Venereology, Volume 4, Issue 3 (September 2025) – 4 articles

Background: There is an urgent need for novel treatment options for Neisseria gonorrhoeae. Methenamine is an interesting urinary antiseptic with a very low propensity to induce antimicrobial resistance. Methods: We assessed the MICs of methenamine-hippurate for 18 N. gonorrhoeae isolates. We then assessed the in vivo efficacy of methenamine-hippurate against N. gonorrhoeae using the Galleria mellonella infection model. Results: We found that all the gonococcal isolates had a methenamine-hippurate MIC of 300 mg/L. This MIC was not higher in isolates with higher ceftriaxone MICs. No toxicity of methenamine at the doses tested was found, and doses as low as 200 mg/kg were effective in the G. mellonella model. Conclusions: Further studies in mice and humans are required to assess if methenamine-hippurate could be used to treat gonococcal urethritis alone or in combination with other agents such as ceftriaxone. Full article

Background/Objectives: Mycoplasma and Ureaplasma species are pathogens commonly associated with urogenital infections in sexually active individuals. Despite their clinical relevance, these organisms are less frequently studied than other sexually transmitted infections (STIs), leading to limited data on their antimicrobial susceptibility and resistance profiles. This study aimed to characterize the antimicrobial susceptibility and resistance patterns of Mycoplasma hominis and Ureaplasma spp. among individuals in Salvador, Bahia, Brazil, and to identify the potential associated risk factors. Methods: We conducted a retrospective descriptive study during 2022–2024 using secondary data obtained from the SMARTLab^® diagnostic system. Sociodemographic and epidemiological data, along with results from IST2 and IST3 diagnostic tests, were analyzed. Absolute and relative frequencies were calculated by sex, age group, and antimicrobial susceptibility profile. Results: Our results revealed a predominance of M. hominis and Ureaplasma spp. infection among women (98.5%), and in individuals aged 38 to 47 years. Ureaplasma spp. accounted for the majority of positive cases. High rates of resistance were observed in the IST2 test, with 75.0% of M. hominis and 84.1% of Ureaplasma urealyticum resistant to ciprofloxacin. In the IST3 test, Ureaplasma spp. demonstrated a 7.3% resistance rate to levofloxacin, which increased to 22.2% in cases of co-infection. Conclusions: These findings underscore the growing threat of antimicrobial resistance in Mycoplasma and Ureaplasma species and highlight the need for targeted public health strategies and diagnostic tools to manage infections caused by these organisms, particularly in high-risk populations. Full article

Background/Objectives: An optimal approach to addressing oral antiretroviral therapy (ART) adherence remains unclear in the research literature. This review aimed to identify definitions and thresholds of adherence, proposed methods and frequencies of evaluating adherence levels, barriers to adherence, and interventions to address adherence problems. Methods: A scoping review of HIV guidelines drew on guidance from the Joanna Briggs Institute. Eligible English and French guidelines and their updates concerned adults with HIV and oral ART from developed countries and international health organizations from 2017 to May 2023. Three databases were systematically searched, along with the gray literature. Then, a targeted search for omitted developed countries was conducted. Document selection and data charting were performed with two reviewers for 20% of records and full texts, followed by an independent review. Inductive–deductive content analysis of extracted data was performed using NVivo 14 software. Results: Twenty-four guidelines were identified from seven countries and two international health organizations. Only two defined ART adherence, and none offered a threshold for adequate adherence. Most guidelines (n = 22/24) reported adherence interventions, 20 guidelines (83%) identified adherence barriers, 20 guidelines (83%) noted variable methods to evaluate adherence, and 17 guidelines (71%) proposed a range of frequencies for assessing adherence. Conclusions: This review underscored a lack of consensus around adherence and its management. Very few guidelines defined adherence, none proposed an optimal threshold, and there was no agreement on how to gauge adherence. These gaps and variability raise questions about how clinicians manage adherence in practice. More systematic and preventative approaches to monitoring adherence may be needed. Full article

Multidrug-resistant (MDR) Mycoplasma genitalium (M. genitalium) presents a significant risk of treatment failure in many sexually transmitted infections (STIs) and can result in persistent and recurrent urethritis or cervicitis. This case report describes a recurrent M. genitalium urethritis resistant to sulfamethoxazole-trimethoprim (TMP-SMX), doxycycline, and moxifloxacin. The infection was ultimately cured after both the removal of a nidus of infection and through the use of Lefamulin. Lefamulin is a novel agent approved for use in community-acquired bacterial pneumonia and bacterial skin infections that may be useful in difficult sexually transmitted infections. Background/Objectives: Deciding whether or not to treat M. genitalium can be challenging as it can be a colonizer, or present with a symptomatic pathogen, and even if it is causing symptoms, it can be drug-resistant. Our objective here is to highlight important considerations on whether or not to treat and, if so, what options exist. Conclusions: In a world of increasing drug-resistant STIs, this case highlights the challenges of managing MDR M. genitalium and how foreign bodies can allow reoccurrence. Also highlighted in this case, Lefamulin appears to be a viable alternative line of treatment of MDR M. genitalium that defies other first-line antibiotics. Full article