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Continuing medical education: Sexually transmitted infections
DOI: 10.1016/j.eimce.2019.04.013
Available online 17 May 2019
Infections caused by Chlamydia trachomatis (including lymphogranuloma venereum) and Mycoplasma genitalium
Infecciones por Chlamydia trachomatis (incluye linfogranuloma venéreo) y Mycoplasma genitalium
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Luis Piñeiroa,
Corresponding author
, Juan Carlos Galánb, Martí Vall-Mayansc
a Servicio de Microbiología, Hospital Universitario Donostia – Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
b Servicio de Microbiología y CIBER en Epidemiología y Salud Pública (CIBERESP), Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
c Unidad de ITS Vall d’Hebron-Drassanes, Servicio de Enfermedades Infecciosas, Hospital Vall d’Hebron, Barcelona, Spain
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Table 1. Recommended antibiotic therapy regimens for C. trachomatis infections.
Table 2. Clinical features of M. genitalium infection in women and in men.
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Abstract

Sexually transmitted infections caused by Chlamydia trachomatis, including lymphogranuloma venereum and Mycoplasma genitalium have increased in last decade. This epidemiological scenario presents new challenges in order to improve and strengthen our control and prevention strategies. The routine clinical diagnosis of urethritis and cervicitis must be combined with the active search for the causal agent in men with symptoms of dysuria or proctitis, and in women with pelvic inflammatory disease. We should also include sexually transmitted infections screening in asymptomatic patients with sexual risk behaviours or sexual contact with patients diagnosed with a sexually transmitted infection. The microbiological diagnosis must be based on molecular techniques capable of detecting C. trachomatis (discriminating between L genotypes associated with lymphogranuloma venereum and other genotypes) and M. genitalium (ideally including the identification of macrolide-resistant strains). A faster and specific diagnosis will allow for a targeted treatment with a suitable antibiotic regimen. We also recommend including contact tracing of sexual partners and, occasionally, a cure test. Finally, sexually transmitted infection screening must be widely implemented in those population groups with a high prevalence of sexually transmitted infections.

Keywords:
Chlamydia trachomatis
Lymphogranuloma venereum
Mycoplasma genitalium
Resumen

El incremento en las infecciones de transmisión sexual por Chlamydia trachomatis, incluyendo el linfogranuloma venéreo, y Mycoplasma genitalium registrado en la última década plantea nuevos retos para mejorar su control y reforzar su prevención. El diagnóstico clínico habitual (uretritis/cervicitis) debe completarse con una búsqueda activa de la infección en varones con disuria o proctitis, mujeres con enfermedad inflamatoria pélvica y contactos asintomáticos. El diagnóstico microbiológico debe basarse en técnicas moleculares, capaces de detectar Chlamydia trachomatis (diferenciando el genotipo L para linfogranuloma venéreo) y Mycoplasma genitalium (incluyendo idealmente la detección de cepas resistentes a macrólidos). Un diagnóstico más rápido y específico permitirá un tratamiento dirigido con la pauta antibiótica idónea. El manejo de estas infecciones de transmisión sexual debe incluir un estudio de los contactos sexuales y en ocasiones un test de cura. Finalmente, deben ser valorados los cribados de infección en grupos de población con mayor prevalencia.

Palabras clave:
Chlamydia trachomatis
Linfogranuloma venéreo
Mycoplasma genitalium

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