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Background: Much controversy surrounds the management of NGU, with many issues not fully addressed by the current 2009 European guideline. For instance, definitive strategies for the integration of Mycoplasma genitalium (MG) testing into diagnostic protocols must be considered; with MG diagnosis currently only occurring in eastern and northern Europe. Another concern is the first line antibiotic choice, with single dose treatment strategies possibly promoting MG resistance. Furthermore, definitive partner management strategies require urgent clarification. The European Collaborative Clinical Group (ECCG) is a network of sexual health specialists under the umbrella of the International Union Against Sexually Transmitted Infections (IUSTI) who conduct questionnaire based research across the European Region. The aim of this study was to evaluate the current practice of NGU management across Europe.
Methods: Five European experts in the field of NGU were interviewed about controversies in management, and a case-based questionnaire developed. The questionnaire was then reviewed and validated by the core group of the ECCG. The final questionnaire was then circulated electronically to the 120 sexual health specialists from 38 countries of the ECCG.
Results: Pilot data suggests there are significant differences in first line treatment pathways across Europe. MG testing is not used on a regular basis by the majority of clinics sampled. There is evidence that divergent and conflicting clinical algorithms are utilised by clinicians, demonstrating their underlying uncertainty and the crucial need for refined guidelines. A full complement of results will be available by the Congress.
Conclusions: Many clinicians argue that ineffective eradication of MG may be significantly associated with recurrent/persistent NGU; further that their practice promotes this. Clinicians are highly concerned that current management strategies are encouraging antibiotic resistance and that this will become established before MG testing becomes more accessible. Our research identifies key areas of uncertainty that will require further scrutiny.