Sitafloxacin therapy for mycoplasma genitalium in men who have sex with men
BACKGROUND: Mycoplasma genitalium infection has been recognized as an alarming STI in recent years. Reportedly, 89.6% and 68.3% of the strains detected in Japan carried mutations associated with macrolide and quinolone respectively. Due to these high rates of macrolide-resistance strains, sitafloxacin monotherapy is used as the first choice for treating M. genitalium infections in Japan. In this study, we aimed to assess the efficacy of sitafloxacin monotherapy for rectal and urogenital M. genitalium infection.
METHODS: Patients diagnosed with M. genitalium infections in National Center for Global Health and Medicine between 2019 and 2021 were treated with sitafloxacin 200 mg for 7 days. A rectal swabs and/or urine sample were collected for assessing quinolone- and macrolide-resistance associated mutations(parC, gyrA and 23S-rRNA) before treatment. Test of cure was recommended at approximately four weeks post-treatment.
RESULTS: Among 114 patients included in this study, the mean age was 34 year-old, all were MSM, and 49.0% were HIV-positive. M. genitalium was detected in 91 rectal samples and 24 urine samples were observed. Among the strains diagnosed with M. genitalium, 70.3%(78/111) were successfully analyzed for parC mutations, 59.5%(66/111) for gyrA mutations and 78.4%(87/111) for 23S-rRNA mutations. Microbiological cure rate of whole strains was 88.6%(101/114). That of the strains carrying S83I was 80.0%(44/55). Among them, the rate of the strains carrying S83IwithoutgyrA mutations was 90.3%(28/31). The cure rate of the wild type strains was 100% (15/15). There was no significant difference in cure rate by anatomical site.
| ParCmutation (AAA) | Cure rate for each parCmutated MG infection | GyrAmutation(AAA) | Cure rate for combined parC and gyrA mutated MG infection | Cure rate for rectal MG infections | Cure rate for urogenital infections | Cure rate for concurrent rectal and urogenital | |
| G248T(S83I) | 80% (35/44, 95CI 64.7-90.2) | G285T(M95I) | 77.8% (7/9, 95CI 40.0-97.2) | 71.4% (5/7, 95CI 29.0-96.3) | 100% (2/2, 95CI 15.8-100) | ||
| G277T(G93C) | 0% (0/2, 95CI 0-84.2) | 0% (0/2, 95CI 0-84.2) | |||||
| G295A(D99N) | 0% (0/1, 95CI 0-97.5) | 0% (0/1, 95CI 0-97.5) | |||||
| G285C(M95I)&G295A(D99N) | 0% (0/1, 95CI 0-97.5) | 0% (0/1, 95CI 0-97.5) | |||||
| Wild type | 90.3% (28/31, 95CI 74.2-98.0) | 87.5% (21/24, 95CI 67.6-97.3) | 100% (6/6, 95CI 54.1-100) | 100% (1/1, 95CI 2.5-100) | |||
| Wild type | 100% (15/15, 95CI 78.2-100) | Wild type | 100% (15/15, 95CI 78.2-100) | 100% (14/14, 95CI 76.8-100) | 100% (1/1, 95CI 2.5-100) | ||
| Others | 95% (51/55, 95CI 83.1-99.4) | Others | 95% (51/55, 95CI 83.1-99.4) | 96.6% (39/42, 95CI 82.2-99.9) | 90.9% (12/13 95CI 58.7-99.8) | ||
| Total | 88.6% (101/114, 95CI 81.3-93.8) | 88.6% (101/114, 95CI 81.3-93.8) | 87.8% (79/90, 95CI 79.2-93.7) | 91.3% (21/23, 95CI 72.0-98.9) | 100% (1/1, 95CI 2.5-100) | ||
| AAA: amino acid substitution, MG:Mycoplasma genitalium | |||||||
CONCLUSIONS: The efficacy of sitafloxacin therapy for wild type M. genitalium infections was very high. However, the cure rate for the strains carrying both parC and gyrA mutations was limited. Resistance profile of bothparC and gyrA is important to predict clinical course. According to the result of this study, we can treat rectal MG infections in the same way as urogenital infections.
N. Ando * (1), D. Mizushima (1), M. Takano (1), T. Aoki (1), Y. Yanagawa (1), K. Watanabe (1), H. Uemura (1), M. Mitobe (2), K. Kobayashi (2), H. Kubota (2), H. Miyake (2), T. Shinkai (2), K. Sadamasu (2), H. Gatanaga (1), S. Oka (1)
(1) National Center for Global Health and Medicine, AIDS Clinical Center, Shinjuku-ku, Japan, (2) Tokyo Metropolitan Institute of Public Health, Laboratory, Shinjuku-ku, Japan