and oropharyngeal gonorrhoea. As no new antimicrobials are entering the market, clinicians must optimize the currently available treatments, but robust data are lacking on how the properties or pharmacokinetics of antimicrobials can be used to inform STI treatment regimens to improve treatment outcomes. This paper provides a detailed overview of the published pharmacokinetics of antimicrobials used to treat STIs and how factors related to the drug (tissue distribution, protein binding and t½), human (pH, inflammation, site of infection, drug side effects and sexual practices) and organism (organism load and antimicrobial resistance) can affect treatment outcomes. As azithromycin is commonly used to treat chlamydia, gonorrhoea and M. genitalium infections, and its pharmacokinetics are well studied, it is the main focus of this review. Suggestions are also provided on possible dosing regimens when using extended and/or higher doses of azithromycin, which appropriately balance efficacy and side effects. The paper also emphasizes the limitations of currently published pharmacokinetic studies including oropharyngeal gonococcal infections, where very limited data exist around ceftriaxone pharmacokinetics and its use in combination with azithromycin. In future, the different anatomical sites of infections may require alternative therapeutic approaches.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Load; Biological Availability; Disease Management; Drug Monitoring; Drug Resistance, Bacterial; Female; Humans; Male; Risk Factors; Sexual Behavior; Sexually Transmitted Diseases, Bacterial; Tissue Distribution; Treatment Outcome

Mycoplasma genitalium is a sexually transmitted infection that causes significant morbidity in men and women and is a co-factor in HIV transmission. However, commercial diagnostic tests are not generally available for M. genitalium and sub-optimal treatment is often given. We review the literature on the burden of infection, how it may present in clinical practice and the effectiveness of current treatment regimens.. In-vivo and in-vitro data strongly suggest that M. genitalium is an important cause of urethritis, cervicitis, pelvic inflammatory disease and potentially asymptomatic proctitis. Studies now consistently demonstrate suboptimal eradication rates with the current treatment regimens recommended first line for the treatment of nongonococcal urethritis. Concurrently, there has been a rapid emergence of antibiotic resistance in M. genitalium, with macrolide resistance now appearing to be endemic in some centres, and quinolone resistance is beginning to emerge.. In the absence of specific M. genitalium diagnostic and antimicrobial resistance testing, azithromycin 1 g should not be used for the management of patients with symptomatic disease potentially caused by M. genitalium. This review offers an alternative evidence-based approach to managing such patients that should, theoretically, reduce the risk of the development of antimicrobial resistance.

Topics: Anti-Bacterial Agents; Azithromycin; Cost of Illness; Disease Management; Drug Resistance, Bacterial; Female; Humans; Male; Mycoplasma genitalium; Mycoplasma Infections; Sexually Transmitted Diseases, Bacterial

Public health control of bacterial sexually transmitted infections (STIs) is dependent on the delivery of effective therapy and so will be compromised by the emergence of resistance. The scope of the problem and the implications for treatment that follow are discussed in this review.. Emerging resistance has been documented in all the bacterial STIs, but is considered rare and unconfirmed in Chlamydia trachomatis whereas is of global concern in Neisseria gonorrhoeae. Azithromycin resistance has now been recognized in Mycoplasma genitalium, Treponema pallidum and N. gonorrhoeae, questioning its widespread use for chlamydial infection and threatening its future use. Rapidly increasing levels of decreased susceptibility to the extended-spectrum cephalosporins in N. gonorrhoeae and emerging treatment failures to both cefixime and ceftriaxone, without an obvious alternative agent, are of considerable concern. Implications for treatment include choice and timing of any change in therapy, reintroduction of test of cure and definition of treatment failure in an era of molecular testing.. Emerging resistance in all bacterial STIs and the particular problem of resistant gonorrhoea will present a challenge to maintain antimicrobial therapy at the forefront of public health control.

Topics: Anti-Bacterial Agents; Azithromycin; Cephalosporins; Drug Resistance, Bacterial; Gonorrhea; Humans; Sexually Transmitted Diseases, Bacterial

Infective complications following induced abortions are still a common cause of morbidity and mortality. This review focusses on defining the strategies to improve care of women seeking an induced abortion and to reduce infective complications. We have considered the evidence for screening and cost-effectiveness for antibiotic prophylaxis. Current evidence suggests that treating all women with prophylactic antibiotics in preference to screening and treating is the most cost-effective way of reducing infective complications following induced abortions. The final strategy to prevent infective complications should be individualized for each region/area depending on the prevalence of organisms causing pelvic infections and the resources available.

Topics: Abortion, Induced; Adolescent; Adult; Antibiotic Prophylaxis; Azithromycin; Cost-Benefit Analysis; Doxycycline; Drug Therapy, Combination; Female; Humans; Metronidazole; Pelvic Inflammatory Disease; Postoperative Complications; Pregnancy; Sexually Transmitted Diseases, Bacterial; Young Adult

The prevalence of female sexually transmitted infection (STI) in Japan is in the decreasing tendency after 2002, however it still actualizes as a social problem. Azithromycin, which is 15-member macrolide antimicrobial agent, has indication to treat the chlamydia STI in a single dose of 1 g. In April 2009, a single dose of 2 g of azithromycin extended release (ER) formulation, which is improved formulation by the viewpoint of pharmacokinetics-pharmacodynamics, was approved and has indications to treat not only chlamydial STI but also gonococcal STI. We considered the clinical application of azithromycin ER to treat female STI, including our new our own experiences because the clinical studies of azithromycin ER for STI had not been conducted. In conclusion, azithromycin ER was suggested theoretically becoming one of the choices of new treatment STI caused by not only chlamydia but also gonococcus, more clinical consideration to treat STI will be necessary in the future.

Topics: Adnexa Uteri; Azithromycin; Chlamydia trachomatis; Delayed-Action Preparations; Diarrhea; Double-Blind Method; Drug Resistance, Bacterial; Female; Humans; Japan; Neisseria gonorrhoeae; Randomized Controlled Trials as Topic; Sexually Transmitted Diseases, Bacterial; Tissue Distribution

Testing for and treating sexually transmitted diseases (STDs) in pregnant women deserves special attention. Treatment possibilities are limited because of potential risks for the developing fetus, and because effects can differ in pregnant compared with non-pregnant women, re-infection may be missed because of the intrinsic delicacy of contact-tracing during pregnancy and because pregnant women are more reluctant to take the prescribed medication in its full dose, if at all. However, the devastating effects of some of these genital infections far outweigh any potential adverse effects of treatment. Although active syphilis has become a rarity in most Western countries, it is still prevalent in South America, Africa and South-East Asia. Benzathine benzylpenicillin (2.4 million units once or, safer, twice 7 days apart) is the treatment of choice, although patients with syphilis of longer standing require 3 weekly injections as well as extensive investigation into whether there has been any damage due to tertiary syphilis. Despite declining rates of gonorrhea, the relative rate of penicillinase-producing strains is increasing, especially in South-East Asia. The recommended treatment is intramuscular ceftriaxone (125 or 250 mg) or oral cefixime 400 mg. Despite good safety records after accidental use, fluoroquinolones are contraindicated during pregnancy. An alternative to a fluoroquinolone in pregnant women with combined gonorrhea and chlamydial infection is oral azithromycin 1 or 2 g. Azithromycin as a single 1 g dose is also preferable to a 7 day course of erythromycin 500 mg 4 times a day for patients with chlamydial infection. Eradication of Haemophilus ducreyi in patients with chancroid can also be achieved with these regimens or intramuscular ceftriaxone 250 mg. Trichomonas vaginalis, which is often seen as a co-infection, has been linked to an increased risk of preterm birth. Patients infected with this parasite should therefore received metronidazole 500 mg twice daily for 7 days as earlier fears of teratogenesis in humans have not been confirmed by recent data. Bacterial vaginosis is also associated with preterm delivery in certain risk groups, such as women with a history of preterm birth or of low maternal weight. Such an association is yet to be convincingly proven in other women. The current advice is to treat only women diagnosed with bacterial vaginosis who also present other risk factors for preterm delivery. The treatment of choice is oral m

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Erythromycin; Female; Humans; Metronidazole; Penicillin G Benzathine; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Sexually Transmitted Diseases, Bacterial; Vaginosis, Bacterial

The lower genital tract infections due to Chlamydia trachomatis are frequent, essentially occurring in young patients, with possible complications and severe sequela, particularly in women where the sterility risk is one of the major consequences. If an effective treatment could be systematically proposed, a good compliance (easy administration and good toleration) is one of the key factor to success. In this context, the azithromycin displays numerous advantages. The azithromycin in vitro activity on Chl. trachomatis strains is permanent with MIC comprised between 0.06 and 0.125 micrograms/ml, with an activity equivalent to those of other macrolides, to tetracyclines and quinolones. Different animal models allow to demonstrate the curative activity of the azithromycin administered as a single dose, at dosage regimen equivalent to those used in man, and a prophylactic activity on the salpingitis onset in provoked Chl. trachomatis infections. Several comparative clinical studies with azithromycin administered as a 1 g single dose displayed very satisfactory results with 98% of bacterial eradication, identical to those obtained with reference treatment. On the other hand, restrictions to the product use are a less constant activity against Neisseria gonorrhoeae and a lack of efficacy on Mycoplasma hominis. The efficacy on Treponema pallidum remains to be clinically tested.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chancroid; Chlamydia Infections; Chlamydia trachomatis; Female; Genital Diseases, Female; Genital Diseases, Male; Gonorrhea; Humans; Male; Mycoplasma Infections; Sexually Transmitted Diseases, Bacterial; Ureaplasma Infections

Topics: Anti-Bacterial Agents; Azithromycin; Cefixime; Cefotaxime; Chlamydia Infections; Chlamydia trachomatis; Female; Gonorrhea; Humans; Male; Research Design; Sexually Transmitted Diseases, Bacterial

Seventy five patients with urogenital chlamydial and mycoplasmic infections were enrolled in the trial. In the etiotropic therapy azithromycin was used in the standard dosage (1.0-1.5 g) depending on the infection. The treatment with azithromycin, in addition to the high eradication rates, was also evident of its effect on the cytokine levels in the patients, that was characteristic of a significant increase of the IFN-gamma level and a decrease of the IL-1beta and IL-6 levels in the blood.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Cytokines; Female; Humans; Interferon-gamma; Interleukins; Male; Middle Aged; Mycoplasma genitalium; Mycoplasma Infections; Sexually Transmitted Diseases, Bacterial; Treatment Outcome

To determine the safety and effectiveness of single-dose rifalazil, a new rifamycin, for the treatment of nongonococcal urethritis (NGU).. Randomized, double-blind trial comparing rifalazil, 2.5, 12.5 or 25 mg, with 1.0 g azithromycin for the treatment of NGU. One hundred and seventy men were evaluated for Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma genitalium infection before therapy and 2- and 5-weeks posttreatment.. C. trachomatis, M. genitalium, and U. urealyticum were present in 42%, 24%, and 28% of subjects, respectively. Microbiologic eradication of C. trachomatis with rifalazil 25 mg at 2- and 5- weeks was 85% and 83%, respectively. Rifalazil was ineffective in eradicating M. genitalium and U. urealyticum. Overall clinical cure rates at 2- and 5-weeks were 86% (95% CI 67-96) and 59% (39-78) in the rifalazil-treated 25 mg group, and 77% (56-91) and 63% (41-81) in the azithromycin-treated group.. Rifalazil was well tolerated and eradicates C. trachomatis but not M. genitalium and U. ureaplasma in men with NGU.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Double-Blind Method; Drug Administration Schedule; Humans; Male; Mycoplasma genitalium; Mycoplasma Infections; Rifamycins; Sexually Transmitted Diseases, Bacterial; Treatment Outcome; Ureaplasma Infections; Ureaplasma urealyticum; Urethritis

Sexually transmitted infections (STIs) are common in female sex workers (FSWs) and may enhance susceptibility to infection with human immunodeficiency virus type 1 (HIV-1).. To examine regular antibiotic prophylaxis in FSWs as a strategy for reducing the incidence of bacterial STIs and HIV-1.. Randomized, double-blind, placebo-controlled trial conducted between 1998-2002 among FSWs in an urban slum area of Nairobi, Kenya. Of 890 FSWs screened, 466 who were seronegative for HIV-1 infection were enrolled and randomly assigned to receive azithromycin (n = 230) or placebo (n = 236). Groups were well matched at baseline for sexual risk taking and STI rates.. Monthly oral administration of 1 g of azithromycin or identical placebo, as directly observed therapy. All participants were provided with free condoms, risk-reduction counseling, and STI case management.. The primary study end point was incidence of HIV-1 infection. Secondary end points were the incidence of STIs due to Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Treponema pallidum, and Haemophilus ducreyi, as well as bacterial vaginosis. Analysis of herpes simplex virus type 2 (HSV-2) infection was performed post hoc.. Seventy-three percent of participants (n = 341) were followed up for 2 or more years or until they reached an administrative trial end point. Incidence of HIV-1 did not differ between treatment and placebo groups (4% [19 cases per 473 person-years of follow-up] vs 3.2% [16 cases per 495 person-years of follow-up] rate ratio [RR], 1.2; 95% CI, 0.6-2.5). Incident HIV-1 infection was associated with preceding infection with N gonorrhoeae (rate ratio [RR], 4.9; 95% CI, 1.7-14.3) or C trachomatis (RR, 3.0; 95% CI, 1.1-8.9). There was a reduced incidence in the treatment group of infection with N gonorrhoeae (RR, 0.46; 95% CI, 0.31-0.68), C trachomatis (RR, 0.38; 95% CI, 0.26-0.57), and T vaginalis (RR, 0.56; 95% CI, 0.40-0.78). The seroprevalence of HSV-2 infection at enrollment was 72.7%, and HSV-2 infection at baseline was independently associated with HIV-1 acquisition (RR, 6.3; 95% CI, 1.5-27.1).. Despite an association between bacterial STIs and acquisition of HIV-1 infection, the addition of monthly azithromycin prophylaxis to established HIV-1 risk reduction strategies substantially reduced the incidence of STIs but did not reduce the incidence of HIV-1. Prevalent HSV-2 infection may have been an important cofactor in acquisition of HIV-1.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Double-Blind Method; Female; Herpes Genitalis; Herpesvirus 2, Human; HIV Infections; HIV-1; Humans; Incidence; Kenya; Prevalence; Risk Factors; Sex Work; Sexually Transmitted Diseases, Bacterial

A randomized controlled trial was carried out to assess the effectiveness of azithromycin versus a standard regimen with doxycycline/ciprofloxacin in the treatment of sexually transmitted infections in a resource-poor environment. Infection with Chlamydia trachomatis was cured in 23/24 (95.8%) of women in the azithromycin arm versus 19/21 (90.5%) in the doxycycline arm (P = 0.6), resulting in three treatment failures. Gonorrhoea was cured in 55/56 (98.2%) women, with one treatment failure in a patient with concomitant C. trachomatis infection. These results indicate that a single oral dose of azithromycin may prove to be a more effective and convenient treatment for sexually transmitted infections in women in a resource-poor environment

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Ciprofloxacin; Doxycycline; Female; Follow-Up Studies; Gonorrhea; Health Resources; Humans; Sexually Transmitted Diseases, Bacterial; South Africa; Treatment Outcome

The aim of this study is to find out the efficacy and safety of azithromycin in the treatment of males with uncomplicated non-gonococcal urethritis. It is an open, non-comparative study carried out in the major sexually transmitted disease clinics in Hong Kong. The subjects were 45 male outpatients with clinical symptoms and signs of acute non-gonococcal urethritis. Patients presenting with acute urethritis were examined and non-gonococcal urethritis were examined and non-gonococcal urethritis was daignosed by the positive urethral smear for white blood cells but negative for gonococcus. They were given a single 1 gram oral dose of azithromycin at the clinic. Follow-ups after one and two weeks to examine for cure and adverse events were made. The result showed that 35 out of 42 evaluable patients were cleared of urethritis. Only 2 out of 22 chlamydial antigen positive patients still remained positive at the last visit. Adverse events were not uncommon but all were only mild. We concluded that 1 gram single dose of azithromycin was effective and well tolerated in the treatment of non-gonococcal urethritis in male patients.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Follow-Up Studies; Hong Kong; Humans; Male; Middle Aged; Pilot Projects; Sexually Transmitted Diseases, Bacterial; Urethritis

We compared a single 1 gm dose of azithromycin with the standard 7-day course of doxycycline for the treatment of uncomplicated chlamydial genital infection in sexually active adolescents. Seventy-three adolescents (65 female) with a cervical or urethral culture positive for Chlamydia trachomatis were enrolled in the study; 46 received azithromycin and 27 received doxycycline. Follow-up evaluations were done 1, 2, and 4 weeks after treatment with azithromycin or initiation of treatment with doxycycline. There were four treatment failures (8.7%) among the patients who received azithromycin and four in the doxycycline-treated group (14.8%); all were female. Six of these girls (three treated with azithromycin and three with doxycycline) gave histories of unprotected intercourse with an untreated partner and were probably reinfected. Almost half the patients were clinically symptom free. The clinical response rate for the remaining patients with symptoms was 97.4% at 4 weeks. Nineteen percent of the azithromycin-treated patients and 33.3% of those treated with doxycycline had mild to moderate drug-related side effects, which were predominantly gastrointestinal. We conclude that treatment with a single oral dose of azithromycin appears to be as safe and efficacious as a 7-day course of doxycycline for the treatment of uncomplicated genital chlamydial infection in adolescents.

Topics: Administration, Oral; Adolescent; Adult; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Drug Administration Schedule; Erythromycin; Female; Humans; Male; Sexually Transmitted Diseases, Bacterial

The use of azithromycin for the treatment of Mycoplasma genitalium infections has led to resistance to macrolides. From July 2014 to July 2020, 7150 samples were analysed for the detection of sexually transmitted infections at the Policlinico of Bari. A total of 67/7150 samples (0.93%) were positive for MG DNA and 47 samples were analysed for the evaluation of six azithromycin resistance-associated mutations. In 5/47 samples, the A2058G mutation was detected (10.63%). Although the cases of positive MG samples and mutations are low in our reality, diagnostic tests to detect azithromycin resistant-associated genes may provide a convenient way to monitor resistance rate.

Topics: Anti-Bacterial Agents; Azithromycin; Drug Resistance, Multiple, Bacterial; Hospitals; Humans; Italy; Mycoplasma genitalium; Mycoplasma Infections; Prevalence; Sexually Transmitted Diseases, Bacterial

Topics: Anti-Bacterial Agents; Azithromycin; Canada; Drug Resistance, Bacterial; Female; Fluoroquinolones; Health Surveys; Humans; Male; Moxifloxacin; Mycoplasma genitalium; Mycoplasma Infections; Practice Guidelines as Topic; Prevalence; Sexually Transmitted Diseases, Bacterial

Mycoplasma genitalium is an important cause of bacterial sexually transmitted diseases. Diagnosis and susceptibility testing of M. genitalium are limited by the fastidious nature of the organism. Therefore, the prevalence of infection and azithromycin resistance are poorly studied.. We conducted an exploratory study on remnant clinical specimens. We collected remnant DNA from consecutive urine samples and clinical swabs (cervical/vaginal, rectal, and pharyngeal) previously tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the Cobas 4800 CT/NG assay (Roche Molecular Systems, Pleasanton, CA) between March-April 2017 from across the University of California, Los Angeles Health System. We then retrospectively tested all specimens with the ResistancePlus MG (550) kit, a molecular assay for the detection of M. genitalium and genetic mutations associated with azithromycin resistance.. Among 500 specimens, the prevalence of M. genitalium was 1.1% (95% confidence interval [CI], 0.04%-3.0%) in urine samples (n = 362), 17.4% (95% CI, 5.7%-39.6%) in rectal swabs (n = 23), and 1.9% (95% CI, 0.3%-7.3%) in cervical/vaginal swabs (n = 106). The prevalence of N. gonorrhoeae was 0.6% in urine samples and 4.3% in rectal swabs, whereas the prevalence of C. trachomatis was 2.2% in urine samples, 4.3% in rectal swabs and 3.8% in cervical/vaginal swabs. Of the 10 M. genitalium positive specimens, 8 (80.0%) had a mutation associated with azithromycin resistance.. The prevalence of M. genitalium infection in our population varied by anatomic site of infection. Most M. genitalium infections had at least 1 mutation associated with azithromycin resistance.

Topics: Anti-Bacterial Agents; Azithromycin; Cervix Uteri; DNA, Bacterial; Drug Resistance, Bacterial; Female; Humans; Los Angeles; Mutation; Mycoplasma genitalium; Mycoplasma Infections; Pharynx; Prevalence; Rectum; Retrospective Studies; Sexually Transmitted Diseases, Bacterial

Mycoplasma genitalium is a sexually transmitted infection (STI), and a common cause of non-gonococcal urethritis (NGU). There is concern regarding the rise in prevalence of M. genitalium and rates of resistance to macrolide antibiotics. International backpackers represent a unique population that may be at an increased risk of STIs. The purpose of this study was to determine the prevalence of M. genitalium and antibiotic resistance in international backpackers.. First void urine samples were obtained utilising opportunistic sampling from 294 non-treatment-seeking international backpackers at a variety of hostels in Cairns, Queensland Australia. Participants also answered a fixed-answer survey regarding sociodemographic characteristics and sexual risk behaviours. Samples were tested for M. genitalium, Chlamydia trachomatis and Neisseria gonorrhoeae using polymerase chain reaction (PCR). Samples positive for M. genitalium were investigated for macrolide resistance-associated mutations in the 23S rRNA genome at positions A2058G, A2058C, A2058T, A2059G and A2059C (Escherichia coli numbering).. Of the 294 samples, 23 failed the internal control. The prevalence of M. genitalium was 1.8% (5/271, 95% confidence interval [CI] ± 1.58), C. trachomatis was 4.1% (11/271, 95% CI ± 2.36) and N. gonorrhoeae was not detected. Macrolide resistance-associated mutations were identified in 40% (2/5) of M. genitalium-positive samples. M. genitalium infection was associated with reporting symptoms (odds ratio [OR] 14.36, 95% CI 2.17-94.94, p < 0.05).. M. genitalium and C. trachomatis are relatively common amongst non-treatment seeking international backpackers, but may not differ from Australian population prevalence. This article provides evidence to further support the increased utilisation of M. genitalium PCR in the diagnosis of NGU, and for macrolide resistance testing for all identified M. genitalium infections.

Topics: Adolescent; Adult; Azithromycin; Cross-Sectional Studies; Drug Resistance, Bacterial; Female; Humans; Male; Mycoplasma genitalium; Mycoplasma Infections; Prevalence; Queensland; Sexually Transmitted Diseases, Bacterial

During 2016, eight Neisseria gonorrhoeae isolates from 7 patients in Hawaii were resistant to azithromycin; 5 had decreased in vitro susceptibility to ceftriaxone. Genomic analysis demonstrated a distinct phylogenetic clade when compared with local contemporary strains. Continued evolution and widespread transmission of these strains might challenge the effectiveness of current therapeutic options.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Drug Resistance, Bacterial; Genome, Bacterial; Gonorrhea; Hawaii; Humans; Microbial Sensitivity Tests; Multilocus Sequence Typing; Neisseria gonorrhoeae; Phylogeny; Sexually Transmitted Diseases, Bacterial

Topics: Anti-Bacterial Agents; Azithromycin; Bacteria; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Sexually Transmitted Diseases, Bacterial

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Drug Resistance, Bacterial; Female; Humans; Macrolides; Male; Middle Aged; Mutation; Mycoplasma genitalium; Mycoplasma Infections; Netherlands; Prevalence; RNA, Ribosomal, 23S; Sexually Transmitted Diseases, Bacterial

Women having a termination of pregnancy (TOP) have higher rates of Chlamydia trachomatis (CT) than the general population. In this study, we explored CT treatment and prevention in Dutch TOP clinics in comparison to that provided in Great Britain (GB).. A qualitative study including 14 semi-structured interviews with health care professionals (HCPs) in TOP clinics (the Netherlands: 9, GB: 5). Interviews were recorded, transcribed, and analysed by thematic content analysis.. Prophylactic treatment with azithromycin is routinely prescribed after surgical TOP, but not after medical TOP ('abortion pill'). Sexually transmitted infections (STI) tests are offered to clients who are considered at high risk of having STI. Uptake varies according to health insurance coverage of STI testing. Some Dutch clinics are able to provide free testing for women under 25 years of age. Sexual health counselling is often limited to discussing birth control. The major difference between the Netherlands and GB is that GB TOP clinics more often offer free STI testing and prophylaxis to their clients.. HCPs in Dutch TOP clinics consider STI testing an important part of their service, but financial barriers prevent testing on location. Dutch TOP clinics should offer STI tests to all women, and collaboration with public health services could improve STI testing and counselling for young people. Furthermore, clinics should treat all TOP clients with prophylactic azithromycin. This could prevent CT and other upper genital tract post-abortion infections.

Topics: Ambulatory Care Facilities; Anti-Bacterial Agents; Antibiotic Prophylaxis; Attitude of Health Personnel; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Interviews as Topic; Male; Netherlands; Nurses; Patient Acceptance of Health Care; Physicians; Practice Guidelines as Topic; Pregnancy; Qualitative Research; Sexually Transmitted Diseases, Bacterial; United Kingdom

Six regional medical associations in Shiga prefecture agreed to cooperate in an investigation of medical care for male gonococcal and chlamydial urethritis. In June 2011, we sent a questionnaire to 372 medical offices in Shiga prefecture, and analyzed replies of respondents. Ten urologists and 175 non-urologists responded to the survey (response rate 49.7%). Among 185 physicians, 52 (10 urologists and 42 nonurologists) have treated male patients with gonococcal and chlamydial urethritis. More than 20% (42/175) of non-urological clinics are involved in the medical management. At initial diagnosis for sexually transmitted male urethritis, all urologists select the nucleic acid amplification method (100%), whereas many non-urologists do not (35%). For the treatment of chlamydial urethritis, non-urologists select levofloxacin (LVFX, 52.8%) rather than azithromycin (AZM, 22.0%), whereas urologists use AZM (78.0%) mostly but do not use LVFX (0%) (p = 0.023). For the treatment of gonococcal urethritis, non-urologists prefer oral new quinolones (53.1%) compared to urologists (25.0%) (p = 0. 74). For cure judgment of gonoccocal and chlamydial urethritis, many non-urologists rely on the improvement of subjective symptoms (50 and 47%), but urologists do not (10 and 0%) (p = 0.022 and 0.026, respectively). As for recognition of the clinical guideline for sexually transmitted disease, most urologists (90%) know it, but few non-urologists (13%) do (p < 0.001). We found that non-urological clinics make a great contribution to the medical treatment for male gonococcal and chlamydial urethritis in Shiga prefecture. It is important to standardize the medical care for sexually transmitted male urethritis by familiarizing non-urological practitioners with the clinical guideline.

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Drug Administration Schedule; Drug Utilization; Female; Gonorrhea; Health Knowledge, Attitudes, Practice; Humans; Japan; Levofloxacin; Male; Nucleic Acid Amplification Techniques; Patient Care; Practice Guidelines as Topic; Sexual Partners; Sexually Transmitted Diseases, Bacterial; Specialization; Surveys and Questionnaires; Urethritis

To compare point-of-care (POC) systems in two different periods: (1) before 2010 when all high-risk patients were offered POC management for urogenital gonorrhoea by Gram stain examination; and (2) after 2010 when only those with symptoms were offered Gram stain examination.. Retrospective comparison of a Gram stain POC system to all high-risk patients (2008-2009) with only those with urogenital symptoms (2010-2011) on diagnostic accuracy, loss to follow-up, presumptively and correctly treated infections and diagnostic costs. Culture was the reference diagnostic method.. In men the sensitivity of the Gram stain was 95.9% (95% CI 93.1% to 97.8%) in 2008-2009 and 95.4% (95% CI 93.7% to 96.8%) in 2010-2011, and in women the sensitivity was 32.0% (95% CI 19.5% to 46.7%) and 23.1% (95% CI 16.1% to 31.3%), respectively. In both periods the overall specificity was high (99.9% (95% CI 99.8% to 100%) and 99.8% (95% CI 99.7% to 99.9%), respectively). The positive predictive value (PPV) and negative predictive value (NPV) before and after 2010 were also high: PPV 97.0% (95% CI 94.5% to 98.5%) and 97.7% (95% CI 96.3% to 98.6%), respectively; NPV 99.6% (95% CI 99.4% to 99.7%) and 98.8% (95% CI 98.5% to 99.0%), respectively. There were no differences between the two time periods in loss to follow-up (7.1% vs 7.0%). Offering Gram stains only to symptomatic high-risk patients as opposed to all high-risk patients saved €2.34 per correctly managed consultation (a reduction of 7.7%).. The sensitivity of the Gram stain is high in men but low in women. When offered only to high-risk patients with urogenital symptoms, the cost per correctly managed consultation is reduced by 7.7% without a significant difference in accuracy and loss to follow-up.

Topics: Adult; Algorithms; Ambulatory Care Facilities; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Chlamydia Infections; Coinfection; Cost-Benefit Analysis; Female; Gentian Violet; Gonorrhea; Humans; Male; Phenazines; Point-of-Care Systems; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Sexually Transmitted Diseases, Bacterial; Urogenital System

To evaluate therapy for Mycoplasma genitalium infection with doxycycline or azithromycin 1 g compared to five days of azithromycin (total dose 1.5 g).. A retrospective case study was performed among patients attending the STD-clinic in Falun, Sweden 1998-2005. All patients with a positive PCR test for M. genitalium were routinely offered a test of cure (toc). Response to doxycycline for 9 days, azithromycin 1 g single dose and extended azithromycin (500 mg on day 1 followed by 250 mg o.d. for 4 days) was determined. In patients with treatment failure after azithromycin, macrolide resistance was monitored before and after treatment. Furthermore, the rate of macrolide resistance was monitored for positive specimens available from 2006-2011.. The eradication rate after doxycycline was 43% (48% for women and 38% for men), for azithromycin 1 g 91% (96% for women and 88% for men) and for extended azithromycin 99% (100% for women and 93% for men). Macrolide resistance developed in 7/7 examined (100%) of those testing positive after azithromycin 1 g, but in none of those treated with extended azithromycin. Macrolide resistance before treatment increased from 0% in 2006 and 2007 to 18% in 2011.. These findings confirm the results from other studies showing that doxycycline is inefficient in eradicating M. genitalium. Although azithromycin 1 g was not significantly less efficient than extended dosage, it was associated with selection of macrolide resistant M. genitalium strains and should not be used as first line therapy for M. genitalium. Monitoring of M. genitalium macrolide resistance should be encouraged.

Topics: Administration, Oral; Ambulatory Care Facilities; Anti-Bacterial Agents; Azithromycin; Doxycycline; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Mycoplasma genitalium; Mycoplasma Infections; Retrospective Studies; Sexually Transmitted Diseases, Bacterial; Sweden

Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) that is potentially associated with reproductive tract sequelae in women. This study aimed to estimate MG incidence and treatment failure and provide estimates of organism load in infection.. 1110 women aged 16-25 years were recruited from primary care clinics in Australia. Women were tested for MG at baseline, 6 months, and 12 months, and MG organism load was measured by quantitative polymerase chain reaction (PCR). MG-positive cases were screened for MG 23S ribosomal RNA (rRNA) gene point mutations shown to confer azithromycin resistance using high-resolution melt following PCR.. MG incidence rate was 1.3 per 100 person-years (n=14; 95% confidence interval [CI], .8-2.3); women reporting 3 or more sex partners in the last 12 months had an increased rate of incident infection (rate ratio [RR], 5.1; 95% CI, 1.3-19.6]). There were 3 cases of MG reinfection (0.8 per 100 person-years [95% CI, .1-.9]. Organism load was higher for prevalent than incident infection (P=.04). There were 3 cases of treatment failure (9.4% [95% CI, 2.0-25.0]); organism load was higher in cases with treatment failure than in successfully treated cases (P<.01). An MG 23S rRNA mutation was detected in 5 cases (3 cases of treatment failure and 2 successfully treated).. Although MG incidence was relatively low, testing should be recommended for women considered to be at increased risk based on sexual history. Our results also suggest that organism load might be important in azithromycin treatment failure.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Australia; Azithromycin; Bacterial Load; Cohort Studies; Communicable Diseases, Emerging; Drug Resistance, Bacterial; Female; Humans; Incidence; Mycoplasma genitalium; Mycoplasma Infections; Point Mutation; RNA, Bacterial; RNA, Ribosomal, 23S; Sexually Transmitted Diseases, Bacterial; Treatment Failure; Vaginosis, Bacterial; Young Adult

Topics: Anti-Bacterial Agents; Azithromycin; Drug Administration Schedule; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Sexually Transmitted Diseases, Bacterial; Treatment Outcome

The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct observed therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago. All patients with genital discharge and their contacts were given one gram oral dose of azithromycin under direct supervision after collection of urethral and cervical swabs for N gonorrhoeae culture and smear and for C trachomatis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7-10 days for follow-up. Of the 735 patients who were enrolled in the study, 319 (43.4%) had N gonorrhoeae and 100 (13.6%) had C trachomatis. Only 151 (36%) of the 419 patients with a pathogenic isolate returned for clinical and microbiological assessment. The remaining 268 (64%) of the 419 patients were lost to follow-up. One hundred and forty-three patients (94.7%) had total abatement of signs and symptoms after taking azithromycin. One patient (0.65%), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis) failed to respond clinically to azithromycin. Microbiological eradication was achieved in 115 (100%) patients who had single infection with N gonorrhoeae and in 23 patients (96%) with C trachomatis infection. Of 12 patients with combined infections, N gonorrhoeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorrhoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervision is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trachomatis in STD clinic attenders in Trinidad.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Dose-Response Relationship, Drug; Female; Gonorrhea; Humans; Male; Middle Aged; Neisseria gonorrhoeae; Outcome Assessment, Health Care; Patient Compliance; Sexually Transmitted Diseases, Bacterial; Trinidad and Tobago

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Antitrichomonal Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Condylomata Acuminata; Doxycycline; Epididymitis; Female; Humans; Infectious Disease Transmission, Vertical; Male; Metronidazole; Papillomaviridae; Papillomavirus Infections; Pelvic Inflammatory Disease; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Complications, Parasitic; Scabies; Sexually Transmitted Diseases; Sexually Transmitted Diseases, Bacterial; Sexually Transmitted Diseases, Viral; Syphilis; Tumor Virus Infections; Urethritis