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O30 Treatment failure in mycoplasma genitalium among gum clinic attendees
  1. Katie Ovens1,
  2. Elizabeth Cross1,
  3. Lucinda Rickwood2,
  4. John Reynolds-Wright3,
  5. Mohammed Osman Hassan-Ibrahim4,
  6. Suneeta Soni1
  1. 1Department GUM/HIV, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  2. 2Brighton and Sussex Medical School, Brighton, UK
  3. 3St John’s Hospital, NHS Lothian, NHS Scotland, Edinburgh, UK
  4. 4Department of Microbiology/Virology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

Abstract

Introduction Macrolide resistance in Mycoplasma genitalium(MG) is of growing concern in countries where azithromycin is used to treat non-gonococcal urethritis(NGU) but UK data is lacking. Patients with NGU or pelvic inflammatory disease (PID) are routinely tested for MG at our clinic and offered test of cure (TOC) 4 weeks post-treatment. We aim to determine rates of MG-positivity 4 weeks after treatment and their associations.

Methods Notes of MG-positive cases between December 2015 and November 2016 were reviewed and data collected on management.

Results 114 cases of MG were identified. 91(80%) were symptomatic and 12(11%) were MG contacts. Should be 52/339(15%) men with NGU and 15/160(9.4%) women with PID were MG-positive.

80/114(78%) were given an azithromycin regimen first line. 59/114(53%) returned for TOC and 24/59(40%) were positive (23 following azithromycin; 1 following moxifloxacin). 19 returned for a second TOC and 14 were negative (1 following azithromycin and 13 following moxifloxacin second line). 5/19(26%) were positive (3 following azithromycin and 2 following moxifloxacin second line). One male patient with confirmed resistance to macrolide and quinolone therapy achieved microbiological cure with pristinamycin.

Having a positive TOC was significantly associated with risk of reinfection (p=0.01) and being symptomatic at TOC (p<0.001), but not significantly associated with gender, sexual orientation, HIV status, concurrent STI (p=0.053) and azithromycin use.

Discussion MG-positivity rates at 4 week TOC are high raising concerns of treatment failure although re-infection may also contribute. As commercial assays are imminently available, diagnoses of MG will increase and where possible should be accompanied by antimicrobial resistance testing.

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