Article Text

PDF

O031 Pelvic Inflammatory Disease (PID), Mycoplasma genitalium and macrolide resistance in England
  1. Gillian Dean1,
  2. Jennifer Whetham1,
  3. Suneeta Soni1,
  4. Rachel Pitt2,
  5. Sarah Alexander2
  1. 1Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
  2. 2Sexually transmitted bacteria reference unit (STBRU), PHE, Colindale, London, UK

Abstract

Background/introduction Mycoplasma genitalium (MG) is increasingly implicated in PID pathogenesis with many studies showing MG is as common as chlamydia in high-risk women. Current PID treatment guidelines specify antibiotics with low efficacy against MG. Increasing reports of macrolide resistance suggests first line treatment for MG (azithromycin) may have limitations.

Aim(s)/objectives To document rates of MG in a cohort of women with acute PID, and the proportion with baseline macrolide resistance.

Methods As part of a multicentre, open-label, non-inferiority RCT comparing ofloxacin/metronidazole (arm-1) with azithromycin 1g day-1; 500 mg od day 2–5, metronidazole/ceftriaxone (arm-2), samples were collected for baseline chlamydia, gonorrhoea and mycoplasma infection. Microbiological cure rates were documented at 6–8 weeks. Positive MG specimens were examined for macrolide resistance using a 23S rRNA PCR.

Results 313 women were recruited, median age 25. Preliminary results showed chlamydia was confirmed in 9.5%, MG in 8.2% and gonorrhoea in 0.4%. Of the 16 samples available for resistance testing, 9 (56%) had macrolide resistance mutations (A2058G/T, A2059G/C) at baseline. The reference laboratory received test-of-cure samples for only 8 patients with MG, of which 6 were negative, however 2 remained positive, both with A2059G nucleotide substitutions. Further results will be presented.

Discussion/conclusion MG infection was nearly as common as chlamydia in this cohort. Failure of patients to return at 6–8 weeks affected our ability to properly assess test-of-cure rates. Baseline macrolide resistance was unexpectedly high and impacted negatively on treatment success.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.