ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Challenges in mycoplasma genitalium and rectal chlamydia trachomatis treatment
Rectal chlamydia is the most common STI in MSM.
Rectal chlamydia is more common than urethral.
Observational studies suggest doxycycline is more effective than azithromycin, but there is no evidence from RCTs
There is a move away from azithromycin to doxycycline.
There is much less evidence for mycoplasma genitalium.
M. genitalium was much more common in HIV positive men than HIV negative, accounting for 21% of symptomatic proctitis (as common as chlamydia) compared with 8% symptomatic proctitis in HIV negative MSM.
May be present in 4% asymptomatic MSM rectally.
M. genitalium is present in MSM and may be increasing.
Most are macrolide resistant.
Recommendations exist for urogenital infections, recommending azithromycin first-line, and moxifloxacin as second-line.
Until we have more evidence on how to treat rectal infections we will need to follow the recommendations for urogenital infection.
Third-line treatment is with pristinamycin.
There is a problem using monotherapy in these situations and we are likely to see resistance emerging.
Unfortunately synergy of pristinamycin with other antibiotics hasn’t been good.
Success rates using pristinamycin are about 85%.