Ureaplasmas in acute and persistent urethritis: clinical implications

描述(申请人提供)：项目摘要。非淋菌性尿道炎(NGU)是美国男性中最常见的性传播疾病综合征，但高达50%的病例没有明确的病因。对持续性或复发性尿道炎的病因更是知之甚少，这种疾病也很常见。解脲支原体可能是其中一些特发性病例的罪魁祸首，但关于这种生物的病原性及其与急性或持续性非淋菌性尿道炎相关程度的证据是相互矛盾的。与沙眼衣原体的血清型相似，解脲支原体可能表现出不同程度的致病性，最近的系统发育分析表明，这两个主要的解脲支原体生物群实际上是不同的物种。Uu parvum一直被命名为biovar 1，而Urealyticum的名字被保留为biovar 2。有限的数据表明Urealyticum(Biovar 2)而不是U parvum与NGU有关，但需要进一步的研究来证实这一观察结果，以及评估这两个物种对常见抗生素治疗方案治疗NGU的不同反应，并确定这种微生物在持续性或复发性NGU中的作用。为了解决这些问题，我们将结合正在进行的另一种生殖器支原体-生殖支原体的随机治疗试验进行一系列研究。具体地说，我们将1)评估解脲支原体(生物群2)和解脲支原体与急性非淋菌性尿道炎的相关性；2)在我们正在进行的随机双盲试验中，确定阿奇霉素和多西环素在根除非淋菌性尿道炎患者中解脲支原体(生物群2)和解脲支原体感染方面的相对疗效，并评估药物的最低抑菌浓度与解脲支原体(生物群2)和解脲支原体持续存在的关系；以及3)评估持续或复发的非淋菌性尿道炎与解脲支原体(生物群2)和解脲支原体的相关性。关联性。NGU每年就诊医生超过200,000人次(CDC，2001)，是一个重大的公共卫生问题。这项研究的结果可能导致确定这种综合征的另一个原因，为治疗决策提供指导，并阐明持续和复发病例的病因。

DESCRIPTION (provided by applicant): Project Summary. Nongonococcal urethritis (NGU) is the most common sexually transmitted disease syndrome seen in men in the United States, yet up to 50% of cases have no defined etiology. Even less is known about the etiology of persistent or recurrent urethritis, which is also frequent. Ureaplasma urealyticum may be responsible for some of these idiopathic cases, but evidence regarding pathogencity of the organism and the degree to which it is associated with acute or persistent NGU is conflicting. Similar to the serovars of Chlamydia trachomatis, Ureaplasma serovars may exhibit varying degrees of pathogenicity, and recent phylogenetic analyses have demonstrated that the two major Ureaplasma biovar groupings are actually distinct species. U. parvum has been designated biovar 1, while the name U. urealyticum was retained for biovar 2. Limited data suggest that U. urealyticum (biovar 2), but not U. parvum is associated with NGU, but further studies are required to confirm this observation, as well as to assess the differential response of these two species to common antibiotic treatment regimens for NGU, and to identify the role of this organism in persistent or recurrent NGU. To address these questions, we will conduct a series of studies in conjunction with an ongoing randomized treatment trial of another genital Mycoplasma, M. genitalium. Specifically, we will 1) Assess the association of U. urealyticum (biovar 2) and U. parvum with acute NGU; 2) Determine, in our ongoing randomized double-blind trial, the relative efficacy of azithromycin and doxycycline in eradicating U. urealyticum (biovar 2) and U. parvum infection among men with NGU, and assess the relationship of the MIC of the drug used to persistence of U. urealyticum (biovar 2) and U. parvum; and 3) Evaluate the association of persistent or recurrent NGU with U. urealyticum (biovar 2) and U. parvum. Relevance. NGU is the subject of over 200,000 physician office visits per year (CDC, 2001), and represents a significant public health problem. The results of this study may lead to the identification of an additional cause of this syndrome, provide guidance on treatment decisions, and shed light on the etiology of persistent and recurrent cases.