Personalization of therapy for infections caused by N. gonorrhoeae, C. trachomatis, M. genitalium and T. vaginalis. Part II. Evaluation of the clinical effectiveness of personalized therapy

Background. Currently used antimicrobial agents, their doses, and treatment durations are clearly defined by standards and clinical guidelines. Nevertheless, treating patients with sexually transmitted infections presents significant challenges despite the availability of highly effective drugs. In this connection, the transition to personalized treatment is relevant, which is consistent with the provisions of the Strategy for Research and Technological Development of the Russian Federation adopted in 2024. Objective. To evaluate the treatment outcomes for patients with uncomplicated gonococcal, chlamydial, M. genitalium infections, and trichomoniasis using the proposed personalized treatment algorithm (PTA) (study group) and clinical guidelines (CG, control group). Material and methods. The study included 1539 patients who received outpatient treatment for sexually transmitted infections at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology (MSPCDC) in 2021—2024, with uncomplicated gonococcal (n=245), chlamydial (n=799), MG infection (n=379), and trichomoniasis (n=116). The first group (study) included 716 patients who received a personalized approach to therapy depending on the concentration of DNA of pathogens in the urogenital tract: higher doses of antimicrobial drugs and longer courses of therapy for high DNA concentrations (>104 gEq/ml) and lower doses and shorter courses for low DNA concentrations (<104 gEq/ml). The second group (control) included 823 patients treated by doctors in accordance with the current 2024 guidelines, without regard to DNA concentration. Real-time PCR was the test method. Pathogen eradication rate was the outcome measure. Results. When treating patients with gonococcal, chlamydial, and MG infections, the PTA method provided better treatment outcomes (100%, 98%, and 92 effectiveness, respectively) than the CG method (93%, 94%, and 80% effectiveness, respectively). When treating patients with trichomoniasis, both the CG method and the PA method ensured 100% treatment effectiveness. Conclusion. Treatment of gonococcal, chlamydial, and MG infections, performed in accordance with the PTA with differentiation of therapy depending on the concentration of pathogen DNA in the urogenital tract of patients, is clinically more effective than treatment according to approved CG, which does not consider the level of pathogen DNA concentration. This necessitates adjustments to the current CG. Treatment of uncomplicated trichomoniasis should be carried out according to the guidelines with a single dose of metronidazole.