TABLE 3.
Clinical management of 4 patients with M. genitalium FQr and AZra
| Parameter | Result for patient |
|||
|---|---|---|---|---|
| Male, 29 yr old | Male, 52 yr old | Male, 52 yr old | Male, 41 yr old | |
| Symptom(s) on presentation | Urethral discharge | Urethral discharge, penile pain | Dysuria, aching testicles | Urethral discharge |
| C. trachomatis/Neisseria gonorrhoeae result | ND | ND | ND | ND |
| Initial treatment | Amoxicillin, 500 mg t.d.s. for 1 wk | Azithromycin, 1 g stat | Azithromycin, 1 g stat | Doxycycline, 100 mg b.i.d. for 7 days |
| M. genitalium/Trichomonas vaginalis result | M. genitalium detected, T. vaginalis ND | M. genitalium detected, T. vaginalis ND | M. genitalium detected, T. vaginalis ND | M. genitalium detected, T. vaginalis ND |
| 1st treatment for M. genitaliumb | Extended course of azithromycin | Extended course of azithromycin | Extended course of azithromycin | Azithromycin, 1 g stat |
| TOC | M. genitalium detected | M. genitalium detected | M. genitalium detected | M. genitalium detected |
| M. genitalium AZr | A2058G | A2059G | A2058G | A2058G |
| Symptom(s) at 1st follow-up | Continued discharge 2 wk postdiagnosis | Improved, no discharge, but abnormal penile sensation | Asymptomatic | Ongoing symptoms |
| 2nd treatmentc | Moxifloxacin | Moxifloxacin | Moxifloxacin | Moxifloxacin |
| Symptom(s) at 2nd follow-up | Asymptomatic | Abnormal penile sensation | Dysuria, aching testicles | Urethral discharge |
| TOC | 3 wk posttreatment, M. genitalium detected | 1 mo post-1st treatment, M. genitalium detected | 4 mo post-1st treatment, M. genitalium detected | 1 mo post-1st treatment, M. genitalium detected |
| M. genitalium FQr | gyrB(R464K) parC(S83R) | gyrB(R464K) parC(S83I) | parC(S83R) | parC(S83I) |
| TOC | 2 wk later, M. genitalium detected | 1 mo post-2nd treatment, M. genitalium detected | 1 mo post-2nd treatment, M. genitalium detected | 1.5 mo post-2nd treatment, M. genitalium detected |
| 3rd treatmentd | Pristinamycin | Pristinamycin | Pristinamycin | Pristinamycin |
| Final TOC | M. genitalium ND | M. genitalium ND | M. genitalium ND | M. genitalium ND |
| Duratione | 187 days | 124 days | 295 days | 165 days |
a
Abbreviations: ND, not detected; t.d.s, 3 times a day; stat, at once; b.i.d., twice a day; TOC, test of cure; AZr, macrolide (azithromycin) resistance; FQr, fluoroquinolone resistance.
b
The extended course represents 500 mg azithromycin stat followed by 250 mg daily for 4 days.
c
The moxifloxacin treatment was 400 mg daily for 7 days.
d
The pristinamycin treatment was 1 g t.d.s. plus 100 mg doxycycline b.i.d. for 10 days.
e
Duration from first presentation including primary care.