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Original research
High rates of treatment failure for Mycoplasma genitalium among men and women attending a sexual health clinic
  1. Katie Jane Ovens1,
  2. John Joseph Reynolds-Wright2,
  3. Elizabeth Louise Anne Cross3,
  4. Lucinda Rickwood4,
  5. Mohammed Osman Hassan-Ibrahim5,
  6. Suneeta Soni1
  1. 1 Department of GUM/HIV, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  2. 2 University of Edinburgh, University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
  3. 3 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  4. 4 Brighton and Sussex Medical School, Brighton, UK
  5. 5 Department of Microbiology/Virology & Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to Dr Katie Jane Ovens, GUM/HIV, Plymouth Hospitals NHS Trust, Plymouth PL6 8DH, UK; katie.ovens{at}nhs.net

Abstract

Background Mycoplasma genitalium (Mgen) causes non-gonococcal urethritis (NGU) and is believed to cause pelvic inflammatory disease (PID). High rates of macrolide resistance are well documented globally for Mgen. In Brighton, patients with NGU and PID are tested for Mgen and test of cure (TOC) offered post-treatment.

Methods Demographic, clinical and treatment history data were collected over a 12-month period for all Mgen-positive patients in a Brighton-based genitourinary clinic.

Results There were 114 patients with Mgen. 18% (61/339) of men with NGU and 9% (15/160) of women with PID had Mgen. 62/114 (54%) returned for first test TOC 4 weeks after treatment. 27/62 (44%) had a positive TOC; 25/27 (92.6%) had received azithromycin first line (500 mg stat then 250 mg OD for 4 days), 1/27 (3.7%) had received moxifloxacin first line (400 mg OD for 14 days) and 1/27 (3.7%) had received doxycycline first line (100 mg BD for 7 days). 20/27 (74%) returned for a second TOC 4 weeks later. 5/20 (25%) patients were positive on second TOC; 3/5 (60%) had received azithromycin second line and 2/5 (40%) had received moxifloxacin second line. Patients were more likely to have a positive TOC if they were at risk of reinfection (9/27 positive TOC vs 3/35 negative TOC; p=0.02). Patients given moxifloxacin were more likely to have a negative TOC (1/27 positive TOC vs 9/35 negative TOC; p=0.03) than those who received other antibiotic regimens.

Conclusions Treatment failure rates for Mgen following azithromycin use are substantial, raising concerns regarding resistance. However, reinfection risk may contribute, suggesting a requirement for improved public awareness and clinician knowledge.

  • genitourinary medicine
  • sexually transmitted infections

https://doi.org/10.1136/bmjsrh-2019-200384

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    Footnotes

    • Twitter @doctorjjrw

    • Contributors KJO and SS were involved in all stages of the study and KJO wrote the first and final draft of manuscript. JJRW participated in study design and data collection. ELAC was involved in the study design, data collection and analysis. LR participated in data collection. MOHI did laboratory work. All authors reviewed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.