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    Persistence of Mycoplasma genitalium Following Azithromycin Therapy

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    91
    Author
    Bradshaw, CS; Chen, MY; Fairley, CK
    Date
    2008-11-03
    Source Title
    PLoS One
    Publisher
    PUBLIC LIBRARY SCIENCE
    University of Melbourne Author/s
    Chen, Marcus; Fairley, Christopher
    Affiliation
    University General
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Bradshaw, C. S., Chen, M. Y. & Fairley, C. K. (2008). Persistence of Mycoplasma genitalium Following Azithromycin Therapy. PLOS ONE, 3 (11), https://doi.org/10.1371/journal.pone.0003618.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/259566
    DOI
    10.1371/journal.pone.0003618
    Abstract
    BACKGROUND: To determine clinical outcomes and cure rates for M.genitalium genital infection in men and women following azithromycin 1 g. METHODOLOGY: Patients attending Melbourne Sexual Health Centre between March 2005 and November 2007 with urethritis/epididymitis, cervicitis/pelvic inflammatory disease and sexual contacts of M.genitalium were tested for M.genitalium by polymerase chain reaction (PCR). M.genitalium-infection was treated with 1 g of azithromycin and a test-of-cure (toc) was performed one month post-azithromycin. Response to azithromycin, and response to moxifloxacin (400 mg daily for 10 days) in individuals with persistent infection post-azithromycin, was determined. PRINCIPAL FINDINGS: Of 1538 males and 313 females tested, 161 males (11%) and 30 females (10%) were infected with M.genitalium. A toc was available on 131 (69%) infected individuals (median = 36 days [range 12-373]). Of 120 individuals prescribed azithromycin only pre-toc, M.genitalium was eradicated in 101 (84%, 95% confidence intervals [CI]: 77-90%) and persisted in 19 (16%, 95% CI: 10-23%). Eleven individuals with persistent infection (9%, 95% CI: 5-15%) had no risk of reinfection from untreated-partners, while eight (7%, 95% CI: 3-12%) may have been at risk of reinfection from doxycycline-treated or untreated-partners. Moxifloxacin was effective in eradicating persistent infection in all cases not responding to azithromycin. Patients with persistent-M.genitalium were more likely to experience persistent symptoms (91%), compared to patients in whom M.genitalium was eradicated (17%), p<0.0001. CONCLUSION: Use of azithromycin 1 g in M.genitalium-infected patients was associated with unacceptable rates of persistent infection, which was eradicated with moxifloxacin. These findings highlight the importance of follow-up in M.genitalium-infected patients prescribed azithromycin, and the need to monitor for the development of resistance. Research to determine optimal first and second-line therapeutic agents for M.genitalium is needed.

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