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• W2788340350 abstract "Takashi Deguchi1Deguchi T Proposed treatment strategies for non-gonococcal urethritis.Lancet Infect Dis. 2017; 17: 1121-1122Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar describes issues in syndromic management of sexually transmitted infections (STIs) and in particular treatment of Mycoplasma genitalium, which shows increasing drug resistance, especially in the Asia-Pacific region, and which might become the first untreatable STI.2Jensen JS Mycoplasma genitalium: yet another challenging STI.Lancet Infect Dis. 2017; 17: 795-796Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar Widespread syndromic use of azithromycin has increased macrolide resistance in several bacterial STIs, and the evidence that macrolide resistance is less likely to develop with an “extended” azithromycin regimen as suggested by Deguchi1Deguchi T Proposed treatment strategies for non-gonococcal urethritis.Lancet Infect Dis. 2017; 17: 1121-1122Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar is not strong.3Horner P Ingle SM Garrett F et al.Which azithromycin regimen should be used for treating Mycoplasma genitalium? A meta-analysis.Sex Transm Infect. 2017; (published online July 17.)DOI:10.1136/sextrans-2016-053060Google Scholar We clearly need to replace syndromic approaches with therapy determined by identification of the causative organism, which will be facilitated by point-of-care tests, which also need to determine drug-resistance profiles for STIs such as M genitalium and Neisseria gonorrhoeae.4Sadiq ST Mazzaferri F Unemo M Rapid accurate point-of-care tests combining diagnostics and antimicrobial resistance prediction for Neisseria gonorrhoeae and Mycoplasma genitalium.Sex Transm Infect. 2017; 93: S65-S68Crossref PubMed Scopus (33) Google Scholar There is, however, an urgent need to establish guidelines for testing, to avoid widespread asymptomatic screening for M genitalium. Although M genitalium has similar prevalence to Chlamydia trachomatis,2Jensen JS Mycoplasma genitalium: yet another challenging STI.Lancet Infect Dis. 2017; 17: 795-796Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar screening cannot currently be recommended. Uncertainty in the natural history of M genitalium causes large uncertainty in the potential benefits of screening,5Smieszek T White PJ Apparently-different clearance rates from cohort studies of Mycoplasma genitalium are consistent after accounting for incidence of infection, recurrent infection, and study design.PLoS One. 2016; 11: e0149087Crossref PubMed Scopus (17) Google Scholar, 6Birger R Saunders J Estcourt C et al.Should we screen for the sexually-transmitted infection Mycoplasma genitalium? Evidence synthesis using a transmission-dynamic model.Sci Rep. 2017; 7: 16162Crossref PubMed Scopus (24) Google Scholar and there is concern about selection for antimicrobial resistance and drug toxicity.7Golden MR Workowski KA Bolan G Developing a public health response to Mycoplasma genitalium.J Infect Dis. 2017; 216: S420-S426Crossref PubMed Scopus (39) Google Scholar Treatment of M genitalium is increasingly challenging with resistant cases requiring costly drugs, which often have limited availability and are associated with rare, but serious, side-effects.1Deguchi T Proposed treatment strategies for non-gonococcal urethritis.Lancet Infect Dis. 2017; 17: 1121-1122Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 2Jensen JS Mycoplasma genitalium: yet another challenging STI.Lancet Infect Dis. 2017; 17: 795-796Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar Until regimens that are more effective and tolerable become available, we recommend sexual health services to avoid unnecessarily identifying asymptomatic infections, due to the consequent imperative to treat. The only patients in whom testing for M genitalium is clearly indicated are those with symptoms (urethritis, cervicitis, pelvic inflammatory disease7Golden MR Workowski KA Bolan G Developing a public health response to Mycoplasma genitalium.J Infect Dis. 2017; 216: S420-S426Crossref PubMed Scopus (39) Google Scholar), and current partners of index patients infected with M genitalium (even if asymptomatic), to prevent potential reinfection. Multiplex tests8Gaydos CA Mycoplasma genitalium: accurate diagnosis is necessary for adequate treatment.J Infect Dis. 2017; 216: S406-S411Crossref PubMed Scopus (42) Google Scholar detecting M genitalium should not be routinely used for patients seeking sexual health care without disease because such an approach would create a de-facto screening programme. However, more information is needed to better understand M genitalium's natural history, and unlinked anonymous monitoring of samples from asymptomatic patients tested for other STIs would provide valuable information that could inform treatment guidelines, including rates of M genitalium co-infection with C trachomatis and N gonorrhoeae.6Birger R Saunders J Estcourt C et al.Should we screen for the sexually-transmitted infection Mycoplasma genitalium? Evidence synthesis using a transmission-dynamic model.Sci Rep. 2017; 7: 16162Crossref PubMed Scopus (24) Google Scholar Treatment of C trachomatis and N gonorrhoeae with azithromycin will select for resistance in patients co-infected with M genitalium and this use needs to be reviewed. To manage M genitalium effectively, testing should always include the antimicrobial resistance profile: antimicrobial resistance is the primary cause of treatment failure with azithromycin and quinolones.3Horner P Ingle SM Garrett F et al.Which azithromycin regimen should be used for treating Mycoplasma genitalium? A meta-analysis.Sex Transm Infect. 2017; (published online July 17.)DOI:10.1136/sextrans-2016-053060Google Scholar Treatment should always be followed by test of cure: some treatment failures have been observed to have a reduced bacterial load and mild or unnoticed symptoms or signs, creating an opportunity for propagation of resistance. The views expressed are those of the authors and not necessarily those of the UK Department of Health, Medical Research Council, National Health Service, National Institute for Health Research, or Public Health England. CSB has received institutional funding for a research nurse from SpeeDx. PJH has received personal fees from BASHH and the Crown Prosecution Service, a grant from Mast Group, and institutional funding for travel, educational activities, and advice from Hologic. JSJ has received a speaker's fee from Hologic, serves on a scientific advisory board of Roche Molecular Systems, and has received grants from Angelini, C10 Pharma, Cempra Pharmaceuticals, Diagenode, Hologic, Nabriva, NYtor, Roche, and SpeeDx. PJW declares no competing interests. Proposed treatment strategies for non-gonococcal urethritisI read with great interest the Comment by Jørgen S Jensen1 in The Lancet Infectious Diseases about Mycoplasma genitalium infections. As the author notes, the increase in macrolide and fluoroquinolone-resistant M genitalium makes the treatment of M genitalium infections difficult. Under these conditions, new treatment strategies for non-gonococcal urethritis in men are needed. In clinical practice, non-gonococcal urethritis is treated with drugs highly active against Chlamydia trachomatis, because it causes approximately 50% of non-gonococcal urethritis. Full-Text PDF" @default.
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• W2788340350 title "Syndromic management of STIs and the threat of untreatable Mycoplasma genitalium" @default.
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