In the 1990s, quinolones were designated as first line therapy for gonococcal infections in the Netherlands.

Background: Mycoplasma genitalium (MG) is associated with urethritis in men and weakly associated with pelvic inflammatory disease in women. Mycoplasma genitalium coinfections with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are commonly reported; however, little is known about their interaction. One study suggested that MG/NG coinfections might increase the bacterial load of NG, which has been shown to have a higher transmission potential. As even less is known about the impact of a simultaneous MG/CT infection, we assessed whether patients with urogenital MG/CT coinfections have a higher bacterial load than patients with a single infection.Methods: There were 1673 urogenital samples from patients from a population-based chlamydia study, and our sexually transmitted infection clinic tested for both CT and MG. When positive, the load was quantified. Nonparametric tests compared the CT and MG load, and linear regression analyses tested the association of the CT and MG load within a patient. Results:In 60 MG-positive patients, MG load ranged from 1.7 to 6.0 log10 copies/ml, similar to the CT load distribution. Only 6 patients were MG-positive and CT-negative, but the MG load distribution was similar to that of CT-positive patients (n.s.). The MG and CT load was unrelated in coinfected persons (n.s.). Conclusions:We found no correlation between the CT and MG load in urogenital samples, and the MG load distribution was similar in CT-positive and CT-negative patients. These results could have implications for the transmission risk of these infections.

IntroductionAlthough routine diagnostic methods for detection of Chlamydia trachomatis (CT) are based on Nucleic Acid Amplification Tests (NAAT) the detection of antibodies can also be used as an additional tool, especially for surveillance. People with a CT infection develop serum IgG and IgA, which are a marker for past infection and in women are correlated with infertility. Although seroprevalence of CT has been well studied in women, little is known about the seroprevalence of CT in men, especially in the high risk group men who have sex with men (MSM). The aim of this study is to assess the seroprevalence of CT in MSM and the development of seroconversion over time.MethodsA seroprevalence study was conducted in 291 MSM visiting the STI clinic of the Public Health Service South Limburg, the Netherlands, at least twice between January 2011 and December 2013. Sera from the last consultation (T2) were tested for the presence of IgG and IgA (Medac, Germany). Individuals with positive serology at T2 were additionally tested one year before (T1) to determine seroconversion. Prevalence data were calculated from the number of IgG and IgA positive sera at T2 and incidence data were calculated from the seroconversion rates between T1 and T2.ResultsThirty-one percent (n=91/291) of MSM was NAAT CT positive in the study period.In 98% (286/291) MSM sera were available for testing. In total, 32% of MSM (91/286) were IgG positive and 17% were IgA positive (48/286), of which 44 were positive for both. The overall prevalence was 33% based on the presence of IgG and/or IgA antibodies (n=95). Seroconversion rate between T1 and T2 showed that 3,8% (n=11) seroconverted for IgG and 4,5% (n=13) for IgA, of which 1.7% (n=5) seroconverted for both. The overall incidence rate was 6,6% (n=19) based on seroconversion of IgG and/or IgA.ConclusionThis study showed that one third of MSM visiting an STI clinic were seropositive for CT. The incidence rate was about 6%. Association of CT seropositivity with sexual behaviour determinants and actual CT positivity will be further studied.

IntroductionCurrent surveillance of antibiotic resistance in Neisseria gonorrhoeae (NG) relies heavily on the culture of NG. However, culture of NG is challenging due to demanding nutritional and growth requirements of this micro-organism. As a result, surveillance data are limited to only cultured strains while of >50% of Dutch NG positive patients no NG is cultured (data from Dutch Gonococcal Surveillance Program). In this study we compared results from direct detection of mosaic penA with detection of cultured strains to investigate feasibility of direct molecular resistance surveillance.MethodsA convenience sample of 106 NG positive samples of which positive NG culture results were available (46 urine, 9 genital swabs, 35 anorectal swabs and 16 oropharyngeal swabs) were collected between 2013–2015. Presence of mosaic penA was determined by real-time PCR. All positive findings were confirmed with sequencing. MICs on cultured NG were determined using E-tests.ResultsLOD determinations of the in-house mosaic penA PCR in comparison to routine NAAT (using COBAS 4800, Roche Diagnostics) showed that the mosaic penA assay was slightly less sensitive than the commercial NAAT. In samples with very low NG loads, mosaic penA detection might be false-negative. Of 106 NG positive samples, 11 samples showed the presence of mosaic penA (6 urine, 4 oropharyngeal and 1 anorectal swab).Of these 11 samples, NG isolates were re-cultured from 8 samples and all isolates contained the mosaic penA gene. MIC values for ceftriaxone varied between 0.016 and 0.094 mg/L and thus no reduced susceptibility was observed. Although cross-detection with mosaic penA from N. meningitidis is possible, no evidence of this was shown in this study.ConclusionIn conclusion, this study indicates that detection of mosaic penA directly from clinical samples is feasible and that results match detection of penA from clinical isolates obtained from these samples. Direct detection of antibiotic resistance genes would show an insight in resistance surveillance of strains that are not or cannot be cultured.