Mycoplasma genitalium Susceptibility and Treatment

生殖支原体最近被认为与男性和女性生殖道感染有关。 可能占所有非淋菌性尿道炎(NGU)病例的25%。这种有机体是 在几乎所有使用DNA扩增方法的研究中与NGU独立相关，并考虑到 这种关联的力量，现在是适当的确定有效的治疗方案的生殖道支原体相关 尿道炎。尽管小规模研究提供了一些关于失败率的有限信息 对于选定的治疗生殖道支原体感染的抗生素方案，到目前为止，还没有系统的、随机的 已经进行了治疗试验。此外，尽管生殖支原体的抗菌活性具有 这些菌株是在10-20年前收集的，因此可能 不能反映该细菌目前的抗菌谱。测定M。 生殖器由于这种有机体的挑剔性质而变得复杂，这使得它的隔离和生长 (抗菌素敏感性检测过程的必要组成部分)具有挑战性。因此，在目标1中 在这个项目中，我们建议改进生殖支原体的分离和培养技术，利用我们的 定量聚合酶链式反应检测生长。有了这些增强的方法，我们将确定 新近收集的生殖支原体临床分离株的药敏结果分析。在目标2中，我们将进行 比较阿奇霉素相对疗效的随机、双盲、安慰剂对照试验 和多西环素根除非淋菌性尿道炎男性生殖道支原体。我们还将描述两国关系 比较慢性支气管炎患者MIC值与耐药与持续感染的关系 在对患者的MIC值进行随访时持续检测生殖道支原体 微生物疗法。最后，在目标3中，一项嵌套病例对照研究将比较持续M。 有持续性/复发性尿道炎症状的患者的生殖器感染(临床 治疗失败或病例)与患者中持续生殖道支原体感染的比例 进行临床治疗(对照)。我们预计这些研究将阐明适当的治疗方法。 针对这种新出现的病原体的治疗方案，以及进一步确定其在非淋菌性尿道炎病原学中的作用。

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.