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"titulo" => "<span class="elsevierStyleItalic">Mycoplasma genitalium</span> macrolide resistance update: Rate among a 2016–2017 cohort of patients in Barcelona, Spain" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "99" "paginaFinal" => "104" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Miguel Fernández-Huerta, Martí Vall, Candela Fernández-Naval, María-Jesús Barberá, Maider Arando, Luis López, Antonia Andreu, Tomàs Pumarola, Judit Serra-Pladevall, Juliana Esperalba, Mateu Espasa" "autores" => array:11 [ 0 => array:3 [ "nombre" => "Miguel" "apellidos" => "Fernández-Huerta" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "Martí" "apellidos" => "Vall" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span 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"apellidos" => "Espasa" "email" => array:1 [ 0 => "mespasa@tauli.cat" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Microbiology Department, Vall d’Hebron University Hospital, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sexually Transmitted Infections Unit Vall d’Hebron-Drassanes, Vall d’Hebron University Hospital, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Drassanes Exprés STI Program, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "University of Barcelona, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actualización en <span class="elsevierStyleItalic">Mycoplasma genitalium</span> y resistencia a macrólidos: tasa en una cohorte de pacientes entre los años 2016–2017 en Barcelona, España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 760 "Ancho" => 1340 "Tamanyo" => 39553 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Rate of macrolide resistance during periods 2013–2014 and 2016–2017 in Barcelona, Spain. Results are displayed overall and stratified by sex/sexual behavior.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Mycoplasma genitalium</span> is a major cause of urethritis, accounting for 15–20% of non-gonococcal urethritis (NGU) in men.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> Additionally, although its pathogenicity in women is less well established, this sexually transmissible infection (STI) is associated with cervicitis, pelvic inflammatory disease (PID), preterm birth and miscarriage.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Since doxycycline demonstrated poor efficacy eradicating the infection,<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">3,4</span></a> the macrolide azithromycin (AZM), given as an extended regimen with 500<span class="elsevierStyleHsp" style=""></span>mg day one followed by 250<span class="elsevierStyleHsp" style=""></span>mg days 2–5, is the recommended first-line treatment against <span class="elsevierStyleItalic">M. genitalium</span>.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> However, the widespread use of this antibiotic, particularly as a single 1<span class="elsevierStyleHsp" style=""></span>g dose, has enhanced the emergence of macrolide resistance worldwide.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6–10</span></a> Single-nucleotide mutations (SNPs) in domain V of the 23S ribosomal RNA (rRNA) gene, predominantly at positions 2058 and 2059 (<span class="elsevierStyleItalic">Escherichia coli</span> numbering), are consistently associated with this resistance.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11,12</span></a> Thus, high levels of macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> have been reported in European countries,<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8,13–17</span></a> in the USA and the Asia-Pacific region.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9,10,18</span></a> Moxifloxacin (MXF) is currently recommended as second-line antibiotic.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> Nevertheless, MXF resistance is appearing in many countries,<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">19–22</span></a> including Spain (<10%),<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8,23</span></a> associated with point mutations in the quinolone resistance determining region (QRDR) of the <span class="elsevierStyleItalic">parC</span> and <span class="elsevierStyleItalic">gyrA</span> genes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2016, as a response to the increasing macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> and the lack of therapeutic alternatives, international treatment guidelines have recommended AZM to be replaced as the initial treatment for NGU with doxycycline (DOX) 100<span class="elsevierStyleHsp" style=""></span>mg twice daily for one week.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">24</span></a> Furthermore, commercial assays for simultaneous detection of <span class="elsevierStyleItalic">M. genitalium</span> and macrolide resistance have recently been developed.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> These facts are providing an ideal scenario for the gradual implementation of “resistance-guided sequential therapy” for <span class="elsevierStyleItalic">M. genitalium</span> that has already demonstrated good efficacy, and that may potentially reduce the selection and transmission of resistance.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">To date, limited data has been published regarding AZM resistance in <span class="elsevierStyleItalic">M. genitalium</span> in Spain.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8,23,27,28</span></a> Thus, the aim of this retrospective study was to estimate the rate of macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> among a 2016–2017 cohort of patients in Barcelona, Spain. Additionally, evolution of macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> was evaluated over time by comparing these series with a previous cohort (2013–2014), studied with similar methodology in the same region.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients and specimens</span><p id="par0025" class="elsevierStylePara elsevierViewall">Between December 2016 and February 2017, a total of 1191 specimens from 1109 patients were tested for <span class="elsevierStyleItalic">M. genitalium</span> at the Microbiology Department of the Vall d’Hebron University Hospital. The samples were collected from four clinical settings as follows: 398 were from subjects attending to the STI Reference Unit Vall d’Hebron-Drassanes, 356 specimens came from different wards at the Vall d’Hebron University Hospital, 356 came from primary care centers in Barcelona and 81 from private clinical centers. Specimens consisted of 613 urethral swabs/first-void urines, 288 vaginal/endocervical swabs, 26 rectal swabs, 4 pharyngeal swabs, 253 semen samples and, regarding adverse pregnancy outcomes, 3 endometrial samples and 4 amniotic fluid samples.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M. genitalium</span> testing was usually performed in samples from patients with urethritis, cervicitis, in sexual contacts of infected partners and when PID or chronic prostatitis were suspected. Its detection among other clinical presentations was performed only if requested by the clinician. Sociodemographic and clinical characteristics of the patients were collected through a comprehensive review of the medical record. Treatment outcomes were determined with a microbiological test of cure (TOC), usually performed three weeks after antibiotic therapy according to clinical guidelines.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> Cure was defined when <span class="elsevierStyleItalic">M. genitalium</span> DNA was not detected.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Ethical approval for the study was obtained from the HUVH Ethics Committee (351/2018).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Laboratory analyses</span><p id="par0040" class="elsevierStylePara elsevierViewall">Firstly, clinical samples were tested for <span class="elsevierStyleItalic">M. genitalium</span> by real-time polymerase chain reaction (qPCR) using the Allplex<span class="elsevierStyleSup">TM</span> STI Essential Assay (Seegene, South Korea). During the study period, positive primary samples were stored at −20<span class="elsevierStyleHsp" style=""></span>°C for subsequent analyses. These specimens were retrospectively tested for <span class="elsevierStyleItalic">M. genitalium</span> and macrolide resistance genotypic markers with the ResistancePlus® MG Assay (SpeeDx, Australia). This is a multiplex qPCR for detection of <span class="elsevierStyleItalic">M. genitalium</span> and five mutations associated with macrolide resistance (A2058G, A2059G, A2058C, A2059C and A2058T; <span class="elsevierStyleItalic">Escherichia coli</span> numbering).<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> Briefly, 400<span class="elsevierStyleHsp" style=""></span>μl of sample was extracted using the NucliSENS® easyMag® platform (bioMérieux, France) and eluted in 100<span class="elsevierStyleHsp" style=""></span>μl of elution buffer. <span class="elsevierStyleItalic">M. genitalium</span> and macrolide resistance was tested with the ResistancePlus® MG Assay on a LightCycler® 480 Instrument II (Roche Diagnostics, Germany). Analysis of the results was performed using the supplied software. Finally, mutations were confirmed by Sanger sequencing of domain V of the 23S rRNA gene using a previously described methodology.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analyses</span><p id="par0045" class="elsevierStylePara elsevierViewall">Since some patients had several specimens taken over time, only first-test-positive samples of each <span class="elsevierStyleItalic">M. genitalium</span> infection episode were selected and studied in order to estimate the rate of antimicrobial resistance.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using Stata (StataCorp, USA). Distributions of categorical variables were compared by Chi-squared (χ<span class="elsevierStyleSup">2</span>) or Fisher exact tests, and quantitative variables were evaluated by Mann–Whitney <span class="elsevierStyleItalic">U</span> test. The 95% confidence intervals (CI) of the proportions were calculated by exact methods. Differences with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 were considered statistically significant.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The original anonymized database from the study conducted by Barberá et al.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a> was kindly given by the corresponding author Antonia Andreu so comparison between cohorts could be performed.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Of the initial 1191 samples tested trough the Allplex<span class="elsevierStyleSup">TM</span> STI Essential Assay during the study period, 122 specimens (10.2% [95% CI, 8.9%–12.1%]) from 106 patients (9.6% [95% CI, 7.9%–11.4%]) resulted positive for <span class="elsevierStyleItalic">M. genitalium</span>. Positivity by specimen was: 63 were urethral swabs/first-void urines (10.3% [95% CI, 8.0%–13.0%]), 31 were vaginal/endocervical swabs (10.8% [95% CI, 7.4%–14.9%]), 22 were rectal swabs (84.6% [95% CI, 65.1%–95.6%]), one was a pharyngeal swab (25.0% [95% CI, 0.6%–80.6%]) and five were semen samples (2.0% [95% CI, 0.6%–4.6%]). Due to insufficient sample volume, of the 122 <span class="elsevierStyleItalic">M. genitalium</span> positive specimens, only 89 were suitable for subsequent analysis of macrolide resistance genotypic markers. Therefore, 89 samples collected from 86 patients with a <span class="elsevierStyleItalic">M. genitalium</span> infection were finally included in the study.</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Characterization of study individuals</span><p id="par0065" class="elsevierStylePara elsevierViewall">The demographic and clinical characteristics of the 86 patients studied are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Among them, 42 were men who had sex with men (MSM) (48.8% [95% CI, 37.9%–59.9%]) and most of them were attended at the STI Reference Unit Vall d’Hebron-Drassanes. In contrast, the majority of men who have sex with women (MSW) and women came from primary health centers and the Vall d’Hebron University Hospital wards.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Considering coinfection as a concurrent infection taking place at the same location, overall 11 <span class="elsevierStyleItalic">M. genitalium</span> cases (12.8% [95% CI, 6.6%–21.7%]) were coinfected with either <span class="elsevierStyleItalic">Chlamydia trachomatis</span> or <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>. Concretely, <span class="elsevierStyleItalic">C. trachomatis</span> was more frequent (8.1% [95% CI, 3.3%–16.1%]) than <span class="elsevierStyleItalic">N. gonorrhoeae</span> (5.8% [95% CI, 1.1%–13.0%]), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.549. Among the 22 women studied, 13 (59.1% [95% CI, 36.4%–79.3%]) were investigated for aberrant vaginal flora using culture and gram staining. Only one case (7.7% [95% CI, 0.2%–36.0%]) was described as normal flora (predominance of <span class="elsevierStyleItalic">Lactobacillus</span> spp.) while 12 (92.3% [95% CI, 64.0%–99.8%]) presented some vaginal dysbiosis (bacterial vaginosis, candidiasis or aerobic vaginitis).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Rate of macrolide resistance mediated mutations</span><p id="par0075" class="elsevierStylePara elsevierViewall">Of the 86 <span class="elsevierStyleItalic">M. genitalium</span> infection episodes studied, macrolide resistance could not be determined in three samples using the ResistancePlus® MG Assay: one vaginal swab, one pharyngeal swab and one rectal swab. Ct values from the Allplex<span class="elsevierStyleSup">TM</span> STI Essential Assay in these specific cases were 36, 38, and 37, respectively.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Therefore, of the remaining 83 <span class="elsevierStyleItalic">M. genitalium</span> infections, macrolide resistance-mediating mutations were detected in 30 episodes (36.1% [95% CI, 25.9%–47.4%]) while 53 (63.9% [95% CI, 52.6%–74.1%]) were classified as “wild type”/non-mutated (WT). Results stratified by sexual behavior are described in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Twelve HIV positive patients had a WT infection while eight had a macrolide resistant infection, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.859. Additionally, five patients harboring resistant infections suffered from a previous <span class="elsevierStyleItalic">M. genitalium</span> infection episode during the last 12 months but only three patients reported so among the WT cohort, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.100. Macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> was significantly more frequent among MSM compared to MSW and women, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001. Furthermore, no significant differences in macrolide resistance rates were found by sexual behavior regarding whether they were attended in an STI-Unit or in other health centers (MSM: 14/21 (66.6%) vs 8/19 (42.1%), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.119; MSW: 2/7 (28.6%) vs 4/15 (26.7%), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.926; Women: 1/4 (25.0%) vs 1/17 (5.9%), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.241).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">AZM resistance associated mutations in the 23S rRNA gene were confirmed by Sanger sequencing in 29/30 <span class="elsevierStyleItalic">M. genitalium</span> infection episodes. Thus, 12 (41.4% [95% CI, 23.5%–61.1%]) harbored a SNP at position A2058G (A2071G, <span class="elsevierStyleItalic">M. genitalium</span> numbering), 15 (51.7% [95% CI, 32.5%–70.6%]) had mutations at position A2059G (A2072G), one (3.4% [95% CI, 0.1%–17.8%]) at A2058T (A2071T) and one (3.4% [95% CI, 0.1%–17.8%]) at A2059C (A2072C). The remaining infection that tested positive for a resistant <span class="elsevierStyleItalic">M. genitalium</span> was unable to be amplified and sequenced.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Treatment outcomes</span><p id="par0090" class="elsevierStylePara elsevierViewall">Since the mutational analysis for macrolide resistance was performed retrospectively, antibiotic therapy was established without resistance information.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Among the 83 <span class="elsevierStyleItalic">M. genitalium</span> infection episodes which macrolide resistance status was determined, 12 did not received antibiotic therapy. Furthermore, in 29 cases information regarding therapy established could not be collected. Thereby, treatment outcomes were evaluated in 42 <span class="elsevierStyleItalic">M. genitalium</span> infections following the registrations in the medical record (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Overall, AZM was used in 26 cases (61.9% [95% CI, 45.6%-76.4%]), DOX in 10 (23.8% [95% CI, 12.1%–39.5%]) and MXF was used in six cases (14.3% [95% CI, 5.4%–28.5%]). Among the macrolide resistant cases, only MXF was able to eradicate <span class="elsevierStyleItalic">M. genitalium</span> while no treatment cure was reported using DOX neither AZM. However, no treatment failure was detected using MXF, DOX or AZM among the WT infections.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Evolution of macrolide resistance over time</span><p id="par0100" class="elsevierStylePara elsevierViewall">Macrolide resistance over time was evaluated in our setting, Barcelona (Spain), by comparing the current cohort with a previous one from 2013 to 2014, studied with a similar methodology.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Firstly, similarity between both populations was evaluated in terms of age, sex/sexual behavior, presence/absence of symptoms and proportion of HIV positive patients. As shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>, no significant differences were found between cohorts although proportion of HIV positive patients was slightly higher in the 2016–2017 study. Secondly, macrolide resistance rates of both cohorts were calculated overall and stratified by sex/sexual behavior (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no significant differences between the 2013 and 2014 population cohort and the current one, neither from an overall approach (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.895) nor between MSM (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.170), MSW (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.208) or women (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.773).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M. genitalium</span> was first isolated in 1981 from men with urethritis,<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> however the first PCRs for detection of <span class="elsevierStyleItalic">M. genitalium</span> were not developed until the early 1990s.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> Thenceforth, the role of <span class="elsevierStyleItalic">M. genitalium</span> in urethritis and many other anogenital disorders has been established. In addition, the antibiotic resistance profile of <span class="elsevierStyleItalic">M. genitalium</span> has been rigorously studied, especially after the appearance of the first AZM treatment failures in <span class="elsevierStyleItalic">M. genitalium</span> associated with SNPs in domain V of the 23S rRNA gene.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6,11</span></a> Despite these efforts, <span class="elsevierStyleItalic">M. genitalium</span> remains still underdiagnosed in some areas due to the lack of easy access to diagnostic tools. Additionally, the alarming capability of this pathogen to develop antimicrobial resistance has complicated the current clinical management of the infection.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">This research provides further evidence regarding macrolide resistance in Spain, where epidemiological data remains limited.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8,23,27,28</span></a> In the current study, the rate of macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> was 36% overall. However, macrolide resistance was significantly more frequent among MSM (55%) compared to MSW or women (27% and 10%, respectively), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001; findings previously reported.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a> Additionally, results from this 2016 to 2017 cohort were compared with a previous report published by Barberá et al., <a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a> where macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> was estimated in similar settings in Barcelona during 2013–2014 with comparable methodology. Inferences from this analysis indicate that macrolide resistance did not significantly increase during this period; neither from an overall approach nor within specific subpopulations (MSM, MSW and women).</p><p id="par0120" class="elsevierStylePara elsevierViewall">Emerging macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> has been widely reported in the last decade, approaching or even exceeding 50% in many countries.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8–10,13–18</span></a> Nevertheless, most of these cross-sectional studies focus on very specific populations at risk for STIs. So, there is limited longitudinal data regarding the overall evolution of macrolide resistance among general population in the medium term.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a> Our research suggests that macrolide resistance may be stabilizing around 35%, at least in our local epidemiology. Several factors could be influencing this situation. Firstly, there is increasing concern about <span class="elsevierStyleItalic">M. genitalium</span> and antibiotic resistance worldwide since first treatment failures appeared a decade ago.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6,11</span></a> Consequently, medical societies are fully aware of this issue leading to a significant improvement on the diagnosis and management of <span class="elsevierStyleItalic">M. genitalium</span> infections in many settings.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5,25</span></a> Secondly, since May 2016, as a response to the increasing macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span>, European guidelines changed to recommend DOX as the first line treatment for non-filiated NGU as the initial empirical approach.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">24</span></a> Thus, this statement also recommends the posterior investigation for further infectious aetiologies (including <span class="elsevierStyleItalic">M. genitalium</span> and macrolide resistance, if available) in order to refine the empirical therapy. Indeed, this treatment change may have contributed to control the spread of macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span>. In fact; Jensen, in a recent comment in <span class="elsevierStyleItalic">Lancet Infect Dis</span>,<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> highlighted the case of Sweden where DOX has been and remains the only recommended antimicrobial treatment for <span class="elsevierStyleItalic">C. trachomatis</span> and where the prevalence of macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> is among the lowest in western Europe, at less than 20%.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> Finally, macrolide resistance in our settings may have reached the plateau leading its stabilization around 35%.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Some limitations to our report must be addressed. First, we should remark that many of the patients included, especially MSM, attended the STI Unit Vall d’Hebron-Drassanes. This clinic is particularly specialized in high risk populations where we could expect higher proportions of macrolide resistance. So, our study may slightly overestimate the real prevalence of macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> among general population in our region. Second, due to the retrospective design of the research, many registrations (mainly regarding treatment outcomes) are missing and limit the power of the results. Finally, it should be noted that <span class="elsevierStyleItalic">M. genitalium</span> was not unlimitedly tested but only on certain clinical presentations as mentioned in methodology.</p><p id="par0130" class="elsevierStylePara elsevierViewall">No selection of resistance mutations was reported among the WT cases treated with AZM although TOC was only performed in 5/15 cases (33%). Additionally, no treatment failures were detected using MXF. Regarding symptoms, there were no cases of proctitis. Nevertheless, it is noteworthy the high proportion of disrupted vaginal biome in women with <span class="elsevierStyleItalic">M. genitalium</span> infections in our cohort (92%).</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion, this study provides further data regarding macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> in Spain. Additionally, a comparison between the current data and previous investigations indicates that macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> did not significantly increase, at least between 2013 and 2017 in our study area, Barcelona. This evidence contrasts with the increasing emergence of antimicrobial resistance in <span class="elsevierStyleItalic">M. genitalium</span> worldwide and could provide a second opportunity for the adequate utilization of AZM against <span class="elsevierStyleItalic">M. genitalium</span> based on novel approaches such as sequential-resistance-guided and/or dual therapy.<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">26,32</span></a> Nevertheless, AZM resistance continues to be a major concern in <span class="elsevierStyleItalic">M. genitalium</span> since therapeutic alternatives remain scarce. A strict local surveillance of <span class="elsevierStyleItalic">M. genitalium</span> and its antibiotic resistance is evidently required to facilitate the optimization of antibiotic administration for NGU and <span class="elsevierStyleItalic">M. genitalium</span> infections, and reduce the selection and transmission of resistance. Indeed, the implementation of combined diagnostic-resistance tests for <span class="elsevierStyleItalic">M. genitalium</span> plays a key role in this purpose.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0140" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">SpeeDx Pty Ltd. supplied all the reagents for molecular testing of <span class="elsevierStyleItalic">M. genitalium</span>. CFN is a researcher who has received partial salary support from SpeeDx Pty Ltd. MFH and ME have participated in symposiums organized by SpeeDx Pty Ltd.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1316207" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1214707" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1316206" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1214708" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients and specimens" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Laboratory analyses" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analyses" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Characterization of study individuals" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Rate of macrolide resistance mediated mutations" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Treatment outcomes" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Evolution of macrolide resistance over time" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack453682" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-07" "fechaAceptado" => "2019-06-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1214707" "palabras" => array:3 [ 0 => "<span class="elsevierStyleItalic">Mycoplasma genitalium</span>" 1 => "Macrolide resistance" 2 => "Antimicrobial surveillance" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1214708" "palabras" => array:3 [ 0 => "<span class="elsevierStyleItalic">Mycoplasma genitalium</span>" 1 => "Resistencia a macrólidos" 2 => "Vigilancia antibiótica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Mycoplasma genitalium</span> is a major cause of urethritis and other genital syndromes. Antibiotic resistance, especially to macrolides, is increasing at an alarming rate worldwide. The aim of this study was to estimate the rate of macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> among a 2016–2017 cohort of patients in Barcelona, Spain; and to compare this estimate with previous data from 2013 to 2014 in this region.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study was conducted retrospectively with <span class="elsevierStyleItalic">M. genitalium</span>-positive samples collected between December 2016 and February 2017 at the Hospital Vall d’Hebron Microbiology Department. Genotypic markers of macrolide resistance were primarily detected using the ResistancePlus® MG molecular assay (SpeeDx). Mutations were then confirmed by sequencing.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Macrolide resistance-mediating mutations were detected in 30/83 infections (36.1% [95% CI, 25.9%–47.4%]). This resistance was more frequent among men who have sex with men (55.0% [95% CI, 38.5%–70.7%]) compared to heterosexual men (27.3% [95% CI, 10.7%–50.2%]) and women (9.5% [95% CI, 1.3%–30.4%]), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001. Additionally, macrolide resistance did not significantly increase in this cohort when compared with previous investigations.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Despite the current notable rate of macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span>, resistance did not significantly increase between 2013–2014 and 2016–2017 in our region. Nevertheless, strict local surveillance and the implementation of rapid diagnostic tests that combine the detection of the bacterium and resistance-mediating mutations may facilitate the optimization of antibiotic administration and reduce the transmission of resistance in <span class="elsevierStyleItalic">M. genitalium</span>.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Mycoplasma genitalium</span> es causa de uretritis y otras enfermedades genitales. Las resistencias antibióticas, especialmente a macrólidos, están aumentando de forma alarmante a nivel mundial. El objetivo del estudio fue estimar la tasa de resistencia a macrólidos en <span class="elsevierStyleItalic">M. genitalium</span> sobre una cohorte de pacientes entre los años 2016-2017 en Barcelona, España; y comparar esta estimación con datos previos de 2013-2014 en esta región.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El estudio se realizó de forma retrospectiva sobre muestras positivas para <span class="elsevierStyleItalic">M. genitalium</span> recogidas entre diciembre 2016 y febrero 2017 en el Departamento de Microbiología del Hospital Vall d’Hebron. Los marcadores genotípicos de resistencia a macrólidos se detectaron en primer lugar con el ensayo molecular ResistancePlus® MG (SpeeDx). Las mutaciones se confirmaron posteriormente por secuenciación.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se detectaron mutaciones asociadas a resistencia a macrólidos en 30/83 (36,1% [IC 95%: 25,9-47,4%]) infecciones. Esta resistencia fue más frecuente en hombres que tienen sexo con hombres (55,0% [IC 95%: 38,5-70,7%]) comparada con la tasa en hombres heterosexuales (27,3% [IC 95%: 10,7-50,2%]) y mujeres (9,5% [IC 95%: 1,3-30,4%]), p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001. Además, la resistencia a macrólidos no aumentó significativamente en esta serie en comparación con investigaciones previas.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A pesar de la tasa notable de resistencia a macrólidos en <span class="elsevierStyleItalic">M. genitalium</span>, esta no aumentó significativamente entre los años 2013-14 y 2016-17 en nuestro entorno. No obstante, una estricta vigilancia a nivel local junto con la implementación de pruebas diagnósticas rápidas que combinan la detección de la bacteria y las mutaciones de resistencia puede facilitar la optimización de la administración antibiótica y reducir la transmisión de resistencias en <span class="elsevierStyleItalic">M. genitalium</span>.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 760 "Ancho" => 1340 "Tamanyo" => 39553 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Rate of macrolide resistance during periods 2013–2014 and 2016–2017 in Barcelona, Spain. Results are displayed overall and stratified by sex/sexual behavior.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">MSM indicates men who have sex with men; MSW, men who have sex with women; CI, confidence intervals; HIV, human immunodeficiency virus.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MSM (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>42)No.; % (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MSW (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22)No.; % (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Women (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22)No.; % (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Characteristics of cases</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age (range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.8 (20.2–68.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.6 (20.2–64.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.5 (18.7–41.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Recruiting site</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>STI unit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22; 52 (36–68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7; 32 (14–55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5; 23 (8–45) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1; 2 (0.1–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3; 14 (3–35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primary health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5; 12 (4–26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15; 68 (45–86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14; 64 (41–83) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14; 33 (20–50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Medical history</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HIV positive<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21; 50 (34–66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Syphilis history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9; 21 (10–37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2; 9 (1–29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1; 5 (0.1–23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Clinical findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Symptomatic<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19; 45 (30–61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13; 59 (36–79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11; 50 (28–72) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Specimens (No.)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vaginal/endocervical swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22; 100 (85–100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urethral swab/first-void urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24; 57 (41–72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22; 100 (85–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pharyngeal swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1; 2 (0.1–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rectal swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>; 48 (32–64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Coinfection</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N. gonorrhoeae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2; 5 (0.6–16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1; 5 (0.1–23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2; 9 (1–29) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">C. trachomatis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3; 7 (2–20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>; 9 (1–29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2; 9 (1–29) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2256350.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">In 10 individuals (six women, three MSW and one MSM), HIV status information was missing.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Information regarding symptomatology was missing in 29 <span class="elsevierStyleItalic">M. genitalium</span> infections (six female infection, seven infections in MSW and 16 infections in MSM).</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Three patients had concurrent urethral and rectal infection by <span class="elsevierStyleItalic">M. genitalium</span>.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">One patient was co-infected with both <span class="elsevierStyleItalic">C. trachomatis</span> and <span class="elsevierStyleItalic">N. gonorrhoeae</span> in urethra.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the 86 <span class="elsevierStyleItalic">M. genitalium</span> infection episodes.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">MSM indicates men who have sex with men; MSW, men who have sex with women; MG, <span class="elsevierStyleItalic">Mycoplasma genitalium</span>; WT, “wild type”/non-mutated; CI, confidence intervals.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexual behavior/Specimens \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">WT MGNo.; % (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">23S rRNA mutant MGNo.; % (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total No. \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">MSM</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18; 45.0 (29.3–61.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22; 55.0 (38.5–70.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urethral swab/first-void urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8; 38.1 (18.1–61.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13; 61.9 (38.4–81.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rectal swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9; 56.3 (29.9–80.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7; 43.8 (19.8–70.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urethral & rectal swab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1; 33.3 (0.8–90.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2; 66.7 (9.4–99.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">MSW</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16; 72.7 (49.8–89.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6; 27.3 (10.7–50.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Women</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19; 90.5 (69.6–98.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2; 9.5 (1.2–30.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Total</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53; 63.9 (52.6–74.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30; 36.1 (25.9–47.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2256351.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">All infections were detected in urethral swabs/first-void urines.</p>" ] 1 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">All infections occurred in vaginal/endocervical swabs.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Rate of macrolide resistance in <span class="elsevierStyleItalic">M. genitalium</span> stratified by sexual behavior.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">MG indicates <span class="elsevierStyleItalic">Mycoplasma genitalium</span>; CI, confidence intervals; NT/NF, no treatment or information not found; WT, “wild type”/non-mutated.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MG infectionsNo.; % (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antibiotic therapy, No.; % \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment cure No.; % \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment failure No.; % \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Loss to follow-up, No.; % \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">23S rRNA mutant cases, 30; 36.1 (25.9–47.4)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doxycycline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3; 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2; 67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1; 33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Azithromycin<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11; 37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5; 45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6; 55 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moxifloxacin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3; 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3; 100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NT/ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13; 43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">WT cases, 53; 63.9 (52.6–74.1)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doxycycline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7; 13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2; 29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5; 71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Azithromycin<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15; 28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5; 33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10; 67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moxifloxacin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3; 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1; 33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2; 67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NT/ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28; 53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2256352.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Five infections were treated with the extended regimen of azithromycin and six were treated with single 1<span class="elsevierStyleHsp" style=""></span>g dose azithromycin.</p>" ] 1 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Ten infections were treated with the extended regimen of azithromycin and five were treated with single 1<span class="elsevierStyleHsp" style=""></span>g dose azithromycin.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Treatment outcomes of the <span class="elsevierStyleItalic">M. genitalium</span> infections with determined macrolide resistance status.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">MSM indicates men who have sex with men; MSW, men who have sex with women; HIV, human immunodeficiency virus; CI, confidence intervals.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics of patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Barbera et al.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a> 2013–2014 cohort% (CI 95%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2016–2017cohort% (CI 95%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age (range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.3 (18.0–50.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.65 (18.7–68.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.324 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex/Sexual behavior</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.3 (28.8–50.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.8 (37.9–59.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.210 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MSW \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.9 (26.6–48.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.6 (16.8–38.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.111 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.8 (15.2–34.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.6 (16.8–38.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.789 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Symptomatic</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.2 (65.7–84.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.4 (62.2–85.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.918 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">HIV positive</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7 (9.4–26.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.6 (18.0–39.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.093 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2256353.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Comparison between the characteristics of patients from the 2013 to 2014 cohort (Barberá et al.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a>) and the 2016–2017 cohort.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0165" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Mycoplasma genitalium</span>: from Chrysalis to multicolored butterfly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. 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Finally, we would like to thank SpeeDx Pty Ltd for their support although they had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/0213005X/0000003800000003/v1_202003070713/S0213005X19302046/v1_202003070713/en/main.assets" "Apartado" => array:4 [ "identificador" => "8591" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/0213005X/0000003800000003/v1_202003070713/S0213005X19302046/v1_202003070713/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X19302046?idApp=UINPBA00004N" ]
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Original article
Mycoplasma genitalium macrolide resistance update: Rate among a 2016–2017 cohort of patients in Barcelona, Spain
Actualización en Mycoplasma genitalium y resistencia a macrólidos: tasa en una cohorte de pacientes entre los años 2016–2017 en Barcelona, España
Miguel Fernández-Huertaa,b, Martí Vallb,c,d, Candela Fernández-Navala,b, María-Jesús Barberác,d,e, Maider Arandob,c,d, Luis Lópezb,c,d, Antonia Andreua,b, Tomàs Pumarolaa,b, Judit Serra-Pladevalla,b, Juliana Esperalbaa,b, Mateu Espasaa,b,d,
Autor para correspondencia
a Microbiology Department, Vall d’Hebron University Hospital, Barcelona, Spain
b Universitat Autònoma de Barcelona, Barcelona, Spain
c Sexually Transmitted Infections Unit Vall d’Hebron-Drassanes, Vall d’Hebron University Hospital, Barcelona, Spain
d Drassanes Exprés STI Program, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
e University of Barcelona, Barcelona, Spain