Sex Transm Dis. 2018 Aug;45(8):522-526. doi: 10.1097/OLQ.0000000000000793.
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).
A total of 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 behaviors, 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% had chlamydia (15-27), and 40% had gonococcal monoinfection (32-48), whereas 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]), whereas 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), whereas moxifloxacin subsequently cured 92% (64-100) and pristinamycin cured 79% (54-94) of infections.
M. genitalium was almost as common as chlamydia in men presenting to a sexual health center with symptoms of proctitis. Men with anorectal MG monoinfection were less likely to have symptoms and signs compared with 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 after treatment being essential.
我们报告了单纯由支原体（MG）引起的直肠炎的临床特征，并与衣原体和淋病奈瑟菌进行了比较。我们确定了一线（阿奇霉素）和二线抗菌药物（莫西沙星、壮观霉素）治疗的治愈率。
2012 年至 2016 年，166 名在墨尔本性健康中心就诊的出现直肠炎症状的患者接受了 MG、沙眼衣原体和淋病奈瑟菌检测。记录了人口统计学特征、性行为、临床症状和体征。使用多项多变量逻辑回归来检验检测到的病原体在症状和体征方面的显著差异。
17%的男性有 MG（95%置信区间，12-24），21%有衣原体（15-27），40%有淋球菌单感染（32-48），而 22%有 MG 合并感染（16-29）。与 MG 单感染的男性相比，衣原体单感染的男性报告更多的肛门疼痛（调整后的优势比（aPOR），4.68 [1.41-14.19]），而淋球菌单感染的男性报告更多的肛门疼痛（aPOR，6.75 [2.21-20.55]）和里急后重（aPOR，15.44 [1.62-146.90]），但肛门瘙痒较少（aPOR，0.32 [0.11-0.93]）。阿奇霉素治疗 MG 的微生物治愈率较低，为 35%（22-50），而莫西沙星随后治愈了 92%（64-100）的感染，壮观霉素治愈了 79%（54-94）的感染。
MG 在因直肠炎症状就诊的性健康中心的男性中与衣原体一样常见。直肠炎单纯感染 MG 的男性与单纯感染衣原体或淋病奈瑟菌的男性相比，症状和体征较少。用阿奇霉素治疗有症状的直肠炎单纯感染 MG 的治愈率较低。我们建议在出现直肠炎的情况下常规检测 MG，并在治疗后进行治疗效果检测。
