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Mycoplasma genitalium is one of the obligate pathogens that cause sexually transmitted diseases. To detect this pathogen in routine practice, only molecular genetic methods are used that are also used to identify the resistance of MGE to antibiotics. The first-line drugs for the treatment of diseases caused by MGE, are tetracycline and macrolides. In recent years, many countries have increasingly recorded cases of unsuccessful therapy macrolides. Mutations that confer antibiotic resistance to macrolides for Mycoplasm genitalium are concentrated in nucleotide positions 2058 and 2059 in region V of the 23S rRNA gene. Unknown status of macrolide resistance M. genitalium can lead to the development of a persistent infection. We describe the first reported cases of clinical josamycin treatment failure from patient with ure - thritis. The reason for antibiotic resistance was a mutation in the 23S rRNA of MGE as a nucleotide substitution in position A2058G.

To investigate the actual practice of antibacterial therapy of sexually-transmitted bacterial diseases (STD) in adult patients at the various regions of the Russian Federation as well as to evaluate the concordance of the antibacterial therapy with national standards, a multicenter retrospective analytical trial was carried out. Investigational data of 1250 subjects (61% males, 39% females, the mean age of 28.8 ± 9.2) with early types of Lues (n = 341), uncomplicated urogenital gonococcal infection (n = 309), candidiasis (n = 310), mycoplasmosis (n = 137) and ureaplasma infection (n = 153), being treated at prevention and treatment facilities of 10 cities of Russia from January to December 2007 were analysed. 1567 prescriptions for the treatment of the underlying disease were registered, among which 1352 (86.2%) prescriptions regarded antibacterial agents. The therapy of early forms of Lues most frequently included benzathine benzylpenicillin (38.4%), procaine penicillin (28.3%), ceftriaxone (26.9%), and benzylpenicillin (5.5%); therapy of uncomplicated urogenital gonococcal infection included: ceftriaxone (57.5%), spectinomycin (9.3%), doxycycline (7.2%), and azithromycin (5.1%); urogenital chlamydial infections: azithromycin (28.2%), doxycycline (22.2%), clarithromycin (14.9%), josamycin (11.1%), and ofloxacin (7.9%); urogenital mycoplasmal and ureaplasmal infections: doxycycline (32.4 and 31.3%), josamycin (21.4 and 21.3%), azithromycin (15.2 and 11.3%), clarithromycin (14.5 and 11.3%), levofloxacin (4.1 and 6.9%). Frequency of administration of ther drugs was less then 5% for each one. The study has demonstrated a high variability of choice of antibacterial agents by physicians along with an evident tendency to exceeding the total doses during the course therapy. The prescribed therapy was conforming with national recommendations in 71.8% of the subjects, while the total treatment doses were consistent with recommended doses in 24% of patients only, that indicates a necessity to change the established practice of bacterial STD therapy in Russia.