Mycoplasma genitalium Susceptibility and Treatment

生殖支原体最近被牵连在男性和女性生殖道感染 并且可能占所有非淋菌性尿道炎（NGU）病例的25%。该微生物 在几乎所有使用DNA扩增方法的研究中， 这种关联的强度，现在是适当的，以确定有效的治疗方案，M。生殖器相关的 尿道炎虽然小规模的研究提供了一些关于失败率的有限信息 对于治疗M.生殖器感染，迄今为止，无系统性，随机化 已经进行了治疗试验。此外，虽然M.生殖器有 已经确定了少量的分离株，这些菌株是在10 - 20年前收集的，因此可能 不能反映这种细菌目前的抗菌特性。测定M. 生殖器是复杂的挑剔的性质，这种生物体，这使得它的隔离和增长 （抗菌药物敏感性试验过程的必要组成部分）具有挑战性。因此，目标1 本课题的主要研究内容是改进M.生殖器，使用我们的 定量PCR测定以测量生长。通过这些改进的方法，我们将确定 最近收集的M.生殖器在目标2中，我们将进行 一项比较阿奇霉素相对有效性的随机、双盲、安慰剂对照试验 强力霉素根除M.非淋菌性尿道炎患者的生殖器我们还将描述 在抗生素耐药性和持续感染之间的关系， 持续检测M.在随访访视时，对发生以下情况的患者的生殖器进行MIC值测定 微生物疗法最后，在目标3中，一项巢式病例对照研究将比较持续性M的比例。 在经历持续性/复发性尿道炎症状的患者中的生殖器感染（临床 治疗失败或病例）与持续性M的比例。患者生殖器感染 临床治愈（对照）。我们预期这些研究将阐明适当的治疗方法 治疗方案，以及进一步确定其在NGU病因学中的作用。

Mycoplasma genitalium has recently been implicated in both male and female reproductive tract infections and may account for up to 25% of all cases of nongonococcal urethritis (NGU). This organism was independently associated with NGU in virtually all studies using DNA amplification methods and, given the strength of this association, it is now appropriate to identify effective treatment regimens for M. genitaliumassociated urethritis. Although small-scale studies have provided some limited information on failure rates for selected antibiotic regimens treating M. genitalium infections, to date, no systematic, randomized treatment trials have been conducted. Further, although antimicrobial susceptibilities of M. genitalium have been determined for a small number of isolates, those strains were collected 10-20 years ago, and thus may not reflect the current antimicrobial profiles of this bacterium. Determining antimicrobial susceptibilities for M. genitalium is complicated by the fastidious nature of this organism, which makes its isolation and growth (necessary components of the antimicrobial susceptibility testing process) challenging. Therefore, in Aim 1 of this project, we propose to improve techniques for isolation and cultivation of M. genitalium, using our quantitative PCR assay to measure growth. With these enhanced methods, we will then determine the antibiotic susceptibility of recently collected clinical strains of M. genitalium. In Aim 2, we will conduct a randomized, double-blinded, placebo-controlled trial to compare the relative effectiveness of azithromycin and doxycycline in eradicating M. genitalium from men with NGU. We will also describe the relationship between antimicrobial resistance and persistent infection by comparing MIC values among patients with persistent detection of M. genitafium at follow-up visits to MIC values in patients who experience microbiologic cure. Finally, in Aim 3, a nested case-control study will compare the proportion of persistent M. genitalium infections among patients experiencing persistent/recurrent symptoms of urethritis (clinical treatment failures or cases) to the proportion of persistent M. genitalium infections among patients experiencing clinical cure (controls). We anticipate that these studies will elucidate the appropriate treatment regimens for this emerging pathogen, as well as further define its role in the etiology of NGU.