Skip to main content
Top
Published in: BMC Infectious Diseases 1/2021

Open Access 01-12-2021 | Doxycycline | Research article

Evaluation of treatment with two weeks of doxycycline on macrolide-resistant strains of Mycoplasma genitalium: a retrospective observational study

Authors: M. Gossé, S. A. Nordbø, B. Pukstad

Published in: BMC Infectious Diseases | Issue 1/2021

Login to get access

Abstract

Background

Increasing macrolide resistance makes treatment of Mycoplasma genitalium infections challenging. The second-line treatment is moxifloxacin, an antibiotic drug best avoided due to the potential of severe side effects and interactions. This study evaluates the effects of treatment with doxycycline 100 mg twice daily for 2 weeks as an alternative to moxifloxacin.

Methods

This retrospective observational study examined the medical records of patients testing positive for macrolide resistant Mycoplasma genitalium from January 1st, 2016 to September 1st, 2019 in Trondheim, Norway. Information regarding symptoms as well as clinical and microbiological cure was collected.

Results

263 infections from 259 patients (161 females/98 males) were examined. 155 (58.9%) had a negative test of cure following treatment. 34.7% of symptomatic patients not achieving microbiological cure experienced symptom relief or clearance. There was no statistical difference between bacterial loads in symptomatic versus asymptomatic patients. The mean difference was 1.6 × 105 copies/ml (95% CI − 1.4 × 105–4.8 × 105, p = 0.30) for women and 1.4 × 106 copies/ml (95% CI -4.0 × 105–3.2 × 106, p = 0.12) for men.

Conclusions

The cure rate of doxycycline in this study is higher than previously reported. This adds support to doxycycline’s role in treatment before initiating treatment with less favorable drugs such as moxifloxacin.
Literature
2.
go back to reference Wiesenfeld HC, Manhart LE. Mycoplasma genitalium in women: current knowledge and research priorities for this recently emerged pathogen. J Infect Dis. 2017;216(suppl_2):389–95.CrossRef Wiesenfeld HC, Manhart LE. Mycoplasma genitalium in women: current knowledge and research priorities for this recently emerged pathogen. J Infect Dis. 2017;216(suppl_2):389–95.CrossRef
3.
go back to reference Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61(3):418–26.CrossRef Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61(3):418–26.CrossRef
5.
go back to reference Jensen JS, Bradshaw CS, Tabrizi SN, Fairley CK, Hamasuna R. Azithromycin treatment failure in Mycoplasma genitalium-positive patients with nongonococcal urethritis is associated with induced macrolide resistance. Clin Infect. 2008;47(12):1546–53.CrossRef Jensen JS, Bradshaw CS, Tabrizi SN, Fairley CK, Hamasuna R. Azithromycin treatment failure in Mycoplasma genitalium-positive patients with nongonococcal urethritis is associated with induced macrolide resistance. Clin Infect. 2008;47(12):1546–53.CrossRef
6.
go back to reference Horner P, Ingle SM, Garrett F, Blee K, Kong F, Muir P, Moi H. Which azithromycin regimen should be used for treating Mycoplasma genitalium? A meta-analysis. Sex Transm Infect. 2018;94(1):14–20.CrossRef Horner P, Ingle SM, Garrett F, Blee K, Kong F, Muir P, Moi H. Which azithromycin regimen should be used for treating Mycoplasma genitalium? A meta-analysis. Sex Transm Infect. 2018;94(1):14–20.CrossRef
7.
go back to reference Lau A, Bradshaw CS, Lewis D, Fairley CK, Chen MY, Kong FY, Hocking JS. The efficacy of azithromycin for the treatment of genital Mycoplasma genitalium: a systematic review and meta-analysis. Clin Infect Dis. 2015;61(9):1389–99.CrossRef Lau A, Bradshaw CS, Lewis D, Fairley CK, Chen MY, Kong FY, Hocking JS. The efficacy of azithromycin for the treatment of genital Mycoplasma genitalium: a systematic review and meta-analysis. Clin Infect Dis. 2015;61(9):1389–99.CrossRef
8.
go back to reference Murray GL, Bradshaw CS, Bissessor M, Danielewski J, Garland SM, Jensen JS, Fairley CK, Tabrizi SN. Increasing macrolide and fluoroquinolone resistance in Mycoplasma genitalium. Emerg Infect Dis. 2017;23(5):809–12.CrossRef Murray GL, Bradshaw CS, Bissessor M, Danielewski J, Garland SM, Jensen JS, Fairley CK, Tabrizi SN. Increasing macrolide and fluoroquinolone resistance in Mycoplasma genitalium. Emerg Infect Dis. 2017;23(5):809–12.CrossRef
11.
go back to reference Tagg KA, Jeoffreys NJ, Couldwell DL, Donald JA, Gilbert GL. Fluoroquinolone and macrolide resistance-associated mutations in Mycoplasma genitalium. J Clin Microbiol. 2013;51(7):2245–9.CrossRef Tagg KA, Jeoffreys NJ, Couldwell DL, Donald JA, Gilbert GL. Fluoroquinolone and macrolide resistance-associated mutations in Mycoplasma genitalium. J Clin Microbiol. 2013;51(7):2245–9.CrossRef
12.
go back to reference Kikuchi M, Ito S, Yasuda M, Tsuchiya T, Hatazaki K, Takanashi M, Ezaki T, Deguchi T. Remarkable increase in fluoroquinolone-resistant Mycoplasma genitalium in Japan. J Antimicrob Chemother. 2014;69(9):2376–82.CrossRef Kikuchi M, Ito S, Yasuda M, Tsuchiya T, Hatazaki K, Takanashi M, Ezaki T, Deguchi T. Remarkable increase in fluoroquinolone-resistant Mycoplasma genitalium in Japan. J Antimicrob Chemother. 2014;69(9):2376–82.CrossRef
13.
go back to reference Fernandez-Huerta M, Barbera MJ, Serra-Pladevall J, Esperalba J, Martinez-Gomez X, Centeno C, Pich OQ, Pumarola T, Espasa M. Mycoplasma genitalium and antimicrobial resistance in Europe: a comprehensive review. Int J STD AIDS. 2020;31(3):190–7.CrossRef Fernandez-Huerta M, Barbera MJ, Serra-Pladevall J, Esperalba J, Martinez-Gomez X, Centeno C, Pich OQ, Pumarola T, Espasa M. Mycoplasma genitalium and antimicrobial resistance in Europe: a comprehensive review. Int J STD AIDS. 2020;31(3):190–7.CrossRef
14.
go back to reference Unemo M, Salado-Rasmussen K, Hansen M, Olsen AO, Falk M, Golparian D, Aasterod M, Ringlander J, Nilsson CS, Sundqvist M, et al. Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 2016. Clin Microbiol Infect. 2018;24(5):533–9.CrossRef Unemo M, Salado-Rasmussen K, Hansen M, Olsen AO, Falk M, Golparian D, Aasterod M, Ringlander J, Nilsson CS, Sundqvist M, et al. Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 2016. Clin Microbiol Infect. 2018;24(5):533–9.CrossRef
15.
go back to reference Li Y, Le WJ, Li S, Cao YP, Su XH. Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection. Int J STD AIDS. 2017;28(11):1106–14.CrossRef Li Y, Le WJ, Li S, Cao YP, Su XH. Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection. Int J STD AIDS. 2017;28(11):1106–14.CrossRef
16.
go back to reference Peyriere H, Makinson A, Marchandin H, Reynes J. Doxycycline in the management of sexually transmitted infections. J Antimicrob Chemother. 2018;73(3):553–63.PubMed Peyriere H, Makinson A, Marchandin H, Reynes J. Doxycycline in the management of sexually transmitted infections. J Antimicrob Chemother. 2018;73(3):553–63.PubMed
17.
go back to reference Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect. 2009;48(12):1649–54.CrossRef Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect. 2009;48(12):1649–54.CrossRef
18.
go back to reference Manhart LE, Gillespie CW, Lowens MS, Khosropour CM, Colombara DV, Golden MR, Hakhu NR, Thomas KK, Hughes JP, Jensen NL, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect. 2013;56(7):934–42.CrossRef Manhart LE, Gillespie CW, Lowens MS, Khosropour CM, Colombara DV, Golden MR, Hakhu NR, Thomas KK, Hughes JP, Jensen NL, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect. 2013;56(7):934–42.CrossRef
19.
go back to reference Schwebke JR, Rompalo A, Taylor S, Sena AC, Martin DH, Lopez LM, Lensing S, Lee JY. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens—a randomized clinical trial. Clin Infect Dis. 2011;52(2):163–70.CrossRef Schwebke JR, Rompalo A, Taylor S, Sena AC, Martin DH, Lopez LM, Lensing S, Lee JY. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens—a randomized clinical trial. Clin Infect Dis. 2011;52(2):163–70.CrossRef
20.
go back to reference Anagrius C, Lore B, Jensen JS. Treatment of Mycoplasma genitalium. Observations from a Swedish STD clinic. PLoS ONE. 2013;8(4): e61481.CrossRef Anagrius C, Lore B, Jensen JS. Treatment of Mycoplasma genitalium. Observations from a Swedish STD clinic. PLoS ONE. 2013;8(4): e61481.CrossRef
21.
go back to reference Read TRH, Fairley CK, Murray GL, Jensen JS, Danielewski J, Worthington K, Doyle M, Mokany E, Tan L, Chow EPF, et al. Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation. Clin Infect Dis. 2019;68(4):554–60.CrossRef Read TRH, Fairley CK, Murray GL, Jensen JS, Danielewski J, Worthington K, Doyle M, Mokany E, Tan L, Chow EPF, et al. Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation. Clin Infect Dis. 2019;68(4):554–60.CrossRef
22.
go back to reference Durukan D, Read TRH, Murray G, Doyle M, Chow EPF, Vodstrcil LA, Fairley CK, Aguirre I, Mokany E, Tan LY, et al. Resistance-guided antimicrobial therapy using doxycycline-moxifloxacin and doxycycline-2.5g azithromycin for the treatment of Mycoplasma genitalium infection: efficacy and tolerability. Clin Infect Dis. 2019. https://doi.org/10.1093/cid/ciz1031.CrossRef Durukan D, Read TRH, Murray G, Doyle M, Chow EPF, Vodstrcil LA, Fairley CK, Aguirre I, Mokany E, Tan LY, et al. Resistance-guided antimicrobial therapy using doxycycline-moxifloxacin and doxycycline-2.5g azithromycin for the treatment of Mycoplasma genitalium infection: efficacy and tolerability. Clin Infect Dis. 2019. https://​doi.​org/​10.​1093/​cid/​ciz1031.CrossRef
25.
go back to reference Gosse M, Lysvand H, Pukstad B, Nordbo SA. A novel simpleprobe PCR assay for detection of mutations in the 23S rRNA gene associated with macrolide resistance in Mycoplasma genitalium in clinical samples. J Clin Microbiol. 2016;54(10):2563–7.CrossRef Gosse M, Lysvand H, Pukstad B, Nordbo SA. A novel simpleprobe PCR assay for detection of mutations in the 23S rRNA gene associated with macrolide resistance in Mycoplasma genitalium in clinical samples. J Clin Microbiol. 2016;54(10):2563–7.CrossRef
26.
go back to reference Van Doorslaer X, Dewulf J, Van Langenhove H, Demeestere K. Fluoroquinolone antibiotics: an emerging class of environmental micropollutants. Sci Total Environ. 2014;500–501:250–69.CrossRef Van Doorslaer X, Dewulf J, Van Langenhove H, Demeestere K. Fluoroquinolone antibiotics: an emerging class of environmental micropollutants. Sci Total Environ. 2014;500–501:250–69.CrossRef
27.
go back to reference Read TRH, Jensen JS, Fairley CK, Grant M, Danielewski JA, Su J, Murray GL, Chow EPF, Worthington K, Garland SM, et al. Use of Pristinamycin for macrolide-resistant Mycoplasma genitalium infection. Emerg Infect Dis. 2018;24(2):328–35.CrossRef Read TRH, Jensen JS, Fairley CK, Grant M, Danielewski JA, Su J, Murray GL, Chow EPF, Worthington K, Garland SM, et al. Use of Pristinamycin for macrolide-resistant Mycoplasma genitalium infection. Emerg Infect Dis. 2018;24(2):328–35.CrossRef
28.
go back to reference Guschin A, Ryzhikh P, Rumyantseva T, Gomberg M, Unemo M. Treatment efficacy, treatment failures and selection of macrolide resistance in patients with high load of Mycoplasma genitalium during treatment of male urethritis with josamycin. BMC Infect Dis. 2015;15:40.CrossRef Guschin A, Ryzhikh P, Rumyantseva T, Gomberg M, Unemo M. Treatment efficacy, treatment failures and selection of macrolide resistance in patients with high load of Mycoplasma genitalium during treatment of male urethritis with josamycin. BMC Infect Dis. 2015;15:40.CrossRef
29.
go back to reference Huang C, Zhu HL, Xu KR, Wang SY, Fan LQ, Zhu WB. Mycoplasma and ureaplasma infection and male infertility: a systematic review and meta-analysis. Andrology. 2015;3(5):809–16.CrossRef Huang C, Zhu HL, Xu KR, Wang SY, Fan LQ, Zhu WB. Mycoplasma and ureaplasma infection and male infertility: a systematic review and meta-analysis. Andrology. 2015;3(5):809–16.CrossRef
30.
go back to reference Alfarraj DA, Somily AM. Isolation of Mycoplasma genitalium from endocervical swabs of infertile women. Saudi Med J. 2017;38(5):549–52.CrossRef Alfarraj DA, Somily AM. Isolation of Mycoplasma genitalium from endocervical swabs of infertile women. Saudi Med J. 2017;38(5):549–52.CrossRef
31.
go back to reference Bjornelius E, Anagrius C, Bojs G, Carlberg H, Johannisson G, Johansson E, Moi H, Jensen JS, Lidbrink P. Antibiotic treatment of symptomatic Mycoplasma genitalium infection in Scandinavia: a controlled clinical trial. Sex Transm Infect. 2008;84(1):72–6.CrossRef Bjornelius E, Anagrius C, Bojs G, Carlberg H, Johannisson G, Johansson E, Moi H, Jensen JS, Lidbrink P. Antibiotic treatment of symptomatic Mycoplasma genitalium infection in Scandinavia: a controlled clinical trial. Sex Transm Infect. 2008;84(1):72–6.CrossRef
32.
go back to reference Vandepitte J, Weiss HA, Kyakuwa N, Nakubulwa S, Muller E, Buve A, Van der Stuyft P, Hayes R, Grosskurth H. Natural history of Mycoplasma genitalium infection in a cohort of female sex workers in Kampala, Uganda. Sex Transm Dis. 2013;40(5):422–7.CrossRef Vandepitte J, Weiss HA, Kyakuwa N, Nakubulwa S, Muller E, Buve A, Van der Stuyft P, Hayes R, Grosskurth H. Natural history of Mycoplasma genitalium infection in a cohort of female sex workers in Kampala, Uganda. Sex Transm Dis. 2013;40(5):422–7.CrossRef
Metadata
Title
Evaluation of treatment with two weeks of doxycycline on macrolide-resistant strains of Mycoplasma genitalium: a retrospective observational study
Authors
M. Gossé
S. A. Nordbø
B. Pukstad
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-021-06910-1

Other articles of this Issue 1/2021

BMC Infectious Diseases 1/2021 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.