Recent research shows that prevalence of<unk> en is currently higher than other commonly occurring STIs (Sexually Transmitted Infections).<unk> en is a fastidious organism with prolonged growth durations. This makes detection of the pathogen in clinical specimens and subsequent isolation, extremely difficult. Lacking a cell wall,<unk>  remains unaffected by commonly used antibiotics. The absence of specific serological assays leaves nucleic acid amplification tests (NAAT) as the only viable option for detection of<unk> en DNA or RNA. However, samples with positive NAAT for the pathogen should be tested for macrolide resistance mutations, which are strongly correlated to azithromycin treatment failures, owing to rapid rates of mutation of the pathogen. Mutations in the 23S rRNA gene of<unk> en have been linked with clinical treatment failure and high level in vitro macrolide resistance. Macrolide resistance mediating mutations have been observed in 20-50% of cases in the UK, Denmark, Sweden, Australia, and Japan. Resistance is also developing towards the second-line antimicrobials like fluoroquinolone. According to the European guidelines, the indication for commencement of diagnosis for<unk> en infection are: # Detection of nucleic acid (DNA and/or RNA) specific for<unk> en in a clinical specimen # Current partners of individuals who tested positive for<unk> en should be treated with the same antimicrobial as the index patient # If current partner does not attend for evaluation and testing, treatment with the same regimen as given to the index patient should be offered on epidemiological grounds # On epidemiological grounds for sexual contacts in the previous 3 months; ideally, specimens for a<unk> en NAAT should be collected before treatment and treatment should not be given before the result are available Screening for<unk> en with a combination of detection and macrolide resistance mutations will provide the adequate information required to develop personalised antimicrobial treatments, in order to optimise patient management and control the spread of antimicrobial resistance (AMR). Detection of resistance Owing to the widespread macrolide resistance, samples that are positive for<unk> en should ideally be followed up with an assay capable of detecting mutations that mediate antimicrobial resistance. The European Guideline on<unk> en infections, in 2016, recommended complementing the molecular detection of<unk> en with an assay capable of detecting macrolide resistance-associated mutations.
Mycoplasma genitalium
Trichomonas vaginalis
Chlamydia trachomatis
Trichomonas tenax
Haemophilus ducreyi
Treponema pallidum
Mycobacterium ulcerans
Trichobacteriosis axillaris