Origins of Repeat Infections with Chlamydia Trachomatis and Mycoplasma Genitalium Among Heterosexual Men

Kissinger, Patricia

Wednesday, March 14, 2012: 10:30 AM

Greenway Ballroom A/B/C

Patricia Kissinger, PhD¹, Stephanie N. Taylor, MD², Leandro A. Mena, MD, MPH³, Scott A. White, MPH¹, Norine Schmidt, MPH¹, Rebecca Lillis, MD², Nicholas Chamberlain⁴, Marcus Loggins⁴ and David H. Martin, MD⁵, 1School of Public Health and Tropical Medicine, Department of Epidemiology, Tulane University, New Orleans, LA, 2Louisiana State University Health Sciences Center, New Orleans, LA, 3Division of Infectious Diseases, University of Mississippi Medical Center and Mississippi State Department of Health, Jackson, MS, 4Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, 5Department of Medicine, Section of infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, LA

Background: Repeat infections with Chlamydia trachomatis (Ct) and Mycoplasma genitalium(Mg) are common and there has been some indication that treatment failure of single-dose 1 g azithromycin for Ct/Mg may be increasing.

Objectives: To determine the origins of these repeat infections to better target treatment approaches.

Methods: Men with non-gonococcal urethritis, partners of Ct infected women, or men who screened positive for Ct and were > 18 years of age, and who had sex with at least one woman in the prior 2 months were included in the study at two urban STD clinics (New Orleans, LA and Jackson, MS). All men were treated with single-dose azithromycin. At baseline and 6-10 week test-of-cure (TOC) visit, participants were interviewed to elicit partner specific sexual exposure and partner treatment information, as well as index interim treatment. Ct and Mg were detected using Gen-Probe TMA assays.

Results: Of 608 men enrolled, 93.9% were African American, mean age was 27.3 (s.d. 8.4),and base line Ct+, Mg+ and Ct+/Mg+ rates were 33.3%, 13.9% , 5.0%. Of 239 men who had either Ct or Mg at baseline, 132 returned for TOC to-date. Of those, 7/91 (7.7%) had repeat Ct infection and 15/49 (30.6%) had repeat MG infection. Of those who retested positive for Ct, 2/7 reported no sexual re-exposure and 5/7 reported re-exposure to a baseline partner. Of those who retested positive for Mg, 13/15 reported no sexual exposure; one reported re-exposure to a baseline partner.

Conclusions: Preliminary data from our ongoing cohort study suggests a high rate of treatment failure for Mg but a low rate for Ct. Genotyping will be conducted and will add to our understanding of the repeat infection rate.

Implications for Programs, Policy, and Research: Identifying sources of repeat infection with Ct and MG will help better focus treatment options.

C7.1 Origins of Repeat Infections with Chlamydia Trachomatis and Mycoplasma Genitalium Among Heterosexual Men