. Nongonococcal urethritis (NGU) is the most common sexually transmitted disease syndrome seen in men in the United States, yet up to 50% of cases have no defined etiology. Even less is known about the etiology of persistent or recurrent urethritis, which is also frequent. Ureaplasma urealyticum may be responsible for some of these idiopathic cases, but evidence regarding pathogencity of the organism and the degree to which it is associated with acute or persistent NGU is conflicting. Similar to the serovars of Chlamydia trachomatis, Ureaplasma serovars may exhibit varying degrees of pathogenicity, and recent phylogenetic analyses have demonstrated that the two major Ureaplasma biovar groupings are actually distinct species. U. parvum has been designated biovar 1, while the name U. urealyticum was retained for biovar 2. Limited data suggest that U. urealyticum (biovar 2), but not U. parvum is associated with NGU, but further studies are required to confirm this observation, as well as to assess the differential response of these two species to common antibiotic treatment regimens for NGU, and to identify the role of this organism in persistent or recurrent NGU. To address these questions, we will conduct a series of studies in conjunction with an ongoing randomized treatment trial of another genital Mycoplasma, M. genitalium. Specifically, we will 1) Assess the association of U. urealyticum (biovar 2) and U. parvum with acute NGU;2) Determine, in our ongoing randomized double-blind trial, the relative efficacy of azithromycin and doxycycline in eradicating U. urealyticum (biovar 2) and U. parvum infection among men with NGU, and assess the relationship of the MIC of the drug used to persistence of U. urealyticum (biovar 2) and U. parvum;and 3) Evaluate the association of persistent or recurrent NGU with U. urealyticum (biovar 2) and U. parvum. Relevance. NGU is the subject of over 200,000 physician office visits per year (CDC, 2001), and represents a significant public health problem. The results of this study may lead to the identification of an additional cause of this syndrome, provide guidance on treatment decisions, and shed light on the etiology of persistent and recurrent cases.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
5R01AI072728-03
Application #
7573466
Study Section
Infectious Diseases, Reproductive Health, Asthma and Pulmonary Conditions Study Section (IRAP)
Program Officer
David, Hagit S
Project Start
2007-03-01
Project End
2012-02-28
Budget Start
2009-03-01
Budget End
2012-02-28
Support Year
3
Fiscal Year
2009
Total Cost
$545,674
Indirect Cost
Name
University of Washington
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Kissinger, Patricia J; White, Scott; Manhart, Lisa E et al. (2016) Azithromycin Treatment Failure for Chlamydia trachomatis Among Heterosexual Men With Nongonococcal Urethritis. Sex Transm Dis 43:599-602
Khosropour, Christine M; Manhart, Lisa E; Gillespie, Catherine W et al. (2015) Efficacy of standard therapies against Ureaplasma species and persistence among men with non-gonococcal urethritis enrolled in a randomised controlled trial. Sex Transm Infect 91:308-13
Khosropour, Christine M; Manhart, Lisa E; Colombara, Danny V et al. (2014) Suboptimal adherence to doxycycline and treatment outcomes among men with non-gonococcal urethritis: a prospective cohort study. Sex Transm Infect 90:3-7
Gillespie, Catherine W; Manhart, Lisa E; Lowens, M Sylvan et al. (2013) Asymptomatic urethritis is common and is associated with characteristics that suggest sexually transmitted etiology. Sex Transm Dis 40:271-4
Manhart, Lisa E; Khosropour, Christine M; Liu, Congzhu et al. (2013) Bacterial vaginosis-associated bacteria in men: association of Leptotrichia/Sneathia spp. with nongonococcal urethritis. Sex Transm Dis 40:944-9
Manhart, Lisa E; Gillespie, Catherine W; Lowens, M Sylvan et al. (2013) Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis 56:934-42
Wetmore, Catherine M; Manhart, Lisa E; Lowens, M Sylvan et al. (2011) Ureaplasma urealyticum is associated with nongonococcal urethritis among men with fewer lifetime sexual partners: a case-control study. J Infect Dis 204:1274-82
Wetmore, Catherine M; Manhart, Lisa E; Lowens, M Sylvan et al. (2011) Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study. Sex Transm Dis 38:180-6
Manhart, Lisa E; Broad, Jennifer M; Golden, Matthew R (2011) Mycoplasma genitalium: should we treat and how? Clin Infect Dis 53 Suppl 3:S129-42
Wetmore, Catherine M; Manhart, Lisa E; Wasserheit, Judith N (2010) Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future. Epidemiol Rev 32:121-36

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