Clinical characteristics of anorectal Mycoplasma genitalium infection and microbial cure in men who have sex with men.

Ong, JJ; Aung, E; Read, TRH; Fairley, CK; Garland, SM; Murray, G; Chen, MY; Chow, EPF; Bradshaw, CS; (2018) Clinical characteristics of anorectal Mycoplasma genitalium infection and microbial cure in men who have sex with men. Sexually transmitted diseases. ISSN 0148-5717 DOI:

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We report clinical characteristics of proctitis caused solely by Mycoplasma genitalium(MG), compared with chlamydia and gonococcus. We determined the proportions cured with first-line (azithromycin) and second-line antimicrobials (moxifloxacin, pristinamycin). 166 patients attending Melbourne Sexual Health Centre from 2012 to 2016 with symptoms of proctitis were tested for MG, Chlamydia trachomatis and Neisseria gonorrhoeae. Demographic characteristics, sexual behaviours, clinical symptoms and signs were recorded. Multinomial multivariable logistic regression was used to test for significant differences in symptoms and signs for the pathogens detected. Seventeen percent of men had MG (95% confidence interval [12-24]), 21% chlamydia [15-27], and 40% gonococcal monoinfection [32-48], whilst 22% had MG coinfection [16-29]. Relative to men with MG monoinfection, those with chlamydial monoinfection reported more anal pain (adjusted prevalence odds ratio(aPOR) 4.68, [1.41-14.19]), while men with gonococcal monoinfection reported more anal pain (aPOR 6.75, [2.21-20.55]) and tenesmus (aPOR 15.44, [1.62-146.90]), but less anal itch (aPOR 0.32, [0.11-0.93]). The microbiological cure for MG using azithromycin was low at 35% [22-50], while moxifloxacin subsequently cured 92% [64-100], and pristinamycin 79% [54-94] of infections. MG was almost as common as chlamydia in men presenting to a sexual health centre with symptoms of proctitis. Men with anorectal MG monoinfection were less likely to have symptoms and signs compared to those with chlamydia or gonococcus monoinfection. Cure for men with symptomatic anorectal MG by azithromycin was low. We suggest routine testing for MG in cases of proctitis, with test of cure following treatment being essential.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 29465653

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