Mycoplasma genitalium and antimicrobial resistance in Europe: a comprehensive review

2020 ◽  
Vol 31 (3) ◽  
pp. 190-197 ◽  
Author(s):  
Miguel Fernández-Huerta ◽  
María J Barberá ◽  
Judit Serra-Pladevall ◽  
Juliana Esperalba ◽  
Xavier Martínez-Gómez ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Sexually Transmitted Infections ◽  
Mycoplasma Genitalium ◽  
Fluoroquinolone Resistance ◽  
Review Of The Literature ◽  
Limited Data ◽  
Comprehensive Review ◽  
Sexually Transmitted ◽  
Resistance Data

Antibiotic resistance in Mycoplasma genitalium has been emerging in Europe. Also, discrepancies on the management and treatment of sexually transmitted infections may have distinctly influenced the prevalence of antimicrobial resistance among European countries. This comprehensive review of the literature published between 2012 and 2018 updates antimicrobial resistance data in M. genitalium in Europe. Overall, macrolide resistance is rapidly increasing in this region, where many countries are exceeding 50%. The limited data regarding fluoroquinolone resistance estimate a prevalence of 5% (interquartile range, 5–6%). The study supports the need to conduct representative and well-defined surveillance on antimicrobial resistance in M. genitalium at both local and European levels. Also, further investigations on new promising antibiotics are required to fight against M. genitalium that may soon become untreatable.

scholarly journals Mycoplasma genitalium in Singapore is Associated with Chlamydia trachomatis Infection and Displays High Macrolide and Fluoroquinolone Resistance Rates

2020 ◽  
Author(s):  
Tim Hart ◽  
Wen Ying Tang ◽  
Siti Aminah Mansoor ◽  
Martin Tze-Wei Chio ◽  
Timothy Sebastian Barkham
Keyword(s):  
Antibiotic Resistance ◽  
Sexual Health ◽  
Mycoplasma Genitalium ◽  
Routine Screening ◽  
High Rate ◽  
Fluoroquinolone Resistance ◽  
Health Clinic ◽  
Resistance Mutations ◽  
Transmitted Infection ◽  
Sexually Transmitted

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.

scholarly journals Antimicrobial resistance in sexually transmitted infections

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Vivian Tien ◽  
Chitra Punjabi ◽  
Marisa K Holubar
Keyword(s):  
Antimicrobial Resistance ◽  
Condom Use ◽  
Sexually Transmitted Infections ◽  
Mycoplasma Genitalium ◽  
Therapeutic Options ◽  
World Health ◽  
Drug Resistant ◽  
Intrinsic Resistance ◽  
Sexually Transmitted ◽  
The World

Abstract Rationale for review International travel facilitates the spread of drug-resistant infections, including sexually transmitted infections (STIs). In 2016, the World Health Organization highlighted the global burden of ‘curable’ STIs, estimating 376 million new infections of gonorrhoea, chlamydia, syphilis and trichomoniasis annually, with considerable geographic variation in both the burden of disease and prevalence of resistance. Travelers’ risk of contracting and transmitting drug-resistant STIs depends in part on their geographic exposure. In this review, we describe the epidemiology of antimicrobial resistance (AMR) and the management of these four common STIs and Mycoplasma genitalium, an increasingly recognized cause of non-gonococcal urethritis. Key findings Multi-drug and extensively drug resistant gonorrhoea strains have been associated with international spread, particularly in travelers returning from Southeast Asia. Chlamydia is the most common bacterial STI worldwide. Although in vitro resistance has been reported, surveillance data suggest that clinically significant resistance to macrolides and tetracyclines is rare. Macrolide resistance in syphilis is now endemic in much of the world but there is no documented penicillin resistance, which remains first-line therapy. Trichomoniasis is the most common non-viral STI worldwide. Although clinical failure after treatment occurs, resistance to metronidazole is thought to be uncommon. Mycoplasma genitalium exhibits intrinsic resistance to many antibiotics, and the prevalence of resistance to both first- and second-line regimens (macrolides and fluoroquinolones) is increasing worldwide, with limited alternative therapeutic options. Recommendations International travelers are at risk for acquiring resistant STIs with limited therapeutic options. Improved diagnostics are urgently needed to improve AMR surveillance and the management of infected patients. As no vaccinations are currently available for these STIs, and pre-exposure prophylaxis is an area of active study with limited data, condom use is critical for prevention. Travel medicine providers should incorporate STI risk reduction counselling, with an emphasis on condom use, into the routine pre-travel consultation.

scholarly journals Mycoplasma genitalium in Singapore is Associated with Chlamydia trachomatis Infection and Displays High Macrolide and Fluoroquinolone Resistance Rates

2020 ◽  
Author(s):  
Tim Hart ◽  
Wen Ying Tang ◽  
Siti Aminah Mansoor ◽  
Martin Tze-Wei Chio ◽  
Timothy Sebastian Barkham
Keyword(s):  
Antibiotic Resistance ◽  
Sexual Health ◽  
Mycoplasma Genitalium ◽  
Routine Screening ◽  
High Rate ◽  
Fluoroquinolone Resistance ◽  
Health Clinic ◽  
Resistance Mutations ◽  
Transmitted Infection ◽  
Sexually Transmitted

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.

scholarly journals Mycoplasma genitalium incidence, persistence, concordance between partners and progression: systematic review and meta-analysis

2019 ◽  
Vol 95 (5) ◽  
pp. 328-335 ◽  
Author(s):  
Manuel Cina ◽  
Lukas Baumann ◽  
Dianne Egli-Gany ◽  
Florian S Halbeisen ◽  
Hammad Ali ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antimicrobial Resistance ◽  
Meta Analysis ◽  
Age Distribution ◽  
Mycoplasma Genitalium ◽  
Developed Countries ◽  
Sexual Partners ◽  
Risk Of Bias ◽  
Infection Status ◽  
Sexually Transmitted

BackgroundMycoplasma genitalium is increasingly seen as an emerging sexually transmitted pathogen, and has been likened to Chlamydia trachomatis, but its natural history is poorly understood. The objectives of this systematic review were to determine M. genitalium incidence, persistence, concordance between sexual partners and the risk of pelvic inflammatory disease (PID).MethodsWe searched Medline, EMBASE, LILACS, IndMed and African Index Medicus from 1 January 1981 until 17 March 2018. Two independent researchers screened studies for inclusion and extracted data. We examined results in forest plots, assessed heterogeneity and conducted meta-analysis where appropriate. Risk of bias was assessed for all studies.ResultsWe screened 4634 records and included 18 studies; six (4201 women) reported on incidence, five (636 women) on persistence, 10 (1346 women and men) on concordance and three (5139 women) on PID. Incidence in women in two very highly developed countries was 1.07 per 100 person-years (95% CI 0.61 to 1.53, I2 0%). Median persistence of M. genitalium was estimated from one to three months in four studies but 15 months in one study. In 10 studies measuring M. genitalium infection status in couples, 39%–50% of male or female sexual partners of infected participants also had M. genitalium detected. In prospective studies, PID incidence was higher in women with M. genitalium than those without (risk ratio 1.73, 95% CI 0.92 to 3.28, I2 0%, two studies).DiscussionIncidence of M. genitalium in very highly developed countries is similar to that for C. trachomatis, but concordance might be lower. Taken together with other evidence about age distribution and antimicrobial resistance in the two infections, M. genitalium is not the new chlamydia. Synthesised data about prevalence, incidence and persistence of M. genitalium infection are inconsistent. These findings can be used for mathematical modelling to investigate the dynamics of M. genitalium.Registration numbersCRD42015020420, CRD42015020405

High Prevalence of Sexually Transmitted Infections and Risk Factors Among HIV-Positive Individuals in Yunnan, China

2021 ◽  
Author(s):  
Wei Tu ◽  
Yu-Ye Li ◽  
Yi-Qun Kuang ◽  
Rong-Hui Xie ◽  
Xing-Qi Dong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sexually Transmitted Infections ◽  
Genital Tract ◽  
Mycoplasma Genitalium ◽  
Cross Sectional Study ◽  
Multiple Infections ◽  
Hiv Positive ◽  
Cross Sectional ◽  
Sexually Transmitted ◽  
High Prevalence

Abstract Background Yunnan has the highest rates of HIV in the country. Other treatable sexually transmitted infections (STIs) are associated with accelerated HIV transmission and poor ART outcomes, but are only diagnosed by syndromic algorithms. Methods We recruited 406 HIV-positive participants for a cross-sectional study (204 ART-naive and 202 ART). Blood samples and first-voided urine samples were collected. Real-time polymerase chain reaction methods were used for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG). Syphilis and HSV-2 tests were also performed. Results Among 406 participants, the overall prevalence of STI was 47.0% and 45.1% in ART-naive individuals and 49.0% in ART individuals, respectively. Testing frequency was 11.6% (11.8% vs 11.4%), 33.2% (29.4% vs 37.1%), 3.2% (3.4% vs 3.0%), 2.0% (3.4% vs 0.5%) and 4.7% (6.4% vs 3.0%) for active syphilis, HSV-2, chlamydia, gonorrhoeae and genitalium. Percentage of multiple infections in both groups was 10.8% (22/204) in ART-naive participants and 9.9% (20/202) in ART participants. Females, age between 18 to 35 years, ever injected drugs, homosexual or bisexual, HIV/HBV coinfection, and not receiving ART were identified as risk factors. Self-reported asymptom was not eliminating of having a laboratory-diagnosed STI. Conclusions STI prevalence was 47.0% (45.1% vs 49.0%), HSV-2, syphilis and MG were the most common STIs in HIV-infected individuals. We found high prevalence (6.4%) of Mycoplasma genitalium in ART-naive individuals. ART can reduce the diversity of STI-HIV coinfection but not the prevalence. HIV-positive individuals tend to neglect or maybe hide their genital tract discomfort, thus we suggest strengthening STI joint screening and treatment services among HIV-infected individuals whether they describe genital tract discomfort or not.

Posttravel Evaluation

2019 ◽  
pp. 603-652
Author(s):  
Gary W. Brunette ◽  
Jeffrey B. Nemhauser
Keyword(s):  
Antimicrobial Resistance ◽  
Infectious Diseases ◽  
Sexually Transmitted Infections ◽  
Diagnostic Tests ◽  
Rapid Diagnostic Tests ◽  
Sexually Transmitted

General Approach to the Returned Traveler Jessica K. Fairley Screening Asymptomatic Returned Travelers Michael Libman, Sapha Barkati Fever Mary Elizabeth Wilson Rapid Diagnostic Tests for Infectious Diseases Elizabeth Rabold, Jesse Waggoner Antimicrobial Resistance D. Cal Ham, Joseph Lutgring, Aditya Sharma Sexually Transmitted Infections Jodie Dionne-Odom...

scholarly journals Levels ofMycoplasma genitaliumAntimicrobial Resistance Differ by Both Region and Gender in the State of Queensland, Australia: Implications for Treatment Guidelines

2019 ◽  
Vol 57 (3) ◽  
Author(s):  
E. L. Sweeney ◽  
E. Trembizki ◽  
C. Bletchly ◽  
C. S. Bradshaw ◽  
A. Menon ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Treatment Guidelines ◽  
Mycoplasma Genitalium ◽  
Macrolide Resistance ◽  
Quinolone Resistance ◽  
Resistance Mutations ◽  
Transmitted Infection ◽  
Content Type ◽  
Sexually Transmitted ◽  
And Gender

ABSTRACTMycoplasma genitaliumis frequently associated with urogenital and rectal infections, with the number of cases of macrolide-resistant and quinolone-resistantM. genitaliuminfection continuing to increase. In this study, we examined the levels of resistance to these two common antibiotic treatments in geographically distinct locations in Queensland, Australia. Samples were screened for macrolide resistance-associated mutations using a commercially available kit (ResistancePlus MG; SpeeDx), and quinolone resistance-associated mutations were identified by PCR and DNA sequencing. Comparisons between antibiotic resistance mutations and location/gender were performed. The levels ofM. genitaliummacrolide resistance were high across both locations (62%). Quinolone resistance mutations were found in ∼10% of all samples, with a number of samples harboring mutations conferring resistance to both macrolides and quinolones. Quinolone resistance was higher in southeast Queensland than in north Queensland, and this was consistent in both males and females (P = 0.007). TheM. genitaliumisolates in rectal swab samples from males harbored high levels of macrolide (75.9%) and quinolone (19%) resistance, with 15.5% harboring resistance to both classes of antibiotics. Overall, the lowest observed level of resistance was to quinolones in females from north Queensland (1.6%). These data highlight the high levels of antibiotic resistance inM. genitaliumisolates within Queensland and the challenges faced by sexually transmitted infection clinicians in managing these infections. The data do, however, show that the levels of antibiotic resistance may differ between populations within the same state, which has implications for clinical management and treatment guidelines. These findings also support the need for ongoing antibiotic resistance surveillance and tailored treatment.

Prevalence of co-infections with other sexually transmitted infections in patients newly diagnosed with anogenital warts in Guangzhou, China

2020 ◽  
Vol 31 (11) ◽  
pp. 1073-1081
Author(s):  
Liuyuan Wang ◽  
Bin Yang ◽  
Lai S Tso ◽  
Peizhen Zhao ◽  
Wujian Ke ◽  
...  
Keyword(s):  
Sexual Health ◽  
Sexually Transmitted Infections ◽  
Mycoplasma Genitalium ◽  
Risk Groups ◽  
Health Clinic ◽  
Surveillance Systems ◽  
Newly Diagnosed ◽  
Anogenital Warts ◽  
Sexually Transmitted ◽  
Medical Histories

Prevalence of co-infecting sexually transmitted infections (STIs) among patients newly diagnosed with anogenital warts is under-reported. Our objective is to determine the prevalence of six common STIs, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), genital herpes (herpes simplex virus type 2 [HSV-2]), HIV, and syphilis for patients visiting a sexual health clinic in Guangzhou, China. Demographics, sexual health, and medical histories were collected at patient intake. Patients diagnosed with anogenital warts (N = 200) were invited to participate. We collected urine samples, and urethral, cervical, and rectal swabs to test for CT, NG, and MG, and blood samples for serological detection of HSV-2, syphilis, and HIV. Overall 49 (24.5%) had a co-infection (22.2% of men and 27.7% of women). All six STIs were observed among men: CT (6.8%), NG (3.4%), MG (5.1%), HIV (4.3%), HSV-2 (4.3%), and syphilis (1.7%). Women had fewer STIs, but at higher rates: CT (13.3%), MG (6.0%), and HSV-2 (8.4%). Individual men had up to two co-infections, while women had no more than one co-infection. Chlamydia was the most common STI. Patients aged 18–25 years (35.4%) had the highest prevalence. Although opportunistic screening is often applied for high-risk groups, expansion to patients with anogenital warts in all health-care settings would improve detection of problematic asymptomatic co-infections, thereby increasing China’s capacity to contribute toward global surveillance systems.

Longitudinal Trends in Antimicrobial Susceptibilities Across Long-Term–Care Facilities: Emergence of Fluoroquinolone Resistance

2005 ◽  
Vol 26 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Melissa Viray ◽  
Darren Linkin ◽  
Joel N. Maslow ◽  
Donald D. Stieritz ◽  
Lesley S. Carson ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Long Term Care ◽  
Care Facility ◽  
Survey Study ◽  
Fluoroquinolone Resistance ◽  
Term Care ◽  
Long Term Care Facility ◽  
Study Sites

AbstractBackgroundAntibiotic resistance in the long-term-care facility (LTCF) setting is of increasing concern due to both the increased morbidity and mortality related to infections in this debilitated population and the potential for transfer of resistant organisms to other healthcare settings. Longitudinal trends in antibiotic resistance in LTCFs have not been well described.Design:Correlational longitudinal survey study.Setting:Four LTCFs in Pennsylvania.Subjects:All clinical cultures of residents of the participating LTCFs (700 total beds) from 1998 through 2003. We assessed the annual prevalence of resistance to various antimicrobials of interest for the following organisms: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and enterococcus species.Results:A total of 4,954 clinical isolates were obtained during the study. A high prevalence of antimicrobial resistance was noted for many organism-drug combinations. This was especially true for fluoroquinolone susceptibility among the Enterobacteriaceae (susceptibility range, 51.3% to 92.2%). In addition, the prevalence of resistance to various agents differed significantly across study sites. Finally, significant increasing trends in resistance were noted over time and were most pronounced for fluoroquinolone susceptibility among the Enterobacteriaceae.Conclusions:The prevalence of antimicrobial resistance has increased significantly in LTCFs, although trends have varied substantially across different institutions. These trends have been particularly pronounced for fluoroquinolone resistance among the Enterobacteriaceae. These findings demonstrate that antimicrobial resistance is widespread and increasing in LTCFs, highlighting the need for future studies to more clearly elucidate the risk factors for, and potential interventions against, emerging resistance in these settings.

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