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Mycoplasma genitalium: update on diagnosis, treatment and resistance
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PATHOLOGY 2015 ABSTRACT SUPPLEMENT
MYCOPLASMA GENITALIUM: UPDATE ON DIAGNOSIS, TREATMENT AND RESISTANCE Sepehr N. Tabrizi Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital; Department of Microbiology, The Royal Children’s Hospital; Department of Obstetrics and Gynaecology, University of Melbourne; Murdoch Childrens Research Institute, Parkville, Vic, Australia Mycoplasma genitalium is a sexually transmitted bacterium and a major causative agent of non-chlamydial non-gonococcal urethritis (NGU) with approximately 20–35% of NGU cases attributed to this infection. In women it has been associated with cervicitis, endometritis, and pelvic inflammatory disease. There are a limited number of commercial nucleic acid amplification assays available for its detection, however none are yet FDA approved and most laboratories are either using these commercial or in-house developed assays to provide diagnostic results. Mycoplasma genitalium infection is primarily treated with macrolide antibiotic azithromycin. However, it has been shown that use of azithromycin in the treatment of NGU and other infections has resulted in increased macrolide resistance, attributed to mutations on the 23S rRNA gene. The currently recommended second line treatment, moxifloxacin, is a fluoroquinolone antibiotic. Moxifloxacin is relatively expensive, can result in side effects and is not suitable in pregnant women, which limits its widespread usage. Resistance to moxifloxacin has also been reported with its increasing use. Detection, appropriate treatment and test of cure of M. genitalium are important in control of this infection.
INTERESTING QA CASES Susan Badman1 and Alison Kesson1,2
Pathology (2015), 47(S1)
1RCPA Quality Assurance Programs Pty Limited, St Leonards, and 2Infectious Diseases and Microbiology, The Children’s
Hospital at Westmead, and Discipline of Paediatrics and Child Health and the Marie Bashir Institute, University of Sydney, NSW, Australia Sexually transmitted infections (STI) are a significant cause of morbidity and some mortality globally. Identification of STIs is important for prevention, treatment and public health. ‘Increases in STI transmissions are a concern in their own right, but also because they can increase the possibility of HIV transmission. Condoms are the best way to reduce the risk of acquiring STIs, however regular comprehensive sexual health testing is also vital, as this is the only way that cases can be diagnosed and the cycle of transmission can be broken.’1 Seventy percent of medical decisions rely on laboratory results.2 The RCPA Quality Assurance Programs Pty Limited (RCPAQAP) offered 45 surveys in 12 modules in 2014 for potentially sexually transmitted infections, and 536 participants enrolled in these modules. RCPAQAP reports enable participants to review the validity of their assay results and identify procedural and technical problems through the comparison of data from other participants performing the same test. Participants receive recommendations with regard to possible reasons for results outside the consensus as well as suggested testing algorithms where appropriate. Multiple surveys throughout the year facilitate trend analysis for ongoing monitoring of performance in testing for STIs.3 References 1. ACON responds to latest NSW HIV and STI data. 18 Sep 2014; cited 18 Nov 2014. http://www.acon.org.au/about-acon/Newsroom/Media-Releases/ 2014/107. 2. Know pathology know healthcare. Cited 18 Nov 2014. http://knowpatho logy.com.au/. 3. Denham I, Bowden F. Genital and sexually transmitted infections. In: Yung A, McDonald M, Spelman D, et al., editors. Infectious Diseases a Clinical Approach. 2nd ed. Melbourne: IP Communications, 2005; 372–88.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
PATHOLOGY 2015 ABSTRACT SUPPLEMENT
MYCOPLASMA GENITALIUM: UPDATE ON DIAGNOSIS, TREATMENT AND RESISTANCE Sepehr N. Tabrizi Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital; Department of Microbiology, The Royal Children’s Hospital; Department of Obstetrics and Gynaecology, University of Melbourne; Murdoch Childrens Research Institute, Parkville, Vic, Australia Mycoplasma genitalium is a sexually transmitted bacterium and a major causative agent of non-chlamydial non-gonococcal urethritis (NGU) with approximately 20–35% of NGU cases attributed to this infection. In women it has been associated with cervicitis, endometritis, and pelvic inflammatory disease. There are a limited number of commercial nucleic acid amplification assays available for its detection, however none are yet FDA approved and most laboratories are either using these commercial or in-house developed assays to provide diagnostic results. Mycoplasma genitalium infection is primarily treated with macrolide antibiotic azithromycin. However, it has been shown that use of azithromycin in the treatment of NGU and other infections has resulted in increased macrolide resistance, attributed to mutations on the 23S rRNA gene. The currently recommended second line treatment, moxifloxacin, is a fluoroquinolone antibiotic. Moxifloxacin is relatively expensive, can result in side effects and is not suitable in pregnant women, which limits its widespread usage. Resistance to moxifloxacin has also been reported with its increasing use. Detection, appropriate treatment and test of cure of M. genitalium are important in control of this infection.
INTERESTING QA CASES Susan Badman1 and Alison Kesson1,2
Pathology (2015), 47(S1)
1RCPA Quality Assurance Programs Pty Limited, St Leonards, and 2Infectious Diseases and Microbiology, The Children’s
Hospital at Westmead, and Discipline of Paediatrics and Child Health and the Marie Bashir Institute, University of Sydney, NSW, Australia Sexually transmitted infections (STI) are a significant cause of morbidity and some mortality globally. Identification of STIs is important for prevention, treatment and public health. ‘Increases in STI transmissions are a concern in their own right, but also because they can increase the possibility of HIV transmission. Condoms are the best way to reduce the risk of acquiring STIs, however regular comprehensive sexual health testing is also vital, as this is the only way that cases can be diagnosed and the cycle of transmission can be broken.’1 Seventy percent of medical decisions rely on laboratory results.2 The RCPA Quality Assurance Programs Pty Limited (RCPAQAP) offered 45 surveys in 12 modules in 2014 for potentially sexually transmitted infections, and 536 participants enrolled in these modules. RCPAQAP reports enable participants to review the validity of their assay results and identify procedural and technical problems through the comparison of data from other participants performing the same test. Participants receive recommendations with regard to possible reasons for results outside the consensus as well as suggested testing algorithms where appropriate. Multiple surveys throughout the year facilitate trend analysis for ongoing monitoring of performance in testing for STIs.3 References 1. ACON responds to latest NSW HIV and STI data. 18 Sep 2014; cited 18 Nov 2014. http://www.acon.org.au/about-acon/Newsroom/Media-Releases/ 2014/107. 2. Know pathology know healthcare. Cited 18 Nov 2014. http://knowpatho logy.com.au/. 3. Denham I, Bowden F. Genital and sexually transmitted infections. In: Yung A, McDonald M, Spelman D, et al., editors. Infectious Diseases a Clinical Approach. 2nd ed. Melbourne: IP Communications, 2005; 372–88.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.