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Lê AS, Labbé AC, Fourmigue A, Dvorakova M, Cox J, Fortin C, Martin I, Grace D, Hart T, Moore D, Lambert G. Mycoplasma genitalium infection among gay, bisexual and other men who have sex with men in Montréal, Canada. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2023; 49:477-486. [PMID: 38504874 PMCID: PMC10946590 DOI: 10.14745/ccdr.v49i1112a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Background The bacteria Mycoplasma genitalium has been identified as a causative agent of urethritis in men, especially in gay, bisexual and other men who have sex with men (gbMSM). Canadian clinic-based data have identified a high prevalence of M. genitalium and resistance to antibiotic treatments. This article estimates the prevalence of M. genitalium infections among Montréal gbMSM, explores correlates for M. genitalium infection and estimates the prevalence of mutations associated with antimicrobial resistance (AMR). Methods Engage Cohort Study is a multi-site longitudinal study on sexually active gbMSM, aged 16 years and older, recruited via respondent-driven sampling in Montréal, Toronto and Vancouver. Participants completed a questionnaire on behaviour and were tested for sexually transmitted and blood-borne infections at each visit. For this sub-study, Montréal participants with a follow-up visit that occurred between November 2018 and November 2019 were included. Results A total of 2,064 samples were provided by 716 participants. Prevalence of M. genitalium infection was 5.7% at rectal and/or urethral sites, 4.0% at rectal site and 2.2% at urethral site. Correlates for M. genitalium infection were younger age and reporting six or more sexual partners in the past six months. Prevalence of macrolide resistance associated mutations (MRAM), quinolone resistance associated mutations (QRAM) and either MRAM or QRAM, was 82%, 29% and 85%, respectively. Conclusion This first population-based study among gbMSM in Canada documents a high prevalence of urethral and rectal M. genitalium infection and high levels of AMR. Our results highlight the importance of access to testing and AMR detection when indicated.
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Affiliation(s)
- Anne-Sophie Lê
- Faculté de médecine, Université de Montréal, Montréal, QC
| | - Annie-Claude Labbé
- Faculté de médecine, Université de Montréal, Montréal, QC
- Division of Infectious Diseases and Microbiology, Hôpital Maisonneuve-Rosemont, Centre intégré de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montréal, QC
| | - Alain Fourmigue
- Research Institute of the McGill University Health Centre, Montréal, QC
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, QC
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montréal, QC
- Direction régionale de santé publique de Montréal, Centre intégré de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC
| | - Claude Fortin
- Faculté de médecine, Université de Montréal, Montréal, QC
- Division of Infectious Diseases and Microbiology, Centre hospitalier de l'Université de Montréal, Montréal, QC
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Trevor Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
- Department of Psychology, Toronto Metropolitan University, Toronto, ON
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Gilles Lambert
- Research Institute of the McGill University Health Centre, Montréal, QC
- Institut National de Santé Publique du Québec, Montréal, QC
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de Jesus Salgado V, de Abreu Oliveira CMP, da Silva ÁMB, de Brito HIL, de Medeiros DS, Soares F, Magno L, Dourado I, Campos GB, Marques LM. Prevalence of Mollicutes among men who have sex with men and transgender women aged 15 to 19 years in Salvador, North-eastern Brazil. BMC Infect Dis 2023; 23:244. [PMID: 37072756 PMCID: PMC10114492 DOI: 10.1186/s12879-023-08213-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/31/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Some species of Mollicutes have been associated with different pathologies of the urogenital tract in humans, with a high prevalence among adult men who have sex with men (MSM) and transgender women (TGW). However, few studies have been performed to investigate its prevalence among adolescents. In this study, we estimated the initial prevalence of Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU), and Ureaplasma parvum (UP); the rate of misdiagnosis at different anatomical sites; and the associated factors with positive tests for Mollicutes among MSM and TGW aged 15 to 19 years enrolled in the PrEP1519 study. METHODS PrEP-1519 is the first study to investigate the effectiveness of pre-exposure prophylaxis for human immunodeficiency virus among adolescent MSM and TGW aged 15 to 19 in Latin America. Oral, anal, and urethral swabs were taken from 246 adolescents upon enrolment in the study to detect MG, MH, UU, and UP by quantitative polymerase chain reaction (qPCR). Bivariate and multivariate analyses were conducted by Poisson regression and 95% confidence intervals (95% CI) were estimated. RESULTS The prevalence of Mollicutes was 32.1%. UU was the most prevalent species (20.7%), followed by MH (13.4%), MG (5.7%), and UP (3.2%); 67.3% of the positive samples would have been missed if only urethral samples had been taken. Receptive anal sex (prevalence ratio [PR] = 1.79; 95% CI = 1.07-3.01) and clinical suspicion of sexually transmitted infection (PR = 1.62; 95% CI = 1.01-2.61) were factors associated with the detection of Mollicutes in general. Group sex (PR = 1.98; 95% CI = 1.12-3.50) and receptive anal sex (PR = 2.36; 95% CI = 0.95-5.86) were associated with the detection of Mycoplasma spp. No sociodemographic, clinical, or behavioural variable was significantly associated with the detection of Ureaplasma spp. CONCLUSIONS A high prevalence of Mollicutes was observed among adolescent MSM and TGW, especially at extragenital sites. Further research is required to understand the epidemiological profile of high-risk adolescents in different regions and contexts, and to investigate the pathogenesis of Mollicutes in the oral and anal mucosa before routine screening can be recommended in clinical practice.
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Affiliation(s)
- Valdiele de Jesus Salgado
- State University of Santa Cruz, Rod. Jorge Amado, Km 16, Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | | | - Ágatha Morgana Bertoti da Silva
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Henrique Inácio Lima de Brito
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Danielle Souto de Medeiros
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Fabiane Soares
- Institute of Collective Health, Federal University of Bahia, Av. Adhemar de Barros, S/nº, Ondina, Salvador, Bahia, 40170-110, Brazil
| | - Laio Magno
- Institute of Collective Health, Federal University of Bahia, Av. Adhemar de Barros, S/nº, Ondina, Salvador, Bahia, 40170-110, Brazil
- Department of Life Sciences, State University of Bahia, Rua Silveira Martins, 2555, Salvador, Bahia, 41000-150, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Av. Adhemar de Barros, S/nº, Ondina, Salvador, Bahia, 40170-110, Brazil
| | - Guilherme Barreto Campos
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Lucas Miranda Marques
- State University of Santa Cruz, Rod. Jorge Amado, Km 16, Salobrinho, Ilhéus, Bahia, 45662-900, Brazil.
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil.
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Pitt R, Boampong D, Day M, Jensen JS, Cole M. Challenges of in vitro propagation and antimicrobial susceptibility testing of Mycoplasma genitalium. J Antimicrob Chemother 2022; 77:2901-2907. [PMID: 35979812 DOI: 10.1093/jac/dkac281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The sexually transmitted bacterial pathogen Mycoplasma genitalium has proved a complex organism to work with in the laboratory setting. Exhibiting an extremely fastidious nature, successful in vitro propagation of M. genitalium has remained elusive for many researchers. Antimicrobial resistance to both first- and second-line recommended therapies (macrolides and fluoroquinolones, respectively) is commonly reported. However, phenotypic susceptibility testing is not routinely performed, due to the difficulties of in vitro growth. Instead, molecular detection of known resistance determinants is used to infer susceptibility/resistance. However, associations between determinant detection and clinical treatment failure are not always clear. Furthermore, molecular assays have limited use for detection of emerging resistance mechanisms. The present review collates and discusses the development of successful culture systems for initial isolation of this organism and current methodologies employed for phenotypic susceptibility testing to aid researchers in this field. As with Neisseria gonorrhoeae, future treatment options are extremely limited for M. genitalium and, if this sexually transmitted infection is to remain treatable, phenotypic susceptibility testing will play an invaluable role in evaluation of potential therapeutics. As such, retainment of these techniques is imperative.
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Affiliation(s)
- Rachel Pitt
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | | | - Michaela Day
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | | | - Michelle Cole
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
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A Systematic Review and Meta-Analysis of Efficacy and Safety of Azithromycin Versus Moxifloxacin for the Initial Treatment of Mycoplasma genitalium Infection. Antibiotics (Basel) 2022; 11:antibiotics11030353. [PMID: 35326816 PMCID: PMC8944501 DOI: 10.3390/antibiotics11030353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 02/01/2023] Open
Abstract
Mycoplasma genitalium is recognized as a remarkable pathogen since azithromycin-resistant strains and treatment failure have been increasingly reported. Nevertheless, international guidelines still recommend azithromycin as a first-line treatment and moxifloxacin as a second-line treatment. We performed a systematic review and meta-analysis to validate the efficacy and safety of both drugs in the initial treatment of M. genitalium. We systematically searched the EMBASE, PubMed, Scopus, Ichushi, and CINAHL databases up to December 2021. We defined efficacy as clinical and microbiologic cure, and safety as persistent diarrhea. Overall, four studies met the inclusion criteria: one showed clinical cure (azithromycin treatment, n = 32; moxifloxacin treatment, n = 6), four showed microbiologic cure (n = 516; n = 99), and one showed safety (n = 63; n = 84). Moxifloxacin improved the microbiologic cure rate compared with azithromycin (odds ratio [OR] 2.79, 95% confidence interval [CI], 1.06–7.35). Clinical cure and safety did not show a significant difference between azithromycin and moxifloxacin treatments (OR 4.51, 95% CI 0.23–88.3; OR 0.63, 95% CI 0.21–1.83). Our meta-analysis showed that moxifloxacin was more effective than azithromycin at eradicating M. genitalium infections and supports its preferential use as a first-line treatment.
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Spiller-Boulter O, Paukner S, Boostrom I, Sands K, Portal EAR, Spiller OB. Determination of In Vitro Antimicrobial Susceptibility for Lefamulin (Pleuromutilin) for Ureaplasma Spp. and Mycoplasma hominis. Antibiotics (Basel) 2021; 10:antibiotics10111370. [PMID: 34827308 PMCID: PMC8614837 DOI: 10.3390/antibiotics10111370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022] Open
Abstract
Lefamulin is the first of the pleuromutilin class of antimicrobials to be available for therapeutic use in humans. Minimum inhibitory concentrations of lefamulin were determined by microbroth dilution for 90 characterised clinical isolates (25 Ureaplasma parvum, 25 Ureaplasma urealyticum, and 40 Mycoplasma hominis). All Mycoplasma hominis isolates possessed lefamulin MICs of ≤0.25 mg/L after 48 h (MIC50/90 of 0.06/0.12 mg/L), despite an inherent resistance to macrolides; while Ureaplasma isolates had MICs of ≤2 mg/L after 24 h (MIC50/90 of 0.25/1 mg/L), despite inherent resistance to clindamycin. Two U. urealyticum isolates with additional A2058G mutations of 23S rRNA, and one U. parvum isolate with a R66Q67 deletion (all of which had a combined resistance to macrolides and clindamycin) only showed a 2-fold increase in lefamulin MIC (1–2 mg/L) relative to macrolide-susceptible strains. Lefamulin could be an effective alternative antimicrobial for treating Ureaplasma spp. and Mycoplasma hominis infections irrespective of intrinsic or acquired resistance to macrolides, lincosamides, and ketolides. Based on this potent in vitro activity and the known good, rapid, and homogenous tissue penetration of female and male urogenital tissues and glands, further exploration of clinical efficacy of lefamulin for the treatment of Mycoplasma and Ureaplasma urogenital infections is warranted.
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Affiliation(s)
| | | | - Ian Boostrom
- Division of Infection and Immunity, Department of Medical Microbiology, Cardiff University, 6th Floor University Hospital of Wales, Cardiff CF14 4XN, UK; (I.B.); (K.S.); (E.A.R.P.)
| | - Kirsty Sands
- Division of Infection and Immunity, Department of Medical Microbiology, Cardiff University, 6th Floor University Hospital of Wales, Cardiff CF14 4XN, UK; (I.B.); (K.S.); (E.A.R.P.)
- Department of Zoology, University of Oxford, Oxford OX1 3RE, UK
| | - Edward A. R. Portal
- Division of Infection and Immunity, Department of Medical Microbiology, Cardiff University, 6th Floor University Hospital of Wales, Cardiff CF14 4XN, UK; (I.B.); (K.S.); (E.A.R.P.)
- Bacterial Reference Department, UK Health Security Agency, London NW9 5DF, UK
| | - Owen B. Spiller
- Division of Infection and Immunity, Department of Medical Microbiology, Cardiff University, 6th Floor University Hospital of Wales, Cardiff CF14 4XN, UK; (I.B.); (K.S.); (E.A.R.P.)
- Bacterial Reference Department, UK Health Security Agency, London NW9 5DF, UK
- Correspondence:
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Brin C, Palich R, Godefroy N, Simon A, Robert J, Bébéar C, Sougakoff W, Agher R, Caumes E, Monsel G. Clinical, epidemiological and therapeutic characteristics of Mycoplasma genitalium infection in a French STI center. Infect Dis Now 2021; 52:13-17. [PMID: 34547546 DOI: 10.1016/j.idnow.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We report the characteristics of Mycoplasmagenitalium (MG) infection in patients from a STI center in Paris. We evaluated outcomes after treatment. METHODS We included all patients tested for MG, Chlamydiatrachomatis (CT) and Neisseria gonorrhoeae (NG) infection in our center from January 2017 to December 2018, using multiplex PCR on urine specimen, vaginal or rectal swabs. We collected data regarding sex, age, HIV status, PrEP use, sexual behavior, NG and CT co-infection, symptoms and treatment. RESULTS MG infection prevalence was 7% (397/5586) (95% CI 6.4-7.8). It ranged from 4.6% in patients consulting for routine STI testing (3.9% in women, 5% in men), to 16% in HIV-positive patients and 25% in PrEP users. Among the 397 MG infected patients, 351 (88%) were asymptomatic and 87 (22%) were co-infected with NG or CT. Among the 270 (68%) treated patients, 249 (92%) received azithromycin. Failure rate was 74% in the 103 patients tested post-treatment. Treatment failure tended to be higher with azithromycin single dose than with 5-day azithromycin (88% vs. 70%; P=0.07). Azithromycin and moxifloxacin were used as second-line treatment in 24 and 23 patients, respectively. Post-treatment PCR remained positive in 55% of the 44 tested patients with a better eradication rate with moxifloxacin than with azithromycin (70% vs. 33%; P=0.04). CONCLUSION MG infection is highly prevalent in PrEP users and HIV-positive patients and is mostly asymptomatic. Management of MG infection should be tailored and adapted to the risk of antibiotic resistance and reinfection.
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Affiliation(s)
- Cécile Brin
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France.
| | - Romain Palich
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France; Inserm, institut Pierre-Louis épidémiologie et santé publique (iPLESP), Sorbonne Université, Paris, France
| | - Nagisa Godefroy
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France
| | - Anne Simon
- Centre de santé sexuelle CeGIDD (centre gratuit d'information, de dépistage et de diagnostic), Sorbonne Université, AP-HP, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - Jérôme Robert
- Inserm (U1135-E2), laboratoire de bactériologie-hygiène, centre d'immunologie et des maladies infectieuses, Sorbonne Université, GH AP-HP, Site Pitié, Paris, France
| | - Cécile Bébéar
- Laboratoire de bactériologie, centre national de référence des IST bactériennes, CHU de Bordeaux, Bordeaux, France
| | - Wladimir Sougakoff
- Inserm (U1135-E2), laboratoire de bactériologie-hygiène, centre d'immunologie et des maladies infectieuses, Sorbonne Université, GH AP-HP, Site Pitié, Paris, France
| | - Rachid Agher
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France
| | - Eric Caumes
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France; Inserm, institut Pierre-Louis épidémiologie et santé publique (iPLESP), Sorbonne Université, Paris, France
| | - Gentiane Monsel
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France; Centre de santé sexuelle CeGIDD (centre gratuit d'information, de dépistage et de diagnostic), Sorbonne Université, AP-HP, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Paris, France
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Parmar NR, Mushanski L, Wanlin T, Lepe A, Lang A, Minion J, Dillon JAR. High Prevalence of Macrolide and Fluoroquinolone Resistance-Mediating Mutations in Mycoplasma genitalium-Positive Urine Specimens From Saskatchewan. Sex Transm Dis 2021; 48:680-684. [PMID: 34397971 DOI: 10.1097/olq.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mycoplasma genitalium is an emerging, sexually transmitted infection, which is more prevalent than Chlamydia trachomatis in some regions. An increase in antibiotic resistance, that is, azithromycin and moxifloxacin, recommended for treating M. genitalium infections has been noted. This is the first detailed report on the prevalence of M. genitalium and its antimicrobial resistance in Saskatchewan, Canada. METHODS Aptima urine specimens (n = 1977), collected for the diagnosis of C. trachomatis/Neisseria gonorrhoeae, were tested for M. genitalium using the Aptima M. genitalium assay (MG-TMA). Antimicrobial resistance was ascertained using polymerase chain reaction and DNA sequencing of 23S rRNA (azithromycin) and parC (moxifloxacin) from Aptima M. genitalium assay-positive specimens; mutations predictive of resistance were noted. RESULTS The prevalence of M. genitalium was 9.6% (189/1977). Predicted resistance to azithromycin (substitutions at positions 2058/2059 in 23S rRNA) was observed in 63.6% (70/110) of the specimens tested, whereas resistance to moxifloxacin (S83I in ParC) was observed in 10.6% (9/85) of the specimens. Mutations in both 23S rRNA and ParC were observed in 2.12% (4/189) of the specimens. Women aged 20 to 24 years had the highest prevalence (18.3%, P < 0.001), and in females, M. genitalium was significantly associated with C. trachomatis or N. gonorrhoeae/C. trachomatis (P < 0.001) coinfection. The prevalence of M. genitalium (9.6%) in the province of Saskatchewan was higher than that of the other 2 bacterial sexually transmitted infections (N. gonorrhoeae (3.09%) and C. trachomatis (6.85%). CONCLUSIONS The prevalence of M. genitalium (9.6%) and associated resistance to azithromycin (63.6%) in Saskatchewan high, suggesting that empiric azithromycin therapy may not be adequate for treating M. genitalium infections.
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Affiliation(s)
| | - Linda Mushanski
- Saskatchewan Health Authority, Roy Romanow Provincial Laboratory, Regina, Saskatchewan, Canada
| | - Tasker Wanlin
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon
| | | | - Amanda Lang
- Saskatchewan Health Authority, Roy Romanow Provincial Laboratory, Regina, Saskatchewan, Canada
| | - Jessica Minion
- Saskatchewan Health Authority, Roy Romanow Provincial Laboratory, Regina, Saskatchewan, Canada
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Lucena Nemirosky J, Espelt R, López Grado E, Sobrino J, Acera A, Pérez J, Jensen JS, Sánchez-Reus F, Prim N. Macrolide resistance in Mycoplasma genitalium in Catalonia, Spain: a 1 year prospective study. J Antimicrob Chemother 2021; 76:2702-2707. [PMID: 34278431 DOI: 10.1093/jac/dkab224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium is an emergent cause of sexually transmitted disease (STD). The first-line treatment is azithromycin, but macrolide resistance is increasing due to mutations in the 23S rRNA gene. OBJECTIVES To determine the rates of M. genitalium infection and macrolide resistance in an area adjacent to Barcelona. METHODS This 1 year prospective study was performed in a heterogenous population that included both low- and high-risk patients. M. genitalium was detected in all specimens sent to our institution for STD detection. Epidemiological and relevant clinical data were collected in the positive cases. Characterization of macrolide-associated resistance was performed by 23S rDNA sequencing. RESULTS Of the 3540 patients included, 132 (3.7%) were positive for M. genitalium. Another sexually transmitted bacteria was detected in 20.4% of the M. genitalium cases, and Chlamydia trachomatis (11%) was the most frequently co-detected microorganism. Only 61.4% of patients received an adequate initial treatment against M. genitalium. The test of cure (TOC) was performed in 42% of patients, and therapeutic failure was detected in 10 cases. The rate of macrolide resistance was 12.6% and the most prevalent mutation was A2058G. There was an association between macrolide resistance and a previous history of M. genitalium detection (P < 0.001). CONCLUSIONS Our results support the contribution of the previous use of macrolides in resistant strains. Given the difficulties in performing TOC in all patients, the inclusion of macrolide resistance in the detection test should be mandatory.
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Affiliation(s)
- J Lucena Nemirosky
- Laboratorio Cerba Internacional SAE, Plaça Ramon Llull, 7, 08203, Sabadell, Barcelona, Spain
| | - R Espelt
- Institut Català de la Salut, Direcció d'Atenció Primaria Metropolitana Nord, Atenció de la Salut Sexual i Reproductiva CAP Sant Fèlix, 08203, Sabadell, Barcelona, Spain
| | - E López Grado
- Institut Català de la Salut, Direcció d'Atenció Primaria Metropolitana Nord, Atenció de la Salut Sexual i Reproductiva CAP Sant Fèlix, 08203, Sabadell, Barcelona, Spain
| | - J Sobrino
- Institut Català de la Salut, Direcció d'Atenció Primaria Metropolitana Nord, Atenció de la Salut Sexual i Reproductiva CAP Sant Fèlix, 08203, Sabadell, Barcelona, Spain
| | - A Acera
- Institut Català de la Salut, Direcció d'Atenció Primaria Metropolitana Nord, Atenció de la Salut Sexual i Reproductiva CAP II Cerdanyola - Ripollet, 08291, Ripollet, Barcelona, Spain
| | - J Pérez
- Catlab (Parc Logistic de Salut), 08232, Viladecavalls, Barcelona, Spain
| | - J S Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - F Sánchez-Reus
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain.,Departament de Genètica i Microbiologia, Universitat Autonòma de Barcelona, Bellaterra, Spain
| | - N Prim
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain.,Laboratori de Referència de Catalunya, 08820, El Prat de Llobregat, Barcelona, Spain
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Cheung C, Bourne C, Varma R. Mycoplasma genitalium: test positivity in syndromic presentations and clinicians' adherence with treatment guidelines at Sydney Sexual Health Centre. Int J STD AIDS 2021; 32:1174-1177. [PMID: 34106023 DOI: 10.1177/09564624211022583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mycoplasma genitalium (M.genitalium) is associated with urethritis, cervicitis, pelvic inflammatory disease, proctitis and epididymitis. Its treatment is complicated by antimicrobial resistance. To assess clinicians' adherence to M.genitalium diagnostic testing recommendations for syndromic presentations, as well as resistance-guided management of M.genitalium at Sydney Sexual Health Centre, we reviewed patients presenting between August and December 2018. 349/372 (94%) syndromic presentations were tested for M.genitalium with 16% M.genitalium test positivity and 81% macrolide resistance. 16/27 (59%) macrolide-sensitive infections and 65/77 (84%) macrolide-resistant infections received resistance-guided treatment. Tests of cure (TOCs) were unnecessarily ordered for 82% macrolide-sensitive cases, while 88% macrolide-resistant cases were correctly ordered TOCs. Co-existing STIs at the time of macrolide-sensitive (p = 0.30) or macrolide-resistant M.genitalium (p = 0.94) diagnosis did not significantly affect adherence to treatment guidelines. This study confirms the expected prevalence of M.genitalium and macrolide resistance in syndromic presentations while our real-world data highlight the decision-making challenges involved with managing M.genitalium, offering insights for further research.
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Affiliation(s)
- Calvin Cheung
- 4334The University of Sydney, Sydney, NSW, Australia
| | - Christopher Bourne
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,379373Sydney Sexual Health Centre, Sydney Eye Hospital, Sydney, NSW, Australia
| | - Rick Varma
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,379373Sydney Sexual Health Centre, Sydney Eye Hospital, Sydney, NSW, Australia
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10
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de Lannoy LH, da Silva RJDC, Nahn EP, de Oliveira EC, Gaspar PC. Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause urethral discharge. Rev Soc Bras Med Trop 2021; 54:e2020633. [PMID: 34008729 PMCID: PMC8210486 DOI: 10.1590/0037-8682-633-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
This article approaches infections that cause urethral discharge. This theme is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. Urethritis can cause severe and even irreversible health damage when not properly treated, or when the microorganism develops antimicrobial resistance. It is noteworthy that the high levels of antimicrobial resistance grown by pathogens that cause urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention, and control actions for infections that cause urethral discharge, to contribute to managers' and health professionals' care qualification. Associated factors with urethritis are: young age, low socioeconomic level, multiple partnerships or new sexual partnership, history of STI, irregular use of condoms, and lack of access to adequate diagnosis and treatment.
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Affiliation(s)
- Leonor Henriette de Lannoy
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Infectologia, Vitória, ES, Brasil
| | - Roberto José de Carvalho da Silva
- Faculdade das Américas, Centro Universitário, São Paulo, SP, Brasil
- Secretaria de Estado da Saúde de São Paulo, Programa Estadual de DST/Aids, São Paulo, SP, Brasil
| | - Edilbert Pellegrini Nahn
- Universidade Federal do Estado do Rio de Janeiro, Campus Macaé, RJ, Brasil
- Faculdade de Medicina de Campos, Campos dos Goytacazes, RJ, Brasil
| | - Eduardo Campos de Oliveira
- Secretaria de Estado da Saúde de Santa Catarina, Gestão Estadual de DST/Aids/HIV de Santa Catarina, Florianópolis, SC, Brasil
| | - Pâmela Cristina Gaspar
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
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11
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Lannoy LHD, Silva RJDCD, Nahn Júnior EP, Oliveira ECD, Gaspar PC. [Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause urethral discharge]. ACTA ACUST UNITED AC 2021; 30:e2020633. [PMID: 33729412 DOI: 10.1590/s1679-4974202100009.esp1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022]
Abstract
This article approach infections that cause urethral discharge, theme which is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. When urethritis is not treated correctly, or when the microorganism develops antimicrobial resistance, it can cause serious and even irreversible health damage. It is noteworthy that the high levels of antimicrobial resistance developed by pathogens that causes urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention and control actions of infections that cause urethral discharge, with the purpose of contributing with managers and health professionals to care qualification.
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Affiliation(s)
| | | | | | - Eduardo Campos de Oliveira
- Secretaria de Estado da Saúde de Santa Catarina, Gerência Estadual de IST/Aids/HV, Florianópolis, SC, Brasil
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12
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Anorectal and Urogenital Mycoplasma genitalium in Nigerian Men Who Have Sex With Men and Transgender Women: Prevalence, Incidence, and Association With HIV. Sex Transm Dis 2021; 47:202-206. [PMID: 31880740 DOI: 10.1097/olq.0000000000001105] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Among 413 Nigerian men who have sex with men and transgender women, retrospective testing for Mycoplasma genitalium revealed mostly asymptomatic infections of the anorectum (prevalence, 36.8%; incidence, 18.4 cases/100 person-years) and urogenital tract (12.4%, 4.0 cases/100 person-years). Risk factors included HIV and increasing number of sex partners.
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13
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Shipitsyna E, Unemo M. A profile of the FDA-approved and CE/IVD-marked Aptima Mycoplasma genitalium assay (Hologic) and key priorities in the management of M. genitalium infections. Expert Rev Mol Diagn 2020; 20:1063-1074. [PMID: 33095669 DOI: 10.1080/14737159.2020.1842198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Mycoplasma genitalium (MG) causes frequently asymptomatic STIs. MG prevalence figures are lacking and management is complicated by the lack of etiological diagnostics and high antimicrobial resistance in many countries. Appropriately validated, quality-assured, and FDA-approved MG diagnostic assays have been lacking. AREAS COVERED The clinical and analytical performance characteristics of the Aptima® MG assay, the first FDA-approved MG nucleic acid amplification test (NAAT), are summarized. Key priorities in the management and control of MG infections are also discussed. EXPERT OPINION Highly sensitive, specific, and quality-assured MG NAATs, e.g. the Aptima MG assay on the automated and flexible Panther® platform, are imperative to improve the management and control of MG infections internationally. This testing, combined with macrolide-resistance testing (not yet available on the Panther platform), offers a rapid, high-throughput, and appropriate diagnosis of MG. Macrolide resistance-guided sequential treatment needs to be implemented for MG infections. Dual antimicrobial therapy, novel antimicrobials and, ideally, a vaccine may become essential.
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Affiliation(s)
- Elena Shipitsyna
- Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , St. Petersburg, Russia
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
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14
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Pitt R, Unemo M, Sonnenberg P, Alexander S, Beddows S, Cole MJ, Clifton S, Mercer CH, Johnson AM, Ison CA, Field N. Antimicrobial resistance in Mycoplasma genitalium sampled from the British general population. Sex Transm Infect 2020; 96:464-468. [PMID: 31924741 PMCID: PMC7476295 DOI: 10.1136/sextrans-2019-054129] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/20/2019] [Accepted: 12/12/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium is a common sexually transmitted infection. Treatment guidelines focus on those with symptoms and sexual contacts, generally with regimens including doxycycline and/or azithromycin as first-line and moxifloxacin as second-line treatment. We investigated the prevalence of antimicrobial resistance (AMR)-conferring mutations in M. genitalium among the sexually-active British general population. METHODS The third national survey of sexual attitudes and lifestyles (Natsal-3) is a probability sample survey of 15 162 men and women aged 16-74 years in Britain conducted during 2010-12. Urine test results for M. genitalium were available for 4507 participants aged 16-44 years reporting >1 lifetime sexual partner. In this study, we sequenced regions of the 23S rRNA and parC genes to detect known genotypic determinants for resistance to macrolides and fluoroquinolones respectively. RESULTS 94% (66/70) of specimens were re-confirmed as M. genitalium positive, with successful sequencing in 85% (56/66) for 23S rRNA and 92% (61/66) for parC genes. Mutations in 23S rRNA gene (position A2058/A2059) were detected in 16.1% (95%CI: 8.6% to 27.8%) and in parC (encoding ParC D87N/D87Y) in 3.3% (0.9%-11.2%). Macrolide resistance was more likely in participants reporting STI diagnoses (past 5 years) (44.4% (18.9%-73.3%) vs 10.6% (4.6%-22.6%); p=0.029) or sexual health clinic attendance (past year) (43.8% (23.1%-66.8%) vs 5.0% (1.4%-16.5%); p=0.001). All 11 participants with AMR-conferring mutations had attended sexual health clinics (past 5 years), but none reported recent symptoms. CONCLUSIONS This study highlights challenges in M. genitalium management and control. Macrolide resistance was present in one in six specimens from the general population in 2010-2012, but no participants with AMR M. genitalium reported symptoms. Given anticipated increases in diagnostic testing, new strategies including novel antimicrobials, AMR-guided therapy, and surveillance of AMR and treatment failure are recommended.
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Affiliation(s)
- Rachel Pitt
- National Infection Service, Public Health England, London, United Kingdom
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | - Pam Sonnenberg
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, UCL, London, United Kingdom
| | - Sarah Alexander
- National Infection Service, Public Health England, London, United Kingdom
| | - Simon Beddows
- National Infection Service, Public Health England, London, United Kingdom
| | | | - Soazig Clifton
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, UCL, London, United Kingdom
| | - Catherine H Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, UCL, London, United Kingdom
| | - Anne M Johnson
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, UCL, London, United Kingdom
| | - Catherine A Ison
- National Infection Service, Public Health England, London, United Kingdom
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, UCL, London, United Kingdom
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15
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Prevalence of Mycoplasma genitalium and Antibiotic Resistance-Associated Mutations in Patients at a Sexually Transmitted Infection Clinic in Iceland, and Comparison of the S-DiaMGTV and Aptima Mycoplasma genitalium Assays for Diagnosis. J Clin Microbiol 2020; 58:JCM.01084-20. [PMID: 32611793 DOI: 10.1128/jcm.01084-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/24/2020] [Indexed: 01/29/2023] Open
Abstract
Mycoplasma genitalium is prevalent among attendees in sexually transmitted infection (STI) clinics, and therapy is hampered by rapidly rising levels of resistance to azithromycin and moxifloxacin. In this study, we evaluated, for the first time in Iceland, the prevalence of M. genitalium and azithromycin and moxifloxacin resistance-associated mutations and assessed the diagnostic performance of the CE/in vitro diagnosis (IVD)-marked S-DiaMGTV (Diagenode Diagnostics) versus the U.S. FDA/CE/IVD-approved Aptima MG (AMG; Hologic) for M. genitalium detection. From October 2018 to January 2019, urine and vaginal swabs were provided by male and female attendees at Iceland's only STI clinic. Specimens were tested with S-DiaMGTV and AMG, and resistance-associated mutations were determined by 23S rRNA gene and parC sequencing. Demographic and clinical data were collected from patient records. M. genitalium prevalence was 9.3% overall; 7.7% (38/491) among male and 10.9% (53/487) among female participants. Azithromycin and moxifloxacin resistance-associated mutations were found in 57.0% (45/79) and 0.0% (0/80) of evaluable specimens, respectively. Sensitivity was 72.5% and 100%, and specificity was 99.9% and 100% for S-DiaMGTV and AMG, respectively. No association was found between M. genitalium and symptoms of urethritis in men. Prevalence rates for M. genitalium and azithromycin resistance-associated genes in Iceland are among the highest reported in Europe. The significantly higher sensitivity of AMG over that of S-DiaMGTV can have important clinical implications. More information is urgently needed to clarify the significance of false-negative results obtained with S-DiaMGTV and other similarly performing widely used real-time PCR methods for diagnosis and management of this sexually transmitted infection.
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16
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Machalek DA, Tao Y, Shilling H, Jensen JS, Unemo M, Murray G, Chow EPF, Low N, Garland SM, Vodstrcil LA, Fairley CK, Hocking JS, Zhang L, Bradshaw CS. Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2020; 20:1302-1314. [PMID: 32622378 DOI: 10.1016/s1473-3099(20)30154-7] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 01/17/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mycoplasma genitalium is now recognised as an important bacterial sexually transmitted infection. We summarised data from studies of mutations associated with macrolide and fluoroquinolone resistance in M genitalium to establish the prevalence of resistance. We also investigated temporal trends in resistance and aimed to establish the association between resistance and geographical location. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, and MEDLINE for studies that included data for the prevalence of mutations associated with macrolide and fluoroquinolone resistance in M genitalium published in any language up to Jan 7, 2019. We defined prevalence as the proportion of M genitalium samples positive for key mutations associated with azithromycin resistance (23S rRNA gene, position 2058 or 2059) or moxifloxacin resistance (S83R, S83I, D87N, or D87Y in parC), or both, among all M genitalium samples that were successfully characterised. We used random-effects meta-analyses to calculate summary estimates of prevalence. Subgroup and meta-regression analyses by WHO region and time period were done. This study was registered with PROSPERO, number CRD42016050370. RESULTS Overall, 59 studies from 21 countries met the inclusion criteria for our study: 57 studies of macrolide resistance (8966 samples), 25 of fluoroquinolone resistance (4003 samples), and 22 of dual resistance to macrolides and fluoroquinolones (3280 samples). The summary prevalence of mutations associated with macrolide resistance among M genitalium samples was 35·5% (95% CI 28·8-42·5); prevalence increased from 10·0% (95% CI 2·6-20·1%) before 2010, to 51·4% (40·3-62·4%) in 2016-17 (p<0·0001). Prevalence of mutations associated with macrolide resistance was significantly greater in samples in the WHO Western Pacific and Americas regions than in those from the WHO European region. The overall prevalence of mutations associated with fluoroquinolone resistance in M genitalium samples was 7·7% (95% CI 4·5-11·4%). Prevalence did not change significantly over time, but was significantly higher in the Western Pacific region than in the European region. Overall, the prevalence of both mutations associated with macrolide resistance and those associated with fluoroquinolone resistance among M genitalium samples was 2·8% (1·3-4·7%). The prevalence of dual resistance did not change significantly over time, and did not vary significantly by geographical region. INTERPRETATION Global surveillance and measures to optimise the efficacy of treatments-including resistance-guided strategies, new antimicrobials, and antimicrobial combination approaches-are urgently needed to ensure cure in a high proportion of M genitalium infections and to prevent further spread of resistant strains. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Dorothy A Machalek
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; The Kirby Institute, University of New South Wales, Kensington, Sydney, NSW, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
| | - Yusha Tao
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hannah Shilling
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jørgen S Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gerald Murray
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Catriona S Bradshaw
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
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17
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Chambers LC, Jensen JS, Morgan JL, Lowens MS, Romano SS, Totten PA, Soge OO, Hughes JP, Golden MR, Manhart LE. Lack of Association Between the S83I ParC Mutation in Mycoplasma genitalium and Treatment Outcomes Among Men Who Have Sex With Men with Nongonococcal Urethritis. Sex Transm Dis 2020; 46:805-809. [PMID: 31259853 DOI: 10.1097/olq.0000000000001035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
From February 2015 to October 2017, among 20 men who have sex with men with Mycoplasma genitalium-associated nongonococcal urethritis, 15% had macrolide resistance and S83I ParC mutations. Azithromycin followed by moxifloxacin cleared Mycoplasma genitalium in 2 of 2 with and 11 of 13 without S83I mutations. Dual failures were cleared after doxycycline. S83I mutations were not associated with moxifloxacin failure.
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Affiliation(s)
- Laura C Chambers
- From the Department of Epidemiology, University of Washington, Seattle, WA
| | | | | | | | - Sarah S Romano
- From the Department of Epidemiology, University of Washington, Seattle, WA
| | | | | | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Matthew R Golden
- From the Department of Epidemiology, University of Washington, Seattle, WA.,HIV/STD Program, Public Health-Seattle and King County.,Department of Medicine
| | - Lisa E Manhart
- From the Department of Epidemiology, University of Washington, Seattle, WA.,Department of Global Health
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18
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Mycoplasma genitalium, Chlamydia trachomatis, and Neisseria gonorrhoeae Detected With Aptima Assays Performed on Self-Obtained Vaginal Swabs and Urine Collected at Home and in a Clinic. Sex Transm Dis 2020; 46:e87-e89. [PMID: 31415336 DOI: 10.1097/olq.0000000000001004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Self-obtained vaginal swabs, first-void urine and pooled specimens were collected at home and in a clinic. Percent prevalence and collection site concordance was 30.3 and 100 for Mycoplasma genitalium (74.4% azithromycin resistant) 15.1 and 96.7 for Chlamydia trachomatis and 6.6 and 100 for Neisseria gonorrhoeae (27% ciprofloxacin-resistant).
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19
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Hart T, Tang WY, Mansoor SAB, Chio MTW, Barkham T. Mycoplasma genitalium in Singapore is associated with Chlamydia trachomatis infection and displays high macrolide and Fluoroquinolone resistance rates. BMC Infect Dis 2020; 20:314. [PMID: 32345231 PMCID: PMC7189604 DOI: 10.1186/s12879-020-05019-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/07/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Mycoplasma genitalium is an emerging sexually transmitted infection, with increasing rates of resistance to fluroquinolones and macrolides, the recommended treatments. Despite this, M. genitalium is not part of routine screening for Sexually Transmitted Infections (STIs) in many countries and the prevalence of infection and patterns of disease remain to be determined in many populations. Such data is of particular importance in light of the reported rise in antibiotic resistance in M. genitalium isolates. METHODS Urine and urethral swab samples were collected from the primary public sexual health clinic in Singapore and tested for C. trachomatis (CT) or N. gonorrhoeae (NG) infection and for the presence of M. genitalium. Antibiotic resistance in M. genitalium strains detected was determined by screening for genomic mutations associated with macrolide and fluroquinolone resistance. RESULTS We report the results of a study into M. genitalium prevalence at the national sexual health clinic in Singapore. M. genitalium was heavily associated with CT infection (8.1% of cases), but present in only of 2.4% in CT negative cases and not independently linked to NG infection. Furthermore, we found high rates of resistance mutations to both macrolides (25%) and fluoroquinolones (37.5%) with a majority of resistant strains being dual-resistant. Resistance mutations were only found in strains from patients with CT co-infection. CONCLUSIONS Our results support targeted screening of CT positive patients for M. genitalium as a cost-effective strategy to reduce the incidence of M. genitalium in the absence of comprehensive routine screening. The high rate of dual resistance also highlights the need to ensure the availability of alternative antibiotics for the treatment of multi-drug resistant M. genitalium isolates.
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MESH Headings
- Ambulatory Care Facilities
- Anti-Bacterial Agents/pharmacology
- Anti-Bacterial Agents/therapeutic use
- Chlamydia Infections/complications
- Chlamydia Infections/diagnosis
- Chlamydia Infections/drug therapy
- Chlamydia trachomatis/drug effects
- Chlamydia trachomatis/genetics
- Chlamydia trachomatis/isolation & purification
- DNA, Bacterial/genetics
- DNA, Bacterial/metabolism
- Drug Resistance, Multiple, Bacterial/genetics
- Fluoroquinolones/pharmacology
- Fluoroquinolones/therapeutic use
- Humans
- Macrolides/pharmacology
- Macrolides/therapeutic use
- Mycoplasma Infections/complications
- Mycoplasma Infections/diagnosis
- Mycoplasma Infections/drug therapy
- Mycoplasma Infections/epidemiology
- Mycoplasma genitalium/drug effects
- Mycoplasma genitalium/genetics
- Mycoplasma genitalium/isolation & purification
- Prevalence
- RNA, Ribosomal, 23S/chemistry
- RNA, Ribosomal, 23S/genetics
- RNA, Ribosomal, 23S/metabolism
- Sequence Analysis, DNA
- Singapore/epidemiology
- Urethra/microbiology
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Affiliation(s)
- Tim Hart
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Wen Ying Tang
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Siti Aminah Bte Mansoor
- Department of Sexually Transmitted Infections Control Clinic, 31 Kelantan Ln, Singapore, 200031, Singapore
| | - Martin T W Chio
- Department of Sexually Transmitted Infections Control Clinic, 31 Kelantan Ln, Singapore, 200031, Singapore
| | - Timothy Barkham
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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20
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Latimer RL, Shilling HS, Vodstrcil LA, Machalek DA, Fairley CK, Chow EPF, Read TR, Bradshaw CS. Prevalence of Mycoplasma genitalium by anatomical site in men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect 2020; 96:563-570. [PMID: 32341023 DOI: 10.1136/sextrans-2019-054310] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To systematically review and appraise published data, to determine the prevalence of Mycoplasma genitalium (MG) in men who have sex with men (MSM) tested at each anatomical site, that is, at the urethra, rectum and/or pharynx. DESIGN Systematic review and meta-analysis. DATA SOURCES Ovid Medline, PubMed, Embase were searched for articles from 1st January 1981 (the year MG was first identified) to 1st June 2018. REVIEW METHODS Studies were eligible for inclusion if they reported MG prevalence in MSM tested at the urethra, rectum and/or pharynx, in at least 50 MSM, using nucleic acid amplification testing. Data were extracted by anatomical site, symptom and HIV status. Summary estimates (95% CIs) were calculated using random-effects meta-analysis. Subgroup analyses were performed to assess heterogeneity between studies. RESULTS Forty-six studies met inclusion criteria, with 34 reporting estimates of MG prevalence at the urethra (13 753 samples), 25 at the rectum (8629 samples) and 7 at the pharynx (1871 samples). MG prevalence was 5.0% (95% CI 3.5 to 6.8; I2=94.0) at the urethra; 6.2% (95% CI 4.6 to 8.1; I2=88.1) at the rectum and 1.0% (95% CI 0.0 to 5.1; I2=96.0) at the pharynx. The prevalence of MG was significantly higher at urethral and rectal sites in symptomatic versus asymptomatic MSM (7.1% vs 2.2%, p<0.001; and 16.1% vs 7.5%, p=0.039, respectively). MG prevalence at the urethra was significantly higher in HIV-positive compared with HIV-negative MSM (7.0% vs 3.4%, p=0.006). CONCLUSION MG was common in MSM, particularly at urethral and rectal sites (5% to 6%). MG was more commonly detected in symptomatic men at both sites, and more common in HIV-positive men at the urethra. MG was uncommonly detected in the pharynx. Site-specific estimates are similar to those for chlamydia and will be helpful in informing testing practices in MSM. PROSPERO REGISTRATION NUMBER CRD42017058326.
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Affiliation(s)
- Rosie L Latimer
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia .,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Hannah S Shilling
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Dorothy A Machalek
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tim Rh Read
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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21
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Read TRH, Fairley CK, Murray GL, Jensen JS, Danielewski J, Worthington K, Doyle M, Mokany E, Tan L, Chow EPF, Garland SM, Bradshaw CS. Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation. Clin Infect Dis 2020; 68:554-560. [PMID: 29873691 PMCID: PMC6355821 DOI: 10.1093/cid/ciy477] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/04/2018] [Indexed: 11/14/2022] Open
Abstract
Background Rising macrolide and quinolone resistance in Mycoplasma genitalium necessitate new treatment approaches. We evaluated outcomes of sequential antimicrobial therapy for M. genitalium guided by a macrolide-resistance assay. Methods In mid-2016, Melbourne Sexual Health Centre switched from azithromycin to doxycycline (100 mg twice daily for 7 days) for nongonococcal urethritis, cervicitis, and proctitis. Cases were tested for M. genitalium and macrolide-resistance mutations (MRMs) by polymerase chain reaction. Directly after doxycycline, MRM-negative infections received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and MRM-positive infections received sitafloxacin (100 mg twice daily for 7 days). Assessment of test of cure and reinfection risk occurred 14-90 days after the second antibiotic. Results Of 244 evaluable M. genitalium infections (52 women, 68 heterosexual men, 124 men who have sex with men) diagnosed from 20 June 2016 to 15 May 2017, MRMs were detected in 167 (68.4% [95% confidence interval {CI}, 62.2%-74.2%]). Treatment with doxycycline decreased bacterial load by a mean 2.60 log10 (n = 56; P < .0001). Microbiologic cure occurred in 73 of 77 MRM-negative infections (94.8% [95% CI, 87.2%-98.6%]) and in 154 of 167 MRM-positive infections (92.2% [95% CI, 87.1%-95.8%]). Selection of macrolide resistance occurred in only 2 of 76 (2.6% [95% CI, .3%-9.2%]) macrolide-susceptible infections. Conclusions In the context of high levels of antimicrobial resistance, switching from azithromycin to doxycycline for presumptive treatment of M. genitalium, followed by resistance-guided therapy, cured ≥92% of infections, with infrequent selection of macrolide resistance.
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Affiliation(s)
- Tim R H Read
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne
- Melbourne Sexual Health Centre, Alfred Health, Carlton
- Correspondence: T. R. H. Read, Melbourne Sexual Health Centre, 580 Swanston St, Carlton, Victoria 3053, Australia ()
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne
- Melbourne Sexual Health Centre, Alfred Health, Carlton
| | - Gerald L Murray
- Murdoch Children’s Research Institute, Parkville
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne
- Infection and Immunity Program, Monash Biomedicine Discovery Institute
- Royal Children’s Hospital, Melbourne, Victoria, Australia
| | | | - Jennifer Danielewski
- Murdoch Children’s Research Institute, Parkville
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne
| | | | | | | | - Litty Tan
- SpeeDx Pty Ltd, Eveleigh, New South Wales
| | - Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne
- Melbourne Sexual Health Centre, Alfred Health, Carlton
| | - Suzanne M Garland
- Murdoch Children’s Research Institute, Parkville
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne
- Royal Children’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne
- Melbourne Sexual Health Centre, Alfred Health, Carlton
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22
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Mycoplasma genitalium Infections With Macrolide and Fluoroquinolone Resistance-Associated Mutations in Heterosexual African American Couples in Alabama. Sex Transm Dis 2020; 46:18-24. [PMID: 29979336 DOI: 10.1097/olq.0000000000000891] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mycoplasma genitalium (MG) is a sexually transmitted pathogen associated with inflammatory syndromes in men and women. Macrolides and fluoroquinolones are recommended MG treatments. The frequency of MG strains with macrolide resistance-associated mutations (MRMs) and quinolone resistance-associated mutations (qRMs) is increasing worldwide, however these data are sparse in populations in the United States. METHODS We investigated the prevalence of MG infections with MRMs and qRMs and MG infection concordance within African American couples in Birmingham, AL. We used a real-time polymerase chain reaction to detect MG and identify MRMs. quinolone resistance-associated mutations were detected using traditional polymerase chain reactions amplifying regions in gyrA, gyrB, parC, and parE. The MG concordance in couples was evaluated by MG positivity and MG genotypes. RESULTS Oral, anal, urine, and/or vaginal specimens were tested from 116 couples. Twenty-eight (12.1%) participants comprising 22 couples tested MG-positive (11.2% in men and 12.9% in women). Macrolide resistance-associated mutations were detected in 17 (60.7%) MG-positive participants, with gender-specific resistance rates of 69.2% for men and 53.3% for women. quinolone resistance-associated mutations were detected in 3 (11.1%) MG-positive participants, all of whom also had MRMs. By MG positivity status, 27.3% of couples were concordant. If MG strain genotypes are also considered, then concordance was 20.0%. CONCLUSIONS Among heterosexual African Americans with MG infection, about 60% had strains with MRMs and 11% had strains with both MRMs and qRMs, highlighting the potential for MG treatment failure to not only macrolides, but also quinolones. These findings may help to guide clinicians in MG testing and treatment decisions in the United States.
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23
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Evaluation of the ResistancePlus MG FleXible Cartridge for Near-Point-of-Care Testing of Mycoplasma genitalium and Associated Macrolide Resistance Mutations. J Clin Microbiol 2020; 58:JCM.01897-19. [PMID: 31896664 DOI: 10.1128/jcm.01897-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Singh AE, Manhart L. Is It Time for the United States and Canada to Reconsider Macrolides as the First-line Empiric Treatment for Males With Symptomatic Urethritis? Clin Infect Dis 2020; 70:811-813. [PMID: 30972414 PMCID: PMC8344297 DOI: 10.1093/cid/ciz297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/04/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Lisa Manhart
- Department of Epidemiology and Center for AIDS and STD, University of Washington, Seattle, Washington
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25
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Martens L, Kuster S, de Vos W, Kersten M, Berkhout H, Hagen F. Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014-2017. Emerg Infect Dis 2019; 25:1297-1303. [PMID: 31211669 PMCID: PMC6590771 DOI: 10.3201/eid2507.181556] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mycoplasma genitalium infections of the urogenital tract are usually treated with azithromycin; however, for the past several years, rates of azithromycin treatment failure have increased. To document the occurrence and frequency of macrolide resistance–mediating mutations (MRMMs) in M. genitalium infections, we collected 894 M. genitalium–positive samples during April 2014–December 2017 and retrospectively tested them for MRMMs. We designated 67 samples collected within 6 weeks after a positive result as test-of-cure samples; of these, 60 were MRMM positive. Among the remaining 827 samples, the rate of MRMM positivity rose from 22.7% in 2014 and 22.3% in 2015 to 44.4% in 2016 but decreased to 39.7% in 2017. Because of these high rates of MRMMs in M. genitalium infections, we recommend that clinicians perform tests of cure after treatment and that researchers further explore the clinical consequences of this infection.
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26
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Affiliation(s)
- Ameeta E Singh
- University of Alberta (Singh), Edmonton, Alta.; Université de Montréal (Labbé), Montréal, Que.; Public Health Agency of Canada (Auguste), Ottawa, Ont.
| | - Annie-Claude Labbé
- University of Alberta (Singh), Edmonton, Alta.; Université de Montréal (Labbé), Montréal, Que.; Public Health Agency of Canada (Auguste), Ottawa, Ont
| | - Ulrick Auguste
- University of Alberta (Singh), Edmonton, Alta.; Université de Montréal (Labbé), Montréal, Que.; Public Health Agency of Canada (Auguste), Ottawa, Ont
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27
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McIver R, Jalocon D, McNulty A, Jeoffreys NJ, Chen SCA, Power M, Couldwell DL. Men Who Have Sex With Men With Mycoplasma genitalium-Positive Nongonococcal Urethritis Are More Likely to Have Macrolide-Resistant Strains Than Men With Only Female Partners: A Prospective Study. Sex Transm Dis 2019; 46:513-517. [PMID: 31295218 DOI: 10.1097/olq.0000000000001009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mycoplasma genitalium was previously less common among men who have sex with men (MSM) compared with men with only female partners (MSW) in men with nongonococcal urethritis (NGU) in Sydney, Australia. We aimed to determine the prevalence of M. genitalium and of macrolide-resistant M. genitalium in men with NGU and to compare differences between prevalence and resistance rates between MSM and MSW. METHODS We enrolled 588 men with NGU in a prospective study at two urban sexual health services. The ResistancePlus MG assay (SpeeDx, Australia) was used to detect both M. genitalium, and macrolide resistance-associated mutations in first-void urine samples. Demographic, behavioral and clinical data were analyzed to investigate associations with M. genitalium infection or the presence of macrolide resistance. RESULTS Mycoplasma genitalium prevalence was 12.8% (75 of 588) overall and among MSM (12.8% [39 of 306]) and MSW (12.8% [36 of 282]; risk ratio [RR], 1.00; 95% confidence interval [CI], 0.65-1.52). Overall, 70.7% (53 of 75) of M. genitalium strains were macrolide-resistant, with significantly more resistance among MSM (89.7%, 35 of 39) than MSW (50%, 18 of 36) (RR, 1.80; 95% CI, 1.27-2.54; P = 0.001). On multivariate analysis, the presence of M. genitalium macrolide resistance mutations was independently associated with having male sexual partners compared with having only female partners (RR, 1.55; 95% CI, 1.02-2.38; P = 0.042). CONCLUSIONS Prevalence of M. genitalium among men with NGU is now similar for MSW and MSM and has increased locally from 5.2% to 12.8% within the last 10 years. Men who have sex with men are significantly more likely than MSW to harbor macrolide-resistant M. genitalium infections. This has treatment implications.
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Affiliation(s)
| | - Dean Jalocon
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-NSW Health Pathology, Westmead
| | | | - Neisha J Jeoffreys
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-NSW Health Pathology, Westmead
| | - Sharon Chih-Ann Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-NSW Health Pathology, Westmead
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Turning the Tide against Antibiotic Resistance by Evaluating Novel, Halogenated Phenazine, Quinoline, and NH125 Compounds against Ureaplasma Species Clinical Isolates and Mycoplasma Type Strains. Antimicrob Agents Chemother 2019; 63:AAC.02265-18. [PMID: 30642935 PMCID: PMC6395908 DOI: 10.1128/aac.02265-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023] Open
Abstract
Escalating levels of antibiotic resistance in mycoplasmas, particularly macrolide resistance in Mycoplasma pneumoniae and M. genitalium, have narrowed our antibiotic arsenal. Further, mycoplasmas lack a cell wall and do not synthesize folic acid, rendering common antibiotics, such as beta-lactams, vancomycin, sulfonamides, and trimethoprim, of no value. Escalating levels of antibiotic resistance in mycoplasmas, particularly macrolide resistance in Mycoplasma pneumoniae and M. genitalium, have narrowed our antibiotic arsenal. Further, mycoplasmas lack a cell wall and do not synthesize folic acid, rendering common antibiotics, such as beta-lactams, vancomycin, sulfonamides, and trimethoprim, of no value. To address this shortage, we screened nitroxoline, triclosan, and a library of 20 novel, halogenated phenazine, quinoline, and NH125 analogues against Ureaplasma species and M. hominis clinical isolates from urine. We tested a subset of these compounds (n = 9) against four mycoplasma type strains (M. pneumoniae, M. genitalium, M. hominis, and Ureaplasma urealyticum) using a validated broth microdilution or agar dilution method. Among 72 Ureaplasma species clinical isolates, nitroxoline proved most effective (MIC90, 6.25 µM), followed by an N-arylated NH125 analogue (MIC90, 12.5 µM). NH125 and its analogue had significantly higher MICs against U. urealyticum isolates than against U. parvum isolates, whereas nitroxoline did not. Nitroxoline exhibited bactericidal activity against U. parvum isolates but bacteriostatic activity against the majority of U. urealyticum isolates. Among the type strains, the compounds had the greatest activity against M. pneumoniae and M. genitalium, with 8 (80%) and 5 (71.4%) isolates demonstrating MICs of ≤12.5 µM, respectively. Triclosan also exhibited lower MICs against M. pneumoniae and M. genitalium. Overall, we identified a promising range of quinoline, halogenated phenazine, and NH125 compounds that showed effectiveness against M. pneumoniae and M. genitalium and found that nitroxoline, approved for use outside the United States for the treatment of urinary tract infections, and an N-arylated NH125 analogue demonstrated low MICs against Ureaplasma species isolates.
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Nolskog P, Backhaus E, Nasic S, Enroth H. STI with Mycoplasma genitalium-more common than Chlamydia trachomatis in patients attending youth clinics in Sweden. Eur J Clin Microbiol Infect Dis 2018; 38:81-86. [PMID: 30327896 DOI: 10.1007/s10096-018-3395-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Abstract
The prevalence of Chlamydia trachomatis in Sweden is well known, whereas the prevalence of Mycoplasma genitalium is less well documented. Youth clinics offer free contraception advice, sexually transmitted infection (STI) testing and/or contact tracing for the age group 15-25 years. The main objective of this study was to determine the prevalence of STIs, the presence of symptoms and the role of contact tracing. From July 2013 to March 2014, 1001 persons, 509 women and 492 men, were included in this study of six youth clinics in the Region of Västra Götaland. Symptoms were registered and whether the patient was tested because of contract tracing. Collection of urine samples, testing, treatment and disease registration were performed according to clinical routines. Urine samples were analysed for C. trachomatis/N. gonorrhoeae on the Cobas 4800 system (Roche). M. genitalium was analysed by lab-developed PCR. Genital infection was present in 16.8%. The prevalence of M. genitalium was higher than for C. trachomatis (9.6% and 7.1%). Men with symptoms have a significantly higher relative risk for infection with M. genitalium or C. trachomatis compared to asymptomatic men, while there is no increase for women. Contact tracing is important since positive outcome has a high relative risk for both infections. The prevalence of M. genitalium was higher than C. trachomatis in this study population. Initial testing for both C. trachomatis and M. genitalium should at least be considered for young men presenting with symptoms of genital infection. In finding positive cases, contact tracing is of great importance.
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Affiliation(s)
- Peter Nolskog
- Department of Communicable Disease Control and Prevention, Region of Västra Götaland, Skaraborg Hospital, 541 85, Skövde, Sweden.
| | - Erik Backhaus
- Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Helena Enroth
- Clinical molecular microbiology, Laboratory Medicine, Unilabs, Skövde, Sweden.,Systems Biology Research Group, School of Biosciences, University of Skövde, Skövde, Sweden
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