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We present two cases of men who have sex with men (MSM) in care at the Infectious Diseases Unit, San Raffaele Hospital, Milan diagnosed with multidrug-resistant (MDR) STIs. Both presented with complaints of urethral discharge and were engaged in receptive/insertive sexual intercourse with >10 partners monthly, with seldom condom use.
The first case is an injecting-drug user with history of hepatitis B and C virus coinfection diagnosed in 2013 with ceftriaxone-resistant Neisseria gonorrhoeae (NG) proctitis, and ciprofloxacin-resistant and azithromycin-resistant Ureaplasma urealyticum (UU) and Chlamydia trachomatis (CT) urethritis, concurrent with primary HIV infection. NG proctitis was treated with benzylpenicillin (2.4 million units/week for 3 weeks), given reduced susceptibility, and with azithromycin (2 g); UU/CT urethritis was treated with doxycycline, given resistance to azithromycin.
The second …
Handling editor Anna Maria Geretti
Contributors SN performed medical visits and contributed to the writing of the article. ARR contributed to the writing of the article and collected clinical data. EB and AC contributed to the review of the article. MC performed medical visits. LG collected and analysed clinical data and contributed to the review of the article. FA contributed to the writing of the article. NM coordinated microbiological activities and contributed to the review of the article. All authors have read and agreed to the published version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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