Time to Eradication of Mycoplasma Genitalium and Chlamydia Trachomatis After Treatment Commenced

NCT ID: NCT01661985

Last Updated: 2014-12-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

160 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-02-28

Study Completion Date

2016-09-30

Brief Summary

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The purpose of this on-going study is to study the number of days after antibiotic treatment has commenced (due to infection caused by the sexually transmitted bacteria Chlamydia trachomatis (CT) and Mycoplasma genitalium(Mg)) it takes to be cured i.e to get a negative test result. The specimens are analyzed on first-catch-urine (men) or patient's self-obtained vaginal sample with quantitive nucleic acid amplification test(NAAT). A secondary aim is to detect macrolide resistant Mg-strains and study whether there are any emerging macrolide resistant Mg-strains after treatment with azithromycin. A third aim is to study whether the participating subjects are adherent to the study protocol meaning 12 samples taken during a period of four weeks.

Detailed Description

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Mycoplasma genitalium (Mg), detected in 1980, causes a urogenital infection through sexual transmission. In contrast to Chlamydia trachomatis antibiotic resistance is common against tetracyclines and is emerging against macrolides such as azithromycin. Both antibiotics are recommended as the first line treatment of chlamydia infection. Recent published data, however, indicate that 1g azithromycin stat may be only bacteriostatic when treating chlamydia.

The consensus to date is that there should always be a test of cure in pregnant women having been treated for chlamydia and in all individuals treated for Mg.

There are no studies published, to our knowledge, where the time to eradication after antibiotic treatment commenced in Mg infection has been evaluated. The first line treatment of a confirmed Mg infection is azithromycin 1.5 g given during a period of 5 days. If macrolide resistance is plausible or confirmed moxifloxacin 400mg for 7 to 10 days is recommended.

Individuals with symptomatic urethritis or cervicitis and/or being sexual partners to individuals being treated for a suspect or confirmed Mg or CT infection were eligible. The study subjects were patients attending either of the STD-clinics in Norrköping or Västervik, Sweden. All samples were sent to Statens Serum Institut(SSI), Mycoplasma department (Jorgen Skov Jensen) for analysis.

Patients accepting enrolment with a confirmed or highly suspected Mg were receiving azithromycin 500 mg the first day and 250mg the following four days.

Patients where macrolide resistant Mg-strain infection was highly suspected received moxifloxacin 400 mg once daily for seven days.

Those subjects intended to treatment but with a lower degree of suspicion of Mg infection were randomized to either a treatment with doxycycline 200 mg the first day and 100 mg once daily the following nine days (the custom and recommendation in Sweden for treatment of chlamydia and non-specific urethritis or cervicitis) OR a treatment with azithromycin 1g as a single dose.

All participants were given test kits for 12 samples, which were to be sampled three times weekly (every second day) during four weeks starting the day after the first day of treatment. They were instructed not to have any sexual intercourse during the first week and with condom afterwards during the study period. The samples were to be sent once weekly (three samples)to SSI.The date of sampling was to be noted on the label of the tube and the attaching paper to SSI, where also any symptoms were to be noted. The results of the tests were sent to the STD-clinic who informed the patient.

The study started in February 2010 and inclusion of patients have ended for those subjects with a verified M genitalium infection (February 2014), whereas patients with a verified or suspected chlamydia infection still are enrolled and randomised to azithromycin 1 g or doxycycline. A manuscript will soon be submitted concerning those subjects being treated for a M genitalium infection.

To date 190 patients have been enrolled and also fulfilled the study protocol with sampling of specimens.

Conditions

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Urethritis Cervicitis Genital Mycoplasma Infection Chlamydia Trachomatis

Keywords

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Mycoplasma genitalium Chlamydia trachomatis Treatment Antibiotic resistance

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Drug: Azithromycin 1g

Azithromycin 1 g,single dose (per os)

Group Type ACTIVE_COMPARATOR

Azithromycin

Intervention Type DRUG

In the randomized arm giver orally 1 g as a single dose. In the non-randomized arm given for 5 days 250mg 2x1 first day and 1x1 following four days.

Drug: Doxycycline/lymecycline 9/10days

Tetracycline either as Doxycycline or during June and July lymecycline (due to lower risk of photo-sensitivity) given for treatment in 9(10)days (per os).

Group Type ACTIVE_COMPARATOR

Doxycycline

Intervention Type DRUG

Doxycycline tablets 100 mg 2x1 the first day and 100 mg daily for following eight days (following the Swedish tradition and experience since the 1970s of treating chlamydia)

lymecycline

Intervention Type DRUG

Lymecycline 300 mg twice daily for 10 days (Summertime due to less risk of phototoxic reactions)

Azithromycin 1.5 g

Patients not randomized but receiving the first line treatment when a confirmed Mg infection

Group Type ACTIVE_COMPARATOR

Azithromycin

Intervention Type DRUG

In the randomized arm giver orally 1 g as a single dose. In the non-randomized arm given for 5 days 250mg 2x1 first day and 1x1 following four days.

Interventions

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Azithromycin

In the randomized arm giver orally 1 g as a single dose. In the non-randomized arm given for 5 days 250mg 2x1 first day and 1x1 following four days.

Intervention Type DRUG

Doxycycline

Doxycycline tablets 100 mg 2x1 the first day and 100 mg daily for following eight days (following the Swedish tradition and experience since the 1970s of treating chlamydia)

Intervention Type DRUG

lymecycline

Lymecycline 300 mg twice daily for 10 days (Summertime due to less risk of phototoxic reactions)

Intervention Type DRUG

Other Intervention Names

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Zitromax Azitromax Doxyferm Tetralysal 300mg

Eligibility Criteria

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Inclusion Criteria

* Individuals attending the STD-clinic and being a sexual partner who has received an antibiotic treatment due to a non-specific urethritis/cervicitis or a confirmed Mycoplasma genitalium/Chlamydia trachomatis infection OR Having a confirmed infection described above or a symptomatic urethritis or cervicitis (non-gonorrhoic)

Exclusion Criteria

* Allergy against any of the drugs, woman being pregnant or breast feeding, Not speaking or understanding Swedish fluently. Other medication with possible interaction to given treatment
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Statens Serum Institut

OTHER

Sponsor Role collaborator

Ostergotland County Council, Sweden

OTHER

Sponsor Role lead

Responsible Party

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Lars Falk

MD PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Lars Falk, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Dept of Derm&Venereology Linköping University hospital

Locations

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R&D dept of Local Health Care, Östergötland county council

Linköping, , Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Lars Falk, MD PhD

Role: CONTACT

Phone: +46 10 103 8507

Email: [email protected]

Jorgen S Jensen, MD DrMedSci

Role: CONTACT

Email: [email protected]

Facility Contacts

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Lars Falk, MD PhD

Role: primary

References

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Falk L, Enger M, Jensen JS. Time to eradication of Mycoplasma genitalium after antibiotic treatment in men and women. J Antimicrob Chemother. 2015 Nov;70(11):3134-40. doi: 10.1093/jac/dkv246. Epub 2015 Aug 17.

Reference Type DERIVED
PMID: 26283670 (View on PubMed)

Other Identifiers

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Ostergotland CC

Identifier Type: -

Identifier Source: org_study_id