Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy

Abstract

Background: Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) are sexually transmitted infections (STIs) associated with nongonococcal urethritis (NGU). We assessed their predictors and persistence after treatment.

Methods: We analyzed data from an NGU treatment trial among symptomatic heterosexual men aged 16-45 years from STI clinics. Nucleic acid amplification tests detected CT, MG, and TV at baseline and at 1 and 4 weeks after therapy. Associations between variables and STI detection were investigated.

Results: Among 293 participants, 44% had CT, 31% had MG, and 13% had TV at baseline. In multivariate analysis, CT infection was associated with young age and STI contact. Young age was also associated with MG, and having ≥ 1 new partner was negatively associated with TV. We detected persistent CT in 12% and MG in 44% of participants at 4 weeks after therapy, which were associated with signs and symptoms of NGU. Persistent CT was detected in 23% of participants after azithromycin treatment vs 5% after doxycycline treatment (P = .011); persistent MG was detected in 68% of participants after doxycycline vs 33% after azithromycin (P = .001). All but 1 TV infection cleared after tinidazole.

Conclusions: Persistent CT and MG after treatment of NGU are common, and were associated with clinical findings and drug regimen.

Figure 1.

Distribution of Chlamydia trachomatis (CT) test results after treatment (visits 2 and 3) for men with positive results at baseline. ^aThree of the 6 participants who missed visit 3 were excluded from further study follow-up because of clinical failure at visit 2. ^bNineteen of the 32 participants who missed visit 3 were excluded from further study follow-up owing to clinical failure at visit 2.

Figure 2.

Distribution of Mycoplasma genitalium (MG) test results after treatment (visits 2 and 3) for men with positive results at baseline. ^aEleven of the 16 participants who missed visit 3 were excluded from further study follow-up because of clinical failure at visit 2. ^bFour of the 11 participants who missed visit 3 were excluded from further study follow-up owing to clinical failure at visit 2.

Figure 3.

Microbiological detection of prevalent Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) in participants identified with clinical failure or clinical cure at visit 2 (V2) and visit 3 (V3) after treatment. Abbreviation: NAAT, nucleic acid amplification test.