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Jensen, J.S.; Cusini, M.; Gomberg, M.; Moi, Harald; Wilson, J. & Unemo, M.
(2022).
2021 European guideline on the management of Mycoplasma genitalium infections.
Journal of the European Academy of Dermatology and Venereology.
ISSN 0926-9959.
36(5),
s. 641–650.
doi:
10.1111/jdv.17972.
Vis sammendrag
Mycoplasma genitalium infection contributes to 10–35% of non-chlamydial non-gonococcal urethritis in men. In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID) in 10–25%. Transmission of M. genitalium occurs through direct mucosal contact.
Clinical features and diagnostic tests
Asymptomatic infections are frequent. In men, urethritis, dysuria and discharge predominate. In women, symptoms include vaginal discharge, dysuria or symptoms of PID – abdominal pain and dyspareunia. Symptoms are the main indication for diagnostic testing. Diagnosis is achievable only through nucleic acid amplification testing and must include investigation for macrolide resistance mutations.
Therapy
Therapy for M .genitalium is indicated if M. genitalium is detected.
Doxycycline has a cure rate of 30–40%, but resistance is not increasing. Azithromycin has a cure rate of 85–95% in macrolide-susceptible infections. An extended course of azithromycin appears to have a higher cure rate, and pre-treatment with doxycycline may decrease organism load and the risk of macrolide resistance selection. Moxifloxacin can be used as second-line therapy but resistance is increasing.
Recommended treatment
Uncomplicated M. genitalium infection without macrolide resistance mutations or resistance testing:
Azithromycin 500 mg on day one, then 250 mg on days 2–5 (oral).
Second-line treatment and treatment for uncomplicated macrolide-resistant M. genitalium infection:
Moxifloxacin 400 mg od for 7 days (oral).
Third-line treatment for persistent M. genitalium infection after azithromycin and moxifloxacin:
Doxycycline or minocycline 100 mg bid for 14 days (oral) may cure 40–70%.
Pristinamycin 1 g qid for 10 days (oral) has a cure rate of around 75%.
Complicated M. genitalium infection (PID, epididymitis):
Moxifloxacin 400 mg od for 14 days.
Main changes from the 2016 European M. genitalium guideline
Due to increasing antimicrobial resistance and warnings against moxifloxacin use, indications for testing and treatment have been narrowed to primarily involve symptomatic patients. The importance of macrolide resistance-guided therapy is emphasised.
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Torayraju, Premnaath; Kalidindi, Kiran; Hartgill, Usha & Moi, Harald
(2021).
Retrospective study of the effectiveness of azithromycin single dose versus one-week doxycycline for anorectal chlamydia in men who have sex with men.
Acta Dermato-Venereologica.
ISSN 0001-5555.
101:adv00396(2),
s. 1–2.
doi:
10.2340/00015555-3750.
Fulltekst i vitenarkiv
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Unemo, M.; Salado-Rasmussen, K.; Hansen, M.; Olsen, Anne Olaug; Falk, M. & Golparian, D.
[Vis alle 14 forfattere av denne artikkelen]
(2017).
Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 2016.
Clinical Microbiology and Infection (CMI).
ISSN 1198-743X.
24(5),
s. 533–539.
doi:
10.1016/j.cmi.2017.09.006.
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Moi, Harald; Hartgill, Usha; Skullerud, Kristin Helene; Reponen, Elina Johanna; Syvertsen, Line & Moghaddam, Amir
(2017).
Microscopy of stained urethral smear in male urethritis; which cutoff should be used?
Sexually Transmitted Diseases.
ISSN 0148-5717.
44(3),
s. 189–194.
doi:
10.1097/OLQ.0000000000000565.
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Lautenschlager, Stephan; Kemp, Michael; Christensen, Jens Jørgen; Mayans, Marti Vall & Moi, Harald
(2017).
2017 European guideline for the management of chancroid.
International Journal of STD and AIDS.
ISSN 0956-4624.
28(4),
s. 324–329.
doi:
10.1177/0956462416687913.
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Moi, Harald; Reinton, Nils; Randjelovic, Ivana; Reponen, Elina Johanna; Syvertsen, Line & Moghaddam, Amir
(2017).
Urethral inflammatory response to ureaplasma is significantly lower than to Mycoplasma genitalium and Chlamydia trachomatis.
.
International Journal of STD and AIDS.
ISSN 0956-4624.
28(8),
s. 773–780.
doi:
10.1177/0956462416666482.
Vis sammendrag
A non-syndromic approach to treatment of people with non-gonococcal urethritis (NGU) requires identification of pathogens and understanding of the role of those pathogens in causing disease. The most commonly detected and isolated micro-organisms in the male urethral tract are bacteria belonging to the family of Mycoplasmataceae, in particular Ureaplasma urealyticum and Ureaplasma parvum To better understand the role of these Ureaplasma species in NGU, we have performed a prospective analysis of male patients voluntarily attending a drop in STI clinic in Oslo. Of 362 male patients who were tested for NGU using microscopy of urethral smears, we found the following sexually transmissible micro-organisms: 16% Chlamydia trachomatis, 5% Mycoplasma genitalium, 14% U. urealyticum, 14% U. parvum and 5% Mycoplasma hominis We found a high concordance in detecting in turn U. urealyticum and U. parvum using 16s rRNA gene and ureD gene as targets for nucleic acid amplification testing (NAAT). Whilst there was a strong association between microscopic signs of NGU and C. trachomatis infection, association of M. genitalium and U. urealyticum infections in turn were found only in patients with severe NGU (>30 polymorphonuclear leucocytes, PMNL/high powered fields, HPF). U. parvum was found to colonise a high percentage of patients with no or mild signs of NGU (0-9 PMNL/HPF). We conclude that urethral inflammatory response to ureaplasmas is less severe than to C. trachomatis and M. genitalium in most patients and that testing and treatment of ureaplasma-positive patients should only be considered when other STIs have been ruled out.
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Jensen, Jørgen Skov; Cusini, Marco; Gomberg, Mikhail & Moi, Harald
(2016).
Background review for the 2016 European guideline on Mycoplasma genitalium infections.
Journal of the European Academy of Dermatology and Venereology.
ISSN 0926-9959.
30(10),
s. 1686–1693.
doi:
10.1111/jdv.13850.
Vis sammendrag
Mycoplasma genitalium is a cause of 10-35% of non-chlamydial non-gonococcal urethritis in men and in women, and is associated with cervicitis and pelvic inflammatory disease (PID). Transmission of M. genitalium occurs through direct mucosal contact. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. In men, urethritis, dysuria and discharge predominates. Asymptomatic infections are frequent. In this review, we present the evidence base for the recommendations in the 2016 European guideline on M. genitalium infections and describe indications for testing, recommended diagnostic methods, treatment and patient management. The guideline was prepared on behalf of the European branch of The International Union against Sexually Transmitted Infections; the European Academy of Dermatology and Venereology; the European Dermatology Forum; the European Society of Clinical Microbiology and Infectious Diseases; the Union of European Medical Specialists. The European Centre for Disease Prevention and Control and the European Office of the World Health Organisation also contributed to their development
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Horner, Patrick J.; Blee, Karla; Falk, Lars; van der Meijden, Willem I. & Moi, Harald
(2016).
2016 European guideline on the management of non-gonococcal urethritis.
International Journal of STD and AIDS.
ISSN 0956-4624.
27(11),
s. 928–937.
doi:
10.1177/0956462416648585.
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O'Farrell, Nigel & Moi, Harald
(2016).
2016 European guideline on donovanosis.
International Journal of STD and AIDS.
ISSN 0956-4624.
27(8),
s. 605–607.
doi:
10.1177/0956462416633626.
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Moreira, Edson Duarte; Giuliano, Anna R.; Palefsky, Joel; Flores, Carlos Aranda; Goldstone, Stephen & Ferris, Daron
[Vis alle 13 forfattere av denne artikkelen]
(2014).
Incidence, clearance, and disease progression of genital human papillomavirus infection in heterosexual men.
Journal of Infectious Diseases.
ISSN 0022-1899.
210(2),
s. 192–199.
doi:
10.1093/infdis/jiu077.
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Reinton, N.; Moi, Harald; Olsen, Anne Olaug; Zarabyan, N.; Bjerner, J. & Tønseth, T.M.
[Vis alle 7 forfattere av denne artikkelen]
(2013).
Anatomic distribution of Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium infections in men who have sex with men.
Sexual Health.
ISSN 1448-5028.
10(3),
s. 199–203.
doi:
10.1071/SH12092.
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Unemo, Magnus; Golparian, Daniel; Skogen, Vegard; Olsen, Anne Olaug; Moi, Harald & Syversen, Gaute
[Vis alle 7 forfattere av denne artikkelen]
(2013).
Neisseria gonorrhoeae Strain with High-Level Resistance to Spectinomycin Due to a Novel Resistance Mechanism (Mutated Ribosomal Protein S5) Verified in Norway.
Antimicrobial Agents and Chemotherapy.
ISSN 0066-4804.
57(2),
s. 1057–1061.
doi:
10.1128/AAC.01775-12.
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Hjelmevoll, Stig Ove; Olsen, Merethe Elise; Sollid, Johanna U Ericson; Haaheim, Håkon; Melby, Kjetil K. & Moi, Harald
[Vis alle 8 forfattere av denne artikkelen]
(2012).
Appropriate Time for Test-of-Cure when Diagnosing Gonorrhoea with a Nucleic Acid Amplification Test.
Acta Dermato-Venereologica.
ISSN 0001-5555.
92(3),
s. 316–319.
doi:
10.2340/00015555-1275.
Fulltekst i vitenarkiv
Vis sammendrag
Culture is commonly regarded as the gold standard for diagnosis of Neisseria gonorrhoeae. However, nucleic acid amplification tests (NAATs) have rapidly replaced culture for diagnostics in many settings. The aim of the present study was to investigate the appropriate time for test-of-cure (TOC) when NAATs are used for diagnosis of gonorrhoea. In total, 30 patients (28 men and 2 women) provided urethral, cervical, rectal or pharyngeal specimens for TOC. All included patients, except one who did not return for second TOC before day 19, tested negative within 2 weeks after treatment with cefixime 400 mg × 1. Antimicrobial susceptibility testing showed that 68% of the culture-positive strains were resistant to ciprofloxacin. Thus, the recommended empirical treatment with ciprofloxacin in Norway should be changed immediately. TOC can be performed 2 weeks after treatment when NAATs are used for diagnosis of gonorrhoea.
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Danielsson, Dan; Teigen, Per Kristen & Moi, Harald
(2011).
The genital econiche: focus on microbiota and bacterial vaginosis.
Annals of the New York Academy of Sciences.
ISSN 0077-8923.
1230,
s. 48–58.
doi:
10.1111/j.1749-6632.2011.06041.x.
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Kemp, M; Christensen, J. J.; Lautenschlager, S; Vall-Mayans, M. & Moi, Harald
(2011).
European guideline for the management of chancroid, 2011.
International Journal of STD and AIDS.
ISSN 0956-4624.
22(5),
s. 241–244.
doi:
10.1258/ijsa.2010.010432.
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Giuliano, Anna R.; Palefsky, Joel M.; Goldstone, Stephen; Moreira, Edson D.; Penny, Mary E. & Aranda, Carlos
[Vis alle 20 forfattere av denne artikkelen]
(2011).
Efficacy of Quadrivalent HPV Vaccine against HPV Infection and Disease in Males.
New England Journal of Medicine.
ISSN 0028-4793.
364(5),
s. 401–411.
doi:
10.1056/nejmoa0909537.
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Vardas, Eftyhia; Giuliano, Anna R.; Goldstone, Stephen; Palefsky, Joel M.; Moreira, Edson D. & Penny, Mary E.
[Vis alle 17 forfattere av denne artikkelen]
(2010).
External Genital Human Papillomavirus Prevalence and Associated Factors Among Heterosexual Men on 5 Continents.
Journal of Infectious Diseases.
ISSN 0022-1899.
203(1),
s. 58–65.
doi:
10.1093/infdis/jiq015.
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O'Farrell, N. & Moi, Harald
(2010).
European guideline for the management of donovanosis, 2010.
International Journal of STD and AIDS.
ISSN 0956-4624.
21(9),
s. 609–610.
doi:
10.1258/ijsa.2010.010245.
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de Vries, HJC; Morre, SA; White, JA & Moi, Harald
(2010).
European guideline for the management of lymphogranuloma venereum, 2010.
International Journal of STD and AIDS.
ISSN 0956-4624.
21(8),
s. 533–536.
doi:
10.1258/ijsa.2010.010238.
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Shahmanesh, M.; Moi, Harald; Lassau, F. & Janier, M.
(2009).
2009 European Guideline on the Management of Male Non-gonococcal Urethritis.
International Journal of STD and AIDS.
ISSN 0956-4624.
20(7),
s. 458–464.
doi:
10.1258/ijsa.2009.009143.
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Moi, Harald; Reinton, Nils & Moghaddam, Amir
(2009).
Mycoplasma genitalium is associated with symptomatic and asymptomatic non-gonococcal urethritis in men.
Sexually Transmitted Infections.
ISSN 1368-4973.
85,
s. 15–18.
doi:
10.1136/sti.2008.032730.
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Moi, Harald; Reinton, Nils & Moghaddam, Amir
(2009).
Mycoplasma genitalium in women with lower genital tract inflammation.
Sexually Transmitted Infections.
ISSN 1368-4973.
85(1),
s. 10–14.
doi:
10.1136/sti.2008.032748.
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Juvkam, kari Hilde; Moi, Harald & Romøren, Maria
(2008).
Gynekologiske infeksjoner.
I Lindbæk, Morten (Red.),
Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593).
Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP).
ISSN 978-82-8081-112-7.
s. 102–105.
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Moi, Harald; Romøren, Maria & Juvkam, Kari Hilde
(2008).
Bakteriell vaginose X84 (del av kap 7.7).
I Lindbæk, Morten (Red.),
Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593).
Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP).
ISSN 978-82-8081-112-7.
s. 106–109.
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Juvkam, Kari Hilde; Moi, Harald & Romøren, Maria
(2008).
Vulvovaginal candida X72 (del av kap 7.7).
I Lindbæk, Morten (Red.),
Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593).
Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP).
ISSN 978-82-8081-112-7.
s. 110–113.
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Romøren, Maria; Juvkam, Kari Hilde & Moi, Harald
(2008).
Trichomoniasis X73, A78 (del av kap 7.7).
I Lindbæk, Morten (Red.),
Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593).
Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP).
ISSN 978-82-8081-112-7.
s. 114–115.
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Romøren, Maria; Juvkam, Kari Hilde & Moi, Harald
(2008).
Seksuelt overførbare infeksjoner (intro til kap 7.8).
I Lindbæk, Morten (Red.),
Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593).
Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP).
ISSN 978-82-8081-112-7.
s. 116–119.
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Romøren, Maria; Juvkam, Kari Hilde & Moi, Harald
(2008).
Gonoré X71, Y71 (del av kap 7.8).
I Lindbæk, Morten (Red.),
Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593).
Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP).
ISSN 978-82-8081-112-7.
s. 120–123.
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Hjelmevoll, Stig Ove; Olsen, Merethe Elise; Sollid, johanna u ericson; Haaheim, Håkon; Melby, KK & Moi, H.
[Vis alle 8 forfattere av denne artikkelen]
(2008).
Clinical validation of a real-time polymerase chain reaction detection of Neisseria gonorrheae porA pseudogene versus culture techniques.
Sexually Transmitted Diseases.
ISSN 0148-5717.
35,
s. 517–520.
doi:
10.1097/OLQ.0b013e3181644bc9.
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Moi, Harald
(2007).
Chlamydiatest for hjemmebruk holder ikke hva den lover.
Tidsskrift for Den norske legeforening.
ISSN 0029-2001.
127(16),
s. 2083–2085.
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d'Auriac, MA; Refseth, UH; Espelund, M; Moi, Harald & Jeansson, Stig
(2007).
A new automated method for isolation of Chlamydia trachomatis from urine eliminates inhibition and increases robustness for NAAT systems.
Journal of Microbiological Methods.
ISSN 0167-7012.
70,
s. 416–423.
doi:
10.1016/j.inimet.2007.05.017.
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Jernberg, Elise J.N. & Moi, Harald
(2007).
Mycoplasma genitalium - etiologisk agens for seksuelt overført infeksjon.
Tidsskrift for Den norske legeforening.
ISSN 0029-2001.
127(17),
s. 2233–2235.
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Anglès d'Auriac, Marc; Refseth, Unn Hilde; Espelund, Mari; Moi, Harald; Størvold, Gunnar & Jeansson, Stig
(2007).
A new automated method for isolation of Chlamydia trachomatis from urine eliminates inhibition and increases robustness for NAAT systems.
Journal of Microbiological Methods.
ISSN 0167-7012.
70(3),
s. 416–423.
doi:
10.1016/j.mimet.2007.05.017.
Vis sammendrag
Chlamydia trachomatis is a leading cause of sexually transmitted infection. Diagnostic methods with easy non-invasive sample collection are important to increase testing and hence to reduce the spread of this infection. To enable more use of urine samples in C. trachomatis diagnostics, automation is an absolute requirement since obtaining high-quality DNA from urine specimens involves extensive processing.
Here, we present a study in which a new automated sample preparation method, BUGS'n BEADS™ STI (BnB STI), was used up-front of the BDProbeTec™ ET end point analysis and compared with the full BDProbeTec™ ET method to analyze C. trachomatis in 1002 urine samples.
The BnB STI system represents a new concept within magnetic sample preparation in which bacteria are first isolated from the sample material followed by purification of bacterial nucleic acid using the same magnetic particles. Similar sensitivity and specificity were obtained with both methods. None of the samples processed with BnB STI inhibited the BDProbeTec™ ET test whereas 1.8% showed inhibition when processed according to the manual BDProbeTec™ ET DNA preparation method. Moreover, the average MOTA scores obtained with the BnB STI system were 48% higher for all amplification controls and 57% higher for positive samples, compared to the manual sample preparation. Based on these results and the significant reduction in hands-on-time for urine sample processing, the automated BnB STI sample preparation method was implemented for routine analysis of C. trachomatis from urine samples.
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Berg, ES; Storvold, G; Anestad, G.; Moi, Harald & Skaug, K
(2005).
Reliability of the Amplicor internal control to disclose false-negative Chlamydia trachomatis PCR results.
Journal of Microbiological Methods.
ISSN 0167-7012.
60(1),
s. 125–129.
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Gjertsen, Inger K; Moi, Harald & Loeb, Michell
(2000).
Utenlandsk partner gir ikke økt risiko for klamydia, uretritt og kondylomer.
Tidsskrift for Den norske legeforening.
ISSN 0029-2001.
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Døsen, Liv Kari & Moi, Harald
(1998).
Gonorrhea caused by fluoroquinolone resistant gonococci.
Tidsskrift for Den norske legeforening.
ISSN 0029-2001.
aug 10(118/18),
s. 2783–2785.
-