ABSTRACT
We evaluated the ResistancePlus® MG assay in providing macrolide resistance-guided treatment (RGT) for Mycoplasma genitalium infection at a UK sexual health centre. M. genitalium-positive samples from men with urethritis and women with pelvic inflammatory disease (PID) were tested for macrolide resistance-mediating mutations (MRMMs). MRMM-positive infections were given moxifloxacin 400 mg; otherwise 2 g azithromycin (1 g single dose and then 500 mg OD) was given. Among 57 M. genitalium-positive patients (32 men and 25 women), MRMMs were detected in 41/57 (72% [95% confidence interval (95% CI) 58-83%). Thirty-two of 43 patients given RGT attended for test of cure. Treatment failure rate was significantly lower at 1/32 (3%) than 10/37 (27%) before RGT (n = 37 [men = 23 and women = 17]; p = 0.008). Treatment failure was lower in male urethritis (0/15 vs. 7/21 p = 0.027) but not in female PID. There was a trend of a shorter time to negative test of cure (TOC) in male urethritis (55.1 [95% 43.7-66.4] vs. 85.1 [95% CI CI 64.1-106.0] days, p = 0.077) but not in female PID. Macrolide resistance is higher than previous UK reports and higher than expected. RGT reduces overall treatment failure and is particularly beneficial in M. genitalium urethritis. Fluoroquinolone resistance will continue to rise with increasing fluoroquinolone use, and RGT is critical to direct appropriate azithromycin use and prevent overuse of moxifloxacin.
Subject(s)
Mycoplasma Infections , Mycoplasma genitalium , Sexual Health , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Female , Humans , Macrolides/therapeutic use , Male , Mycoplasma Infections/diagnosis , Mycoplasma Infections/drug therapy , Mycoplasma genitalium/genetics , United KingdomABSTRACT
We present 2 cases of Mycoplasma genitalium infection that were successfully treated with moxifloxacin despite the presence of quinolone resistance-associated mutations in these strains.
Subject(s)
Drug Resistance, Bacterial , Moxifloxacin , Mycoplasma Infections , Mycoplasma genitalium , Quinolones , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial/drug effects , Drug Resistance, Bacterial/genetics , Humans , Moxifloxacin/therapeutic use , Mutation/genetics , Mycoplasma Infections/drug therapy , Mycoplasma genitalium/drug effects , Mycoplasma genitalium/genetics , Quinolones/pharmacology , Retrospective Studies , Treatment OutcomeABSTRACT
Recent studies have documented disproportionately high rates of sexually transmitted infections (STIs), HIV, and births among adolescents in rural areas of the United States. Despite this, the majority of sexual health education programs and interventions were developed for adolescents in metropolitan areas, and may not be appropriate or relevant for rural youth. The present study investigates the perspectives of 73 African American youth in rural Georgia who participated in a cognitive-behavioral intervention to reduce sexual risk behaviors, in an effort to understand how the intervention and ones similar to it may be tailored to better meet the needs of rural adolescents. Findings highlight the importance of incorporating diverse teaching and recruitment strategies into interventions when delivering them to rural youth, as well as the need to expand education and risk reduction efforts. Additional research is warranted to understand better how to meet the sexual health education needs of rural youth.
