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C. trachomatis, M. genitalium often persist after treatment for nongonococcal urethritis
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After treatment of nongonococcal urethritis, persistent Chlamydia trachomatis and Mycoplasma genitalium were common among men, recent data indicate.
“Most sexually active men who develop symptoms of nongonococcal urethritis will have C. trachomatis or M. genitalium infections, and persistent infection is common after standard recommended therapy,” Arlene C. Seña, MD, MPH, associate professor of medicine at the University of North Carolina, told Infectious Disease News. “More than 40% of men in our study had persistent M. genitalium infection and 12% had persistent C. trachomatis at 4 weeks using sensitive nucleic acid amplification testing, which did not always correlate with clinical symptoms.”
Seña and colleagues analyzed data from a trial of nongonococcal urethritis treatment. The study included heterosexual men aged 16 to 45 years who presented at STD clinics. Nucleic acid amplification tests for C. trachomatis, M. genitalium and Trichomonas vaginalis were conducted at baseline and then 1 to 4 weeks after therapy.
Among the 293 men, 44% had C. trachomatis, 31% had M. genitalium and 13% had T. vaginalis at baseline. After 4 weeks of therapy, the researchers identified persistent C. trachomatis in 12% of the men and persistent M. genitalium in 44% of the men. After treatment with azithromycin, C. trachomatis persisted in 23% of the men, and after treatment with doxycycline, it persisted in 5%. After treatment with doxycycline, M. genitalium persisted in 68% of the men, and after treatment with azithromycin, it persisted in 33% of the men.
“Clinicians should include M. genitalium infections in their differential diagnosis for men with urethritis,” Seña said. “Unfortunately, testing for M. genitalium using nucleic acid amplification testing is not yet commercially available, but azithromycin is the drug of choice. For persistent C. trachomatis infections after azithromycin treatment, clinicians should consider giving doxycycline due to the possibility of macrolide resistance.”
References:
Seña AC. J Infect Dis. 2012;206:357-365.
Disclosures:
Dr. Seña reports no relevant financial disclosures.