Department of Epidemiology, University of Washington, Seattle.
Center for AIDS and STD, University of Washington, Seattle.
Clin Infect Dis. 2019 Jun 18;69(1):113-120. doi: 10.1093/cid/ciy843.
Although Mycoplasma genitalium (MG) is an acknowledged cause of nongonococcal urethritis (NGU), access to diagnostic testing is limited. Syndromic management is common, yet little is known about natural history.
Between August 2014 and April 2016, 13 heterosexual men aged ≥16 years with MG were identified within a cohort study of men with and without NGU attending an urban sexually transmitted diseases clinic. Men had 6-7 monthly visits. NGU was defined as ≥5 polymorphonuclear leukocytes per high-power field on urethral Gram stain plus either visible urethral discharge or urethral symptoms. Men with NGU received 1 g of azithromycin. Men with persistent NGU received moxifloxacin 400 mg for 14 days. First-void urine was retrospectively tested for MG using transcription-mediated amplification. Resistance-associated mutations were detected by polymerase chain reaction (PCR) and sequencing. Organism load was determined by quantitative PCR.
Sixty-two percent of MG-positive men had macrolide resistance-mediating mutations (MRMM) at enrollment; 31% had parC mutations (all outside the quinolone resistance-determining region). MG persisted after azithromycin in 7 men, 6 of whom had MRMM. The median duration of persistence in the absence of curative therapy was 143 days (range, 21-228). Five men experienced symptom resolution after azithromycin, but MG persisted for another 89-186 days before moxifloxacin. Organism load was somewhat lower in MRMM than wild-type infections (P = .16).
The high prevalence of macrolide resistance and long duration of infection after symptom resolution highlights the need for diagnostic MG testing of men with NGU to direct therapy.
虽然支原体生殖器（MG）是公认的非淋球菌性尿道炎（NGU）的病因，但诊断检测的可及性有限。综合征管理很常见，但对其自然史知之甚少。
在 2014 年 8 月至 2016 年 4 月期间，在一项针对患有和不患有 NGU 的男性的队列研究中，在一家城市性传播疾病诊所中发现了 13 名年龄≥16 岁的异性恋男性患有 MG。男性有 6-7 次每月就诊。NGU 的定义是尿道革兰氏染色每高倍镜视野中≥5 个多形核白细胞，加上可见尿道分泌物或尿道症状。患有 NGU 的男性接受 1 克阿奇霉素治疗。持续患有 NGU 的男性接受莫西沙星 400 毫克治疗 14 天。使用转录介导扩增法对首次尿液进行 MG 的回顾性检测。通过聚合酶链反应（PCR）和测序检测耐药相关突变。通过定量 PCR 确定病原体负荷。
62%的 MG 阳性男性在入组时具有大环内酯类耐药中介突变（MRMM）；31%的人具有 parC 突变（均在喹诺酮类耐药决定区之外）。7 名男性在阿奇霉素治疗后 MG 持续存在，其中 6 名男性具有 MRMM。在没有治疗的情况下，持续存在的中位数持续时间为 143 天（范围，21-228 天）。5 名男性在阿奇霉素治疗后症状缓解，但在莫西沙星之前 MG 又持续了 89-186 天。MRMM 感染的病原体负荷略低于野生型感染（P =.16）。
大环内酯类耐药的高患病率和症状缓解后感染持续时间长，突出表明需要对患有 NGU 的男性进行 MG 诊断检测，以指导治疗。
