Antibiotic treatment of symptomatic Mycoplasma genitalium infection in Scandinavia: a controlled clinical trial.

OBJECTIVES: To evaluate the microbiological cure rate after treatment with tetracyclines or azithromycin in patients infected with M genitalium. METHODS: One hundred and fifty-two men and 60 women positive for M genitalium were recruited. Patients treated either with doxycyline for 9 days or with azithromycin 1 g stat. were compared. Those still positive for M genitalium after primary doxycycline treatment received an extended course of azithromycin 500 mg on day 1 followed by 250 mg daily for the following 4 days, whereas those with treatment failure after azithromycin received doxycycline 100 mg twice daily for 15 days. RESULTS: The eradication rate after azithromycin 1 g stat. was 85% (95% CI 69 to 94) in men (n = 39) and 88% (95% CI 64 to 99) in women (n = 17) and after doxycycline 17% (95% CI 9 to 27) in men (n = 76) and 37% (95% CI 19 to 58) in women (n = 27). Extended azithromycin eradicated M genitalium from 96% (95% CI 85 to 99) of the men (n = 47) and from all six women who failed on doxycycline. Extended doxycycline treatment was insufficient. Persistent urethral inflammation was seen in a substantial portion of the men after eradication of M genitalium regardless of the antibiotic drug, indicating a poor predictive value of urethral smears in evaluation of persistent or recurrent infection. CONCLUSIONS: Azithromycin was more effective than doxycycline in treating patients infected with M genitalium. The extended course of azithromycin was highly effective but was given after the initial treatment with doxycycline. Randomised clinical trials are needed to compare the different dosages of azithromycin.

Evaluation of HIV testing in Sweden, 1985-1991.

OBJECTIVE: Evaluation of the extent and outcome of HIV testing in Sweden. DESIGN: Data from screening programmes, laboratory and clinical reports were compared and a national survey on HIV testing was performed. RESULTS: The proportion found to be positive in screening of blood donors, pregnant women and sexually transmitted disease patients were approximately 1/100,000, 1/10,000 and 1-2/1000, respectively. One-quarter of the men and one-third of the women in Sweden aged 16-74 years reported that they had been tested for HIV at least once. CONCLUSION: There is a high cost involved in detecting HIV-infected individuals through general testing. This cost can be justified if we believe that awareness of an infection substantially reduces the risk of further transmission.

HIV testing in Swedish STD clinics 1986-1994.

In 1986 Swedish STD clinicians decided on a national policy of offering HIV tests routinely to all their patients. During the period July 1986 through December 1994, 224,722 tests were performed. HIV tests for one or more specific reasons were carried out on 7% of the patients, and 20% requested the test solely because of anxiety. The remaining 73%, accepted the test as part of the clinical routine without giving any specific reason. Of those offered a test, 54% had been tested at least once before. Twenty-three per cent did not accept the test. Among those tested, 373 persons (0.2%) were found to have a newly detected HIV infection. Contact tracing was the reason for testing in 11%, whilst 32% were tested for other specific reasons, 29% requested testing for no stated specific reason and 28% had been tested as a routine. Of all the tested men who reported sex with men, 7% proved to be HIV positive. The 373 persons with newly detected HIV infection constituted 14% of the total newly detected cases in Sweden during the period in question.

Prevalence trends in Sweden for the new variant of Chlamydia trachomatis.

In 2006, a new variant of Chlamydia trachomatis (nvCT) was discovered in Sweden that was not detectable with Abbott m2000 (Abbott) and Amplicor/COBAS Amplicor/TaqMan48 (Roche). The proportion of nvCT was 20-64% of the detected Chlamydia cases in counties using Abbott/Roche test systems. Although the ProbeTec system from Becton Dickinson (BD) could detect nvCT, the proportion of nvCT in counties using BD was 7-19%. The objective of the current study was to follow the nvCT proportions from 2007 to 2009 in two counties that used Roche and had introduced test systems able to detect nvCT in late 2006. The nvCT was also followed in two counties that used BD, and in all four counties the effect of nvCT on the serotype distribution of C. trachomatis wild-type strains was analysed. A total of 2576 specimens positive for C. trachomatis were collected in the four counties at three time points, and analysed for nvCT and serotype E. The proportion of nvCT declined significantly in the two counties using Roche, from 65% and 48% in 2007 to 24% for both counties in 2009 (p <0.001). The nvCT proportion increased in Norrbotten county, which used BD, from 9% in 2007 to 19% in 2009 (p 0.03). In Uppsala county, which also used BD but was surrounded by counties using detection systems from Roche, the proportion of nvCT declined from 24% in 2007 to 18% in 2009 (p <0.03). No major difference in the level of serotype E was seen. The proportion of nvCT seems to rapidly converge in the Swedish counties after the selective diagnostic advantage for nvCT has been lost in the Abbott/Roche counties.

Mycoplasma genitalium: prevalence, clinical significance, and transmission.

OBJECTIVES: To study the prevalence, symptoms and signs of Mycoplasma genitalium and Chlamydia trachomatis infections in STD clinic attendees and in partners of M genitalium infected patients. METHODS: M genitalium and C trachomatis were detected by polymerase chain reaction from urethral and endocervical swab specimens in a cross sectional study among 445 female and 501 male STD clinic attendees. Partners of 26 female and 26 male M genitalium positive index patients were examined. RESULTS: The prevalence of C trachomatis and M genitalium was 4% and 6.3%, respectively, among the women and 5.4% and 6%, respectively, among the men. Dual infections were uncommon. M genitalium was strongly associated with urethritis in both men and women and with cervicitis in women. Among M genitalium infected men, symptomatic urethritis was more common than asymptomatic urethritis. M genitalium and C trachomatis were not associated with symptoms of urethritis or cervicitis in women. Of 26 male partners of M genitalium positive female index patients, 38% were positive, and 77% of the negative partners had symptoms of urethritis. The concordance rate for 22 female partners of male index patients was 45%. For both men and women the M genitalium prevalence was significantly higher in partners of M genitalium positive index patients than in M genitalium negative index patients with urethritis and/or cervicitis. CONCLUSIONS: M genitalium is associated with urethritis in both men and women and with cervicitis in women. A high concordance rate was found among sexual partners of M genitalium infected patients, indicating that the infection is sexually transmitted.

Prevention of sexually transmitted diseases and abortions--the present situation for medical care of sexually transmitted diseases in Sweden.

In Sweden, the high numbers of infections with Chlamydia trachomatis and human papillomavirus and the threat of human immunodeficiency virus has been the origin of an ongoing change in the care for people with sexually transmitted diseases (STDs). This is based on the view that traditional STDs, HIV, and abortions are different consequences of the same thing--unprotected intercourse--so prevention of one means prevention of the others and they should always be considered together. There is a growing understanding that epidemiological aspects of STD have to be improved. To attain these goals, new measures are taken at different levels. Central organization committees are created in the counties for the management of STD care. Youth clinics are given better resources. A new kind of department for problems related to sexuality is developed with contributions primarily from gynecology and venereology. The well-established Swedish tradition for sex education is reinforced.