Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, Victoria, 3010, Australia.
Sex Transm Dis. 2019 Feb;46(2):73-79. doi: 10.1097/OLQ.0000000000000924.
There are limited published data describing clinical features and therapeutic response in women meeting the criteria for presumptive treatment of pelvic inflammatory disease associated with Mycoplasma genitalium (MG-PID). The MG-PID has been reported to respond poorly to standard PID treatment regimens and while moxifloxacin is recommended in several treatment guidelines, published data to support its use are scant.
We conducted a retrospective study of women at Melbourne Sexual Health Centre between 2006 and 2017, who met the Centers for Disease Control and Prevention criteria for presumptive treatment of PID, and had MG detected as the sole pathogen. Clinical and laboratory characteristics of MG-PID were compared to cases of chlamydial PID (CT-PID) by multivariable analysis. Microbiological and clinical cure following moxifloxacin and standard PID treatment was determined for women with MG-PID who returned for test of cure between 14 and 120 days.
Ninety-two patients with MG-PID were compared with 92 women with CT-PID. The MG-PID was associated with increased lower abdominal tenderness (adjusted odds ratio, 2.29; 95% confidence interval [CI], 1.14-4.60), but a lesser vaginal polymorphonuclear response compared to CT-PID by multivariable analysis. Of the 92 women with MG-PID, 54/92 (59%) received moxifloxacin (10-14 days) and 37/54 had a test of cure between 14 and 120 days; 27/37 (73%) cases had a median of 7 days of a standard regimen containing doxycycline and metronidazole +/- azithromycin before moxifloxacin. Microbial cure following moxifloxacin was 95% (95% CI, 82-99%) and did not differ from standard therapy (P = 0.948), however clinical cure was significantly higher following moxifloxacin (89%; 95% CI, 75-97%; P = 0.004)] although adverse effects were more common.
Women meeting Centers for Disease Control and Prevention criteria for presumptive treatment of MG-PID did not significantly differ to those with CT-PID. Moxifloxacin was associated with higher rates of symptom resolution in women with PID, and although microbial cure was high, it did not differ between regimens.
目前仅有有限的数据描述了符合疑似治疗条件的女性的临床特征和治疗反应，这些女性患有解脲支原体相关盆腔炎（MG-PID）。有报道称，MG-PID 对标准 PID 治疗方案反应不佳，虽然几种治疗指南都推荐使用莫西沙星，但支持其使用的数据却很少。
我们对 2006 年至 2017 年间在墨尔本性健康中心就诊的符合美国疾病控制与预防中心疑似 PID 治疗标准且仅检测到解脲支原体为病原体的女性进行了回顾性研究。采用多变量分析比较 MG-PID 与衣原体 PID（CT-PID）的临床和实验室特征。对 14 至 120 天期间返回进行治愈检测的 MG-PID 女性，比较莫西沙星和标准 PID 治疗后的微生物学和临床治愈情况。
将 92 例 MG-PID 患者与 92 例 CT-PID 患者进行比较。多变量分析显示，MG-PID 与下腹触痛增加相关（调整后的优势比，2.29；95%置信区间[CI]，1.14-4.60），但与 CT-PID 相比，阴道多形核白细胞反应较低。92 例 MG-PID 患者中，54 例（59%）接受了莫西沙星（10-14 天）治疗，其中 37 例（54%）在 14 至 120 天期间进行了治愈检测；37 例中有 27 例（73%）在接受莫西沙星治疗前，先接受了包含多西环素和甲硝唑 +/-阿奇霉素的标准治疗方案，中位数为 7 天。莫西沙星治疗后的微生物学治愈率为 95%（95%CI，82-99%），与标准治疗无差异（P=0.948），但莫西沙星治疗后的临床治愈率明显更高（89%；95%CI，75-97%；P=0.004），尽管不良反应更为常见。
符合美国疾病控制与预防中心疑似治疗标准的 MG-PID 患者与 CT-PID 患者无显著差异。莫西沙星可使 PID 患者的症状缓解率更高，尽管微生物学治愈率高，但两种方案之间无差异。
