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Mycoplasma genitalium: high prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in western Sydney.
Sex Transm Infect. 2018 09; 94(6):406-410.ST

Abstract

OBJECTIVES

We aimed to estimate the prevalence of Mycoplasma genitalium infection and of mutations linked to macrolide resistance using the ResistancePlus MG assay (SpeeDx, Sydney, New South Wales, Australia) in first-void urine (FVU), anorectal and oropharyngeal samples from men who have sex with men (MSM) attending Western Sydney Sexual Health Centre (WSSHC).

METHODS

Consecutive symptomatic and asymptomatic MSM attending for STI testing were prospectively enrolled. M. genitalium testing using the ResistancePlus MG assay was performed on FVU, anorectal and oropharyngeal samples routinely collected for Chlamydia trachomatis and Neisseria gonorrhoeae assays.

RESULTS

Overall, the prevalence of M. genitalium infection in the study group was 13.4% (68/508). Most (79.4%, 54/68) M. genitalium harboured macrolide resistance mutations (87.5% of urethral and 75.6% of anorectal infections). The anorectum was the most commonly infected site (45/505, 8.9%), followed by the urethra (24/508, 4.7%). No oropharyngeal M. genitalium infections were detected (0/508). Most of the anorectal (93.3%) and urethral (79.2%) infections were asymptomatic.MSM who were taking HIV pre-exposure prophylaxis (PrEP) were twice as likely to be infected with M. genitalium compared with MSM who were not on PrEP (OR 2.1, 95% CI 1.3 to 3.6; P=0.0041). Always using condoms for anal sex in the last 3 months was protective of infection (OR 0.8, 95% CI 0.6 to 1.0; P=0.0186).

CONCLUSIONS

We demonstrated a high prevalence of M. genitalium and very high levels of macrolide resistance among MSM attending WSSHC. Our findings support the routine use of an assay to detect macrolide resistance mutations in M. genitalium infections. This will ensure, in regions or populations with high rates of macrolide resistance among M. genitalium strains, that first-line treatment with azithromycin will only be used if a macrolide-sensitive strain is identified.

Authors+Show Affiliations

Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia. Marie Bashir Institute for Infectious Diseases and Biosecurity and Sydney Medical School-Westmead, University of Sydney, Sydney, New South Wales, Australia.Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, NSW Health Pathology, Westmead, New South Wales, Australia.Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia.Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, NSW Health Pathology, Westmead, New South Wales, Australia.Marie Bashir Institute for Infectious Diseases and Biosecurity and Sydney Medical School-Westmead, University of Sydney, Sydney, New South Wales, Australia. Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, NSW Health Pathology, Westmead, New South Wales, Australia.Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia. Marie Bashir Institute for Infectious Diseases and Biosecurity and Sydney Medical School-Westmead, University of Sydney, Sydney, New South Wales, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29567802

Citation

Couldwell, Deborah L., et al. "Mycoplasma Genitalium: High Prevalence of Resistance to Macrolides and Frequent Anorectal Infection in Men Who Have Sex With Men in Western Sydney." Sexually Transmitted Infections, vol. 94, no. 6, 2018, pp. 406-410.
Couldwell DL, Jalocon D, Power M, et al. Mycoplasma genitalium: high prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in western Sydney. Sex Transm Infect. 2018;94(6):406-410.
Couldwell, D. L., Jalocon, D., Power, M., Jeoffreys, N. J., Chen, S. C., & Lewis, D. A. (2018). Mycoplasma genitalium: high prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in western Sydney. Sexually Transmitted Infections, 94(6), 406-410. https://doi.org/10.1136/sextrans-2017-053480
Couldwell DL, et al. Mycoplasma Genitalium: High Prevalence of Resistance to Macrolides and Frequent Anorectal Infection in Men Who Have Sex With Men in Western Sydney. Sex Transm Infect. 2018;94(6):406-410. PubMed PMID: 29567802.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mycoplasma genitalium: high prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in western Sydney. AU - Couldwell,Deborah L, AU - Jalocon,Dean, AU - Power,Melissa, AU - Jeoffreys,Neisha J, AU - Chen,Sharon C-A, AU - Lewis,David A, Y1 - 2018/03/22/ PY - 2017/11/21/received PY - 2018/02/04/revised PY - 2018/02/17/accepted PY - 2018/3/24/pubmed PY - 2019/1/22/medline PY - 2018/3/24/entrez KW - anorectal KW - azithromycin KW - drug resistance KW - men who have sex with men KW - mycoplasma genitalium KW - prevalence SP - 406 EP - 410 JF - Sexually transmitted infections JO - Sex Transm Infect VL - 94 IS - 6 N2 - OBJECTIVES: We aimed to estimate the prevalence of Mycoplasma genitalium infection and of mutations linked to macrolide resistance using the ResistancePlus MG assay (SpeeDx, Sydney, New South Wales, Australia) in first-void urine (FVU), anorectal and oropharyngeal samples from men who have sex with men (MSM) attending Western Sydney Sexual Health Centre (WSSHC). METHODS: Consecutive symptomatic and asymptomatic MSM attending for STI testing were prospectively enrolled. M. genitalium testing using the ResistancePlus MG assay was performed on FVU, anorectal and oropharyngeal samples routinely collected for Chlamydia trachomatis and Neisseria gonorrhoeae assays. RESULTS: Overall, the prevalence of M. genitalium infection in the study group was 13.4% (68/508). Most (79.4%, 54/68) M. genitalium harboured macrolide resistance mutations (87.5% of urethral and 75.6% of anorectal infections). The anorectum was the most commonly infected site (45/505, 8.9%), followed by the urethra (24/508, 4.7%). No oropharyngeal M. genitalium infections were detected (0/508). Most of the anorectal (93.3%) and urethral (79.2%) infections were asymptomatic.MSM who were taking HIV pre-exposure prophylaxis (PrEP) were twice as likely to be infected with M. genitalium compared with MSM who were not on PrEP (OR 2.1, 95% CI 1.3 to 3.6; P=0.0041). Always using condoms for anal sex in the last 3 months was protective of infection (OR 0.8, 95% CI 0.6 to 1.0; P=0.0186). CONCLUSIONS: We demonstrated a high prevalence of M. genitalium and very high levels of macrolide resistance among MSM attending WSSHC. Our findings support the routine use of an assay to detect macrolide resistance mutations in M. genitalium infections. This will ensure, in regions or populations with high rates of macrolide resistance among M. genitalium strains, that first-line treatment with azithromycin will only be used if a macrolide-sensitive strain is identified. SN - 1472-3263 UR - https://www.unboundmedicine.com/medline/citation/29567802/Mycoplasma_genitalium:_high_prevalence_of_resistance_to_macrolides_and_frequent_anorectal_infection_in_men_who_have_sex_with_men_in_western_Sydney_ DB - PRIME DP - Unbound Medicine ER -