Evaluation of Clinical, Gram Stain, and Microbiological Cure Outcomes in Men Receiving Azithromycin for Acute Nongonococcal Urethritis: Discordant Cures Are Associated With Mycoplasma genitalium Infection

Abstract

Resolution of nongonococcal urethritis signs and symptoms does not always correlate with microbiological cure; discordant cures occur in one third of men. Clinical cure accurately correlates with Gram stain and microbiological cure for NGU bacterial pathogens, except Mycoplasma genitalium.

Sexually transmitted pathogens causing urethritis: A mini-review and proposal of a clinically based diagnostic and therapeutic algorithm

“…They observed that clinical cure (loss of symptoms) predicted microbiological cure (Test of cure via NAATs) for those infected with CT, UU, and TV. However, that was not the case for MG, as microbiological failure has been observed in men who experienced clinical cures (21). Macrolide-resistant MG infections were highly linked to microbiological failure (21).…”

“…However, that was not the case for MG, as microbiological failure has been observed in men who experienced clinical cures (21). Macrolide-resistant MG infections were highly linked to microbiological failure (21). The authors, therefore, concluded that in azithromycin-treated MG-NGU infected men, the microbiological cure must be gained, at least in those settings where macrolide resistance cannot be tested (21).…”

“…Macrolide-resistant MG infections were highly linked to microbiological failure (21). The authors, therefore, concluded that in azithromycin-treated MG-NGU infected men, the microbiological cure must be gained, at least in those settings where macrolide resistance cannot be tested (21). Interestingly, until today, no one has investigated NGU outcomes according to the new CDC recommendations in the United States.…”

“…Men who are infected with MG should abstain from sexual intercourse until after they (and their sexual partners) complete treatment, have no more symptoms, and have a negative TOC (3-5 weeks after the end of treatment) (27). In the case of azithromycin-treated MG-NGU cases, Toh et al observed that 1-week abstinence seems to be insufficient and recommended a test of cure be performed in (probably) all MG-infected patients (21). They, moreover, recommend abstinence from unprotected sex until a test of cure, to avoid MG transmission (21).…”

“…In the case of azithromycin-treated MG-NGU cases, Toh et al observed that 1-week abstinence seems to be insufficient and recommended a test of cure be performed in (probably) all MG-infected patients (21). They, moreover, recommend abstinence from unprotected sex until a test of cure, to avoid MG transmission (21). CDC does not recommend TOC in those who are asymptomatic and received a recommended CDC treatment regimen (6).…”