Antibiotic treatment of symptomatic Mycoplasma genitalium infection in Scandinavia: a controlled clinical trial.

OBJECTIVES: To evaluate the microbiological cure rate after treatment with tetracyclines or azithromycin in patients infected with M genitalium. METHODS: One hundred and fifty-two men and 60 women positive for M genitalium were recruited. Patients treated either with doxycyline for 9 days or with azithromycin 1 g stat. were compared. Those still positive for M genitalium after primary doxycycline treatment received an extended course of azithromycin 500 mg on day 1 followed by 250 mg daily for the following 4 days, whereas those with treatment failure after azithromycin received doxycycline 100 mg twice daily for 15 days. RESULTS: The eradication rate after azithromycin 1 g stat. was 85% (95% CI 69 to 94) in men (n = 39) and 88% (95% CI 64 to 99) in women (n = 17) and after doxycycline 17% (95% CI 9 to 27) in men (n = 76) and 37% (95% CI 19 to 58) in women (n = 27). Extended azithromycin eradicated M genitalium from 96% (95% CI 85 to 99) of the men (n = 47) and from all six women who failed on doxycycline. Extended doxycycline treatment was insufficient. Persistent urethral inflammation was seen in a substantial portion of the men after eradication of M genitalium regardless of the antibiotic drug, indicating a poor predictive value of urethral smears in evaluation of persistent or recurrent infection. CONCLUSIONS: Azithromycin was more effective than doxycycline in treating patients infected with M genitalium. The extended course of azithromycin was highly effective but was given after the initial treatment with doxycycline. Randomised clinical trials are needed to compare the different dosages of azithromycin.

Relationship of Ureaplasma urealyticum biovar 2 to nongonococcal urethritis.

The aim of this study was to determine the frequency of Ureaplasma urealyticum biovars 1 and 2 among 340 men with or without nongonococcal urethritis (NGU) attending a venereal disease clinic in Sweden. NGU was defined by the presence of at least four polymorphonuclear leukocytes per microscopic field (x1,000 magnification) on a smear in which Neisseria gonorrhoeae could not be detected. Ureaplasma urealyticum was detected by polymerase chain reaction, and biovar determination was performed directly on the amplicons by liquid hybridization with biovar-specific probes. Patients with NGU were younger, had had more sexual partners, and exhibited symptoms of urethritis more often than patients without NGU. Ureaplasma urealyticum was detected with the same frequency among patients with and among those without NGU. Among patients with NGU, Ureaplasma urealyticum-positive men were more frequently symptomatic than Ureaplasma urealyticum-negative men. Among patients without NGU, Ureaplasma urealyticum-positive men had had more sexual partners than Ureaplasma urealyticum-negative men. Ureaplasma urealyticum biovar 2 was detected more often among patients with NGU than among those without (P=0.012). Logistic regression analysis was performed using detection of biovar 2 as the response variable and the following four variables as explanatory variables: presence or absence of NGU, symptoms of urethritis, number of partners, and age < or = 24 years. The only association found was that between Ureaplasma urealyticum biovar 2 and age < or = 24 years. More studies should be conducted to determine the possible pathogenic impact of Ureaplasma urealyticum biovar 2.

Mycoplasma genitalium in non-gonococcal urethritis--a study in Swedish male STD patients.

Urethral swab specimens obtained from 101 men attending an STD clinic were examined for the presence of Mycoplasma genitalium by polymerase chain reaction (PCR) amplification. Fifty patients had non-gonococcal urethritis (NGU), and 51 patients were included as controls without urethritis. M. genitalium DNA was detected in 13 (26%) of the urethritis patients and in 5 (10%) of the control patients (P=0.06). No patient positive for M. genitalium had a simultaneous chlamydial infection. Thus, in the 36 patients with non-chlamydial NGU, the prevalence of M. genitalium infection was 36% (P=0.007 compared with controls). All patients with M. genitalium positive urethritis had a high grade urethritis defined as >10 polymorphonuclear cells per high power microscopical field. Compared with the control group, those with M. genitalium positive urethritis had more often had a history of urethritis than had those with chlamydial NGU or those with M. genitalium negative, non-chlamydial NGU.

Genomic HLA-typing by RFLP-analysis using DR beta and DQ beta cDNA probes reveals normal DR-DQ linkages in patients with psoriasis vulgaris.

Thirty-five patients with psoriasis vulgaris were HLA-typed by RFLP-analysis using DR beta and DQ beta cDNA probes. A closer association to the DQ than to the DR locus was not found in this small material.