If the urethritis persists 2 weeks later, Dr. Horner recommended treating patients empirically with a combination of moxifloxacin and metronidazole to cover possible infection by either M. genitalium or U. urealyticum.
In theory, this overall approach has the potential to resolve 89% of infections after the first round of treatment and 99% after the second round, with low potential for generating resistant strains of M. genitalium, based on pathogen prevalence and susceptibility profiles that Dr. Horner sees in Bristol. Those outcomes are an improvement on the cure rates and resistance risks when initial treatment is applied completely empirically, he explained.
Infection-specific treatment would work even better once rapid, point-of-care genetic tests become available for M. genitalium and U. urealyticum, Dr. Horner said.
Dr. Manhart, Dr. Wiesenfeld, and Dr. Hillier had no disclosures. Dr. Jensen said that his institution provides diagnostic testing for M. genitalium commercially and also evaluates various new antimicrobials under contract. Dr. Horner said that he has been a consultant to or received research support from Aquarius Population Health, Cepheid, Hologic, and Siemens.
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