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.
Mycoplasma genitalium: an unknown agent.
My focus today was on Mycoplasma Genitalium as it has been a topic of many discussions recently.
Several presenters discussed this topic
Dr Catriona Bradshaw, Melbourne Sexual Health
Dr Jorgen Jensen, Statens Serum Institute, Copenhagen
Prof. Charlotte Gaydos, John Hopkins Centre
Dr Lisa Manhart, University of Washington
Mycoplasma Genitalium (MG) causes symptoms similar to C. Trachomatis & N. Gonorrhoea
Sequelae in women include pelvic inflammatory disease, spontaneous abortion, preterm birth and infertility.
Diagnosis is limited to NAAT as culture lacks sensitivity and takes a long time. It is however recommended that NAAT testing should include resistance assay.
First line treatment regimes have included azithromycin and doxycycline, individually or in varying combinations, but doxycycline has a low efficacy rate and macrolide resistance has developed after 20 years use of azithromycin for other STI's.
Moxifloxacin has been used as second line treatment but the past 10 years has seen emerging failure rates in some countries with rates as high as 15% in Asia-Pacific regions. Recent warnings from FDA and Europe, high cost and side effects make this option unpopular.
Funding for testing and trials of new classes of antmicrobials include
The emergence of dual class resistance to both macrolides and quinolones means there is no highly effective class of antimicrobials currently available to treat MG.
Prof. Basil Donovan from the Kirby Institute Sydney in his discussion of treatment of chlamydia, advocates for alternatives to azithromycin. This concerns me, as my experience in a sexual health clinic is that poor compliance is a major factor for using single dose treatments. I hope that new antimicrobial treatments will include single dose.