Pathogens Other Than Chlamydia Linked to Postgonococcal Urethritis
By Megan Rauscher
NEW YORK (Reuters Health) Oct 11 - Urethritis that persists after successful eradication of laboratory-confirmed gonococcal infection (i.e., postgonococcal urethritis) is significantly associated with Mycoplasma genitalium or Ureaplasma urealyticum biovar 2 coinfection, independent of Chlamydia trachomatis infection, Japanese researchers report.
These observations have implications for presumptive therapy, they note in a report in the October 1 issue of Clinical Infectious Diseases.
Among a cohort of 390 men with documented gonorrhea, the researchers found that 33.8% were coinfected with C. trachomatis, M. genitalium, and/or U. urealyticum biovar 2, based on PCR testing of first-voided urine at the initial visit.
Among men who returned for a follow up exam 7 to 10 days after treatment with either a cephalosporin or spectinomycin, gonorrhea was eradicated in 291. However, of these, 104 (35.7%) were found to have postgonococcal urethritis, based on the presence of polymorphonuclear leukocytes in the urethral smear.
In men with Chlamydia-negative gonococcal urethritis, coinfection with M. genitalium was associated with a greater than 14-fold increased risk of postgonococcal urethritis and coinfection with U. urealyticum biovar 2 was associated with about a 3.6-fold greater risk of postgonococcal urethritis.
"In this study, we provide additional data suggesting that M. genitalium and U. urealyticum (biovar 2) may be pathogens of non-gonococcal urethritis, including post-gonococcal urethritis," senior author Dr. Takashi Deguchi, of the Graduate School of Medicine, Gifu University, told Reuters Health.
"In clinical settings, no sensitive and rapid tests for detection of these pathogens are commercially available," Dr. Deguchi pointed out. Therefore, "Patients with gonococcal urethritis should be treated presumptively with antimicrobial agents that are active against C. trachomatis and these pathogens."
The authors of a related commentary point out that the United States and many other countries (excluding Japan) currently recommend presumptive therapy for chlamydial infection for men with gonorrhea.
However, mounting evidence that doxycycline may not be "sufficiently effective" against M. genitalium and U. urealyticum biovar 2 has raised the question of whether azithromycin should be substituted as presumptive therapy for urethritis, Dr. Lisa E. Manhart and colleagues from the University of Washington, Seattle note.
Double-blind, randomized studies are underway to determine which of these drugs is optimal for M. genitalium, U. urealyticum biovar 2, U. parvum, and idiopathic urethritis. Results are expected in 2010.
In the meantime, Dr. Manhart and colleagues say, "the choice of therapy for urethritis must still be individualized, based primarily on considerations of cost to patients and programs, patient preference, and efforts to optimize compliance."
Clin Infect Dis 2007;45:866-874.
This is a part of article Pathogens Other Than Chlamydia Linked to Postgonococcal Urethritis Taken from "Azithromycin Zithromax" Information Blog