Treatment efficacy, treatment failures and selection of macrolide resistance in patients with high load of Mycoplasma genitalium during treatment of male urethritis with josamycin

Table 3 Details of three failures to treat Mycoplasma genitalium urethritis with josamycin, including bacterial load in log ₁₀ genome equivalents/mL (23S rRNA gene), symptoms and microscopy results at different visits

Patients	Sexual orientation	0 d/t	3 d/t	8 d/t	2 d/at	10-14 d/at
Case A^a	Heterosexual	6.4 (WT)	4.7 (WT)	NA	2.1 (A2059G)	3.2 (A2059G)
		Severe urethritis symptoms, 25–30 PMNL/hpf	Less severe urethritis symptoms, 10–15 PMNL/hpf	Mild itching only, 2–3 PMNL/hpf	Asymptomatic, <5 PMNL/hpf	Asymptomatic, <5 PMNL/hpf
Case B^a	Heterosexual	6.2 (WT)	2.5 (WT)	0.8 (NA)	2.0 (A2062G)	1.9 (A2062G)
		Severe urethritis symptoms, 60 PMNL/hpf	Less severe urethritis symptoms, 20–30 PMNL/hpf	Mild discharge and itching, 15–20 PMNL/hpf	Asymptomatic, 10–12 PMNL/hpf	Severe urethritis symptoms, 100 PMNL/hpf
Case C^a	Heterosexual	7.2 (WT)	7.0 (WT)	4.3 (WT)	5.0 (A2059G)	7.5 (A2059G)
		Asymptomatic, <5 PMNL/hpf	Asymptomatic, <5 PMNL/hpf	Asymptomatic, <5 PMNL/hpf	Asymptomatic, <5 PMNL/hpf	Severe urethritis symptoms, 40–60 PMNL/hpf

d/t, days of treatment; d/at, days after completed therapy; WT, wild-type 23S rRNA gene sequence; NA, not assessed (specimen not available and too low concentration of M. genitalium DNA for 23S rRNA gene sequencing, respectively); PMNL/hpf, polymorphonuclear leucocytes/high power field.
^aAll three patients repeatedly reassured that they had not had any unprotected sexual contacts between initiation of the josamycin treatment and test of cure. All patients were subsequently successfully treated with moxifloxacin 400 mg single oral dose daily in 10 days, which was confirmed by lack of symptoms, signs and M. genitalium DNA at follow up visit four weeks after the treatment.

ISSN: 1471-2334