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Efficacy of standard therapies against Ureaplasma species and persistence among men with non-gonococcal urethritis enrolled in a randomised controlled trial
  1. Christine M Khosropour1,
  2. Lisa E Manhart1,2,
  3. Catherine W Gillespie1,3,
  4. M Sylvan Lowens4,
  5. Matthew R Golden1,4,5,
  6. Nicole L Jensen5,
  7. George E Kenny5,
  8. Patricia A Totten5
  1. 1Department of Epidemiology, University of Washington, Seattle, WA, USA
  2. 2Department of Global Health, University of Washington, Seattle, WA, USA
  3. 3Children's National Health System, Washington, DC, USA
  4. 4Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA
  5. 5Department of Medicine, University of Washington, Seattle, WA, USA
  1. Correspondence to Dr Lisa E Manhart, UW Center for AIDS and STD, 325 9th Avenue, Seattle, WA 98104, USA; lmanhart{at}u.washington.edu

Abstract

Objective Ureaplasma urealyticum biovar 2 (UU-2), but not Ureaplasma parvum (UP), has been associated with non-gonococcal urethritis (NGU), but little is known about species-specific responses to standard therapies. We examined species-specific treatment outcomes and followed men with treatment failure for 9 weeks.

Methods From May 2007 to July 2011, men aged ≥16 attending a sexually transmitted disease (STD) clinic in Seattle, Washington, with NGU (urethral discharge or urethral symptoms plus ≥5 polymorphonuclear leucocytes /high-powered field) enrolled in a double-blind, randomised trial. Participants received active azithromycin (1 g) + placebo doxycycline or active doxycycline (100 mg twice a day ×7 days) + placebo azithromycin. Ureaplasma were detected in culture followed by species-specific PCR. Outcomes were assessed at 3, 6 and 9 weeks. At 3 weeks, men with persistent Ureaplasma detection received ‘reverse therapy’ (eg, active doxycycline if they first received active azithromycin). At 6 weeks, persistently positive men received moxifloxacin (400 mg×7 days).

Results Of 490 men, 107 (22%) and 60 (12%) were infected with UU-2 and UP, respectively, and returned at 3 weeks. Persistent detection was similar for UU-2-infected men initially treated with azithromycin or doxycycline (25% vs 31%; p=0.53), but differed somewhat for men with UP (45% vs 24%; p=0.11). At 6 weeks, 57% of UU-2-infected and 63% of UP-infected men who received both drugs had persistent detection. Failure after moxifloxacin occurred in 30% and 36%, respectively. Persistent detection of UU-2 or UP was not associated with signs/symptoms of NGU.

Conclusions Persistent detection after treatment with doxycycline, azithromycin and moxifloxacin was common for UU and UP, but not associated with persistent urethritis.

Trial registration number NCT00358462.

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