Evaluation of Clinical, Gram Stain, and Microbiological Cure Outcomes in Men Receiving Azithromycin for Acute Nongonococcal Urethritis: Discordant Cures Are Associated With Mycoplasma genitalium Infection.
Evaluation of Clinical, Gram Stain, and Microbiological Cure Outcomes in Men Receiving Azithromycin for Acute Nongonococcal Urethritis: Discordant Cures Are Associated With Mycoplasma genitalium Infection.
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DOI：
10.1097/olq.0000000000001509
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发表时间：
2022-01-01
影响因子：
3.1
通讯作者：
Jordan SJ
中科院分区：
文献类型：
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作者：
Toh E;Gao X;Williams JA;Batteiger TA;Coss LA;LaPradd M;Ren J;Geisler WM;Xing Y;Dong Q;Nelson DE;Jordan SJ
在患有非淋球菌性尿道炎（NGU）的男性中，临床医生和患者分别依靠临床治愈来指导是否需要额外的检测/治疗以及何时恢复性生活；然而，不一致的临床和微生物治疗结果确实发生。临床治愈在多大程度上准确地反映了特定性传播感染（STI）的微生物治愈尚不清楚。对患有NGU的男性进行淋病奈瑟菌、沙眼衣原体（CT）、生殖支原体（MG）、阴道毛滴虫、嗜尿性脑膜炎奈瑟菌ST11分支菌株和解脲原体（UU）的检测。男性接受1克阿奇霉素治疗，并进行1个月的治愈试验。在MG感染中，我们评估了大环内酯耐药介导突变（MRM）的存在，并使用原位散弹枪宏基因组测序、系统发育分析、多位点分型分析和定量PCR研究了微生物治疗失败的其他假设。在280名NGU患者中，121人被纳入本分析。在单一感染组中，52例有CT， 16例有MG， 7例有UU， 10例有混合感染，36例有特发性NGU。CT的临床治愈率为85%，UU为100%，MG为50%，特发性NGU为67%。临床治愈能准确预测除MG外所有STI的微生物治愈。不一致的结果与MG-NGU显著相关，主要反映了临床治愈男性的微生物学失败。MG MRM，而不是MG负荷或菌株，与微生物失效密切相关。在阿奇霉素治疗的NGU中，临床治愈预测除MG外所有STI的微生物治愈。当无法进行MRM检测时，NGU管理应包括MG检测和确认阿奇霉素处理的MG-NGU的微生物治愈。非淋球菌性尿道炎体征和症状的缓解并不总是与微生物治疗相关；三分之一的男性出现不一致的治疗。临床治愈率与革兰氏染色法和微生物治愈率准确相关，但生殖支原体除外。
In men with nongonococcal urethritis (NGU), clinicians and patients rely on clinical cure to guide the need for additional testing/treatment and when to resume sex, respectively; however, discordant clinical and microbiological cure outcomes do occur. How accurately clinical cure reflects microbiological cure in specific sexually transmitted infections (STI) is unclear. Men with NGU were tested for Neisseria gonorrhoeae, Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Trichomonas vaginalis, urethrotropic Neisseria meningitidis ST11 clade strains, and Ureaplasma urealyticum (UU). Men received azithromycin 1 g and returned for a 1-month test-of-cure visit. In MG infections, we evaluated for the presence of macrolide resistance-mediating mutations (MRM) and investigated alternate hypotheses for microbiological treatment failure using in situ shotgun metagenomic sequencing, phylogenetic analysis, multiple locus typing analyses, and quantitative PCR. Of 280 men with NGU, 121 were included in this analysis. In the monoinfection group, 52 had CT, 16 had MG, 7 had UU, 10 had mixed infection, and 36 men had idiopathic NGU. Clinical cure rates were 85% for CT, 100% for UU, 50% for MG, and 67% for idiopathic NGU. Clinical cure accurately predicted microbiological cure for all STI, except MG. Discordant results were significantly associated with MG-NGU and predominantly reflected microbiological failure in men with clinical cure. MG MRM, but not MG load or strain, were strongly associated with microbiological failure. In azithromycin-treated NGU, clinical cure predicts microbiological cure for all STI, except MG. NGU management should include MG testing and confirmation of microbiological cure in azithromycin-treated MG-NGU when MRM testing is unavailable. Resolution of nongonococcal urethritis signs and symptoms does not always correlate with microbiological cure; discordant cures occur in one third of men. Clinical cure accurately correlates with Gram stain and microbiological cure for NGU bacterial pathogens, except Mycoplasma genitalium.