Mycoplasma genitalium in Primary Care: Prevalence and azithromycin resistance in Santiago de Compostela Health Care Area

Objectives. Mycoplasma genitalium is associated with persistent/recurrent sexually transmitted infections. The aim of this work was to estimate the prevalence and azithromycin resistance of M. genitalium in general population that was attended at Primary Care of Santiago de Compostela Health Care Area. Material and methods. The study was carried out in 2019 in general population of Santiago de Compostela Health Care Area. Real-time multiplex PCR was used for screening of sexually transmitted infections associated pathogens and detection of mutations in the 23S rRNA gene. Results. A total of 502 women and 532 men were studied. The prevalence of M. genitalium was 2,4% in men and 2,9% in women. Overall azithromycin resistance was 20% all of them detected in men. The mutations found were A2059G, A2058G and A2058T. Conclusions. Although the proportion of M. genitalium infection is low, the high percentage of azithromycin resistance detected supports the relevance of these data in order to the right management of the patients with sexually transmitted diseases and, so as, to avoid the emergence of resistance in other pathogens of the urogenital tract.

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In VitroActivity of the New Fluoroketolide Solithromycin (CEM-101) against Macrolide-Resistant and -Susceptible Mycoplasma genitalium Strains

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02411-14 ◽

2014 ◽

Vol 58 (6) ◽

pp. 3151-3156 ◽

Cited By ~ 40

Author(s):

Jørgen Skov Jensen ◽

Prabhavathi Fernandes ◽

Magnus Unemo

Keyword(s):

Clinical Trials ◽

Sexually Transmitted Infections ◽

Antimicrobial Agents ◽

Mycoplasma Genitalium ◽

Macrolide Resistance ◽

23S Rrna ◽

Rrna Gene ◽

Content Type ◽

Sexually Transmitted

ABSTRACTMycoplasma genitaliumhas become well established as an etiological agent of sexually transmitted infections, but due to its fastidious growth requirements, only a fewM. genitaliumstrains are available to determine the MICs of currently used and new antimicrobial agents. Recent clinical trials have suggested that treatment with azithromycin has decreasing efficacy due to an increasing prevalence of macrolide resistance, and alternative treatment with moxifloxacin is similarly under pressure from emerging resistance. Thus, there is an urgent need for new antimicrobials. Thein vitroactivity of the newly developed fluoroketolide solithromycin (CEM-101) was evaluated against a collection of 40M. genitaliumstrains, including 15 with high-level macrolide resistance and 5 multidrug-resistant strains with resistance to both macrolides and quinolones. Furthermore, the MIC of solithromycin was correlated with mutations in the 23S rRNA gene and in the genes encoding ribosomal proteins L4 and L22. Thein vitroresults showed that solithromycin has activity againstM. genitaliumsuperior to that of other macrolides, doxycycline, and fluoroquinolones. Accordingly, this new fluoroketolide might be an effective option for treatment ofM. genitaliuminfections. However, the efficacy of solithromycin in clinical trials with follow-up for test of cure and detection of genotypic and phenotypic resistance needs to be evaluated prior to widespread use. In a phase 2 clinical trial, solithromycin was highly effective as a single oral dose againstC. trachomatisandNeisseria gonorrhoeae, suggesting that solithromycin could be a treatment option for several sexually transmitted infections, including in syndromic treatment of urethral and vaginal discharge.

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Antimicrobial resistance in Mycoplasma genitalium sampled from the British general population

Sexually Transmitted Infections ◽

10.1136/sextrans-2019-054129 ◽

2020 ◽

Vol 96 (6) ◽

pp. 464-468 ◽

Cited By ~ 3

Author(s):

Rachel Pitt ◽

Magnus Unemo ◽

Pam Sonnenberg ◽

Sarah Alexander ◽

Simon Beddows ◽

...

Keyword(s):

Antimicrobial Resistance ◽

General Population ◽

Sexual Health ◽

Treatment Guidelines ◽

Mycoplasma Genitalium ◽

Macrolide Resistance ◽

Sample Survey ◽

23S Rrna ◽

Health Clinic ◽

Rrna Gene

BackgroundMycoplasma 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.MethodsThe 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.Results94% (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.ConclusionsThis 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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Macrolide Resistance in Mycoplasma genitalium in Singapore

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.093 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S104-S104 ◽

Cited By ~ 2

Author(s):

Timothy Barkham ◽

Wen Ying Tang ◽

Siti Aminah Mansoor ◽

Martin Tze-Wei Chio

Keyword(s):

Direct Detection ◽

Bacterial Genome ◽

Mycoplasma Genitalium ◽

Clinical Diagnostics ◽

Macrolide Resistance ◽

23S Rrna ◽

Rrna Gene ◽

Resistance Mutations ◽

Transmitted Infection ◽

Sexually Transmitted

Abstract Background Mycoplasma genitalium was first reported as a cause of non-gonococcal urethritis in 1980. It has progressed from being an ‘emerging’ sexually transmitted infection (STI) to an accepted STI. Prevalence of infection has been reported as the Netherlands 4.5%, Sweden 6.3%, UK 1.2% and France 4%. M. genitalium has the smallest known bacterial genome and was the second bacterial genome fully sequenced. It has minimal requirements and is said to approach the minimum possible for a living cell. It is extremely fastidious; only a few strains have been cultured worldwide. Diagnosis relies on direct detection. It does not have a cell wall so it is not susceptible to antibiotics such as penicillins and cephalosporins. Therapy depends on fluoroquinolones and macrolides but resistance to macrolides has been widely reported: 13% France, 18% Sweden, 40% UK, Australia and Denmark, 100% Greenland, 30% Japan. Methods Ethics approval was granted. DNA extracts left over after routine clinical diagnostics at the Department of STI Control (DSC) Clinic, Kelantan Lane, Singapore were harvested. DNA had been extracted on a Cobas 4800 instrument (Roche) from urine and urethral swabs collected for testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). A 2-plex real-time PCR assay targeting the pdhD and mgpB genes was used to screen for M. genitalium. Samples were deemed positive if both targets were detected. If only one target was detected, the sample was retested; if reactive in either target upon retest, the sample was considered positive for M. genitalium. Positive DNA preps were then screened for macrolide resistance mutations after Sanger sequencing of the 23S rRNA gene. Results 368 anonymised DNA elutes from 254 urines and 114 urethral swabs were collected between May and July 2016. One hundred eighty-four were CT/NG positive and 184 were CT/NG negative. Sixteen (4.3%) were positive for M. genitalium. Four (25%) of these 16 samples contained macrolide resistance associated mutations; A2058T (x2), A2058G (x1), and A2059G (x1). Conclusion M. genitalium was detected in 4.3% of samples. Macrolide resistance mutations were detected in 25%, similar to international rates. Some guidelines recommend testing for resistance to guide therapy and to perform a test of cure. Disclosures All authors: No reported disclosures.

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Clinical case of failure of josamycin in a patient with urethritis caused by Mycoplasma genitalium

Vestnik dermatologii i venerologii ◽

10.25208/0042-4609-2018-94-4-55-59 ◽

2018 ◽

Vol 94 (4) ◽

pp. 55-59 ◽

Cited By ~ 1

Author(s):

L. M. Zubareva ◽

I. A. Eydel’shteyn ◽

A. V. Romanov ◽

V. V. Evstaf’ev ◽

R. S. Kozlov

Keyword(s):

Antibiotic Resistance ◽

Molecular Genetic ◽

Mycoplasma Genitalium ◽

23S Rrna ◽

Routine Practice ◽

Rrna Gene ◽

First Line ◽

Sexually Transmitted ◽

23S Rrna Gene ◽

Unknown Status

Mycoplasma genitalium is one of the obligate pathogens that cause sexually transmitted diseases. To detect this pathogen in routine practice, only molecular genetic methods are used that are also used to identify the resistance of MGE to antibiotics. The first-line drugs for the treatment of diseases caused by MGE, are tetracycline and macrolides. In recent years, many countries have increasingly recorded cases of unsuccessful therapy macrolides. Mutations that confer antibiotic resistance to macrolides for Mycoplasm genitalium are concentrated in nucleotide positions 2058 and 2059 in region V of the 23S rRNA gene. Unknown status of macrolide resistance M. genitalium can lead to the development of a persistent infection. We describe the first reported cases of clinical josamycin treatment failure from patient with ure - thritis. The reason for antibiotic resistance was a mutation in the 23S rRNA of MGE as a nucleotide substitution in position A2058G.

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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

Journal of Clinical Microbiology ◽

10.1128/jcm.01084-20 ◽

2020 ◽

Vol 58 (9) ◽

Author(s):

Ingibjörg Hilmarsdóttir ◽

Eva Mjöll Arnardóttir ◽

Elísabet Reykdal Jóhannesdóttir ◽

Freyja Valsdóttir ◽

Daniel Golparian ◽

...

Keyword(s):

Sexually Transmitted Infection ◽

False Negative ◽

Mycoplasma Genitalium ◽

23S Rrna ◽

Rrna Gene ◽

Transmitted Infection ◽

Content Type ◽

Sexually Transmitted ◽

Negative Results

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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961. Prevalence and Macrolide Resistance of Mycoplasma genitalium After Initiation of HIV Preexposure Prophylaxis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.063 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S29-S29

Author(s):

Jens Van Praet ◽

Sanne Steyaert ◽

Stefaan Vandecasteele ◽

Barbara Van Den Bergh ◽

Hilde Mahieu ◽

...

Keyword(s):

Mycoplasma Genitalium ◽

Macrolide Resistance ◽

23S Rrna ◽

Rrna Gene ◽

Sexually Transmitted ◽

Preexposure Prophylaxis ◽

23S Rrna Gene ◽

Resistant Strains ◽

Taqman Array

Abstract Background Recent evidence shows that patients using HIV preexposure prophylaxis (PrEP) have an increased rate of bacterial sexually transmitted infections (STIs), including syphilis, chlamydia, and gonorrhea. The rate of Mycoplasma genitalium infections and the susceptibility of M. genitalium in patients on PrEP have been less well described. Methods We studied all patients who started on PrEP in the AZ Sint-Jan Hospital Bruges from January 6, 2017 to January 4, 2019. Patients were screened for M. genitalium and other bacterial STIs with rectal swabs, pharyngeal swabs, first-voided urine and blood collections at baseline and quarterly intervals after initiating PrEP. TaqMan array card technology was used to detect M. genitalium and determine macrolide-resistance mediating mutations in the region V of the 23S rRNA gene (A2058G, A2059G, A2058C, and others). Patients with an STI were treated based on a national guideline. Proportions were estimated using a Generalized Estimating Equations model with independent correlation structure. Results A total of 136 males and 1 female (median age, 40 years (interquartile range (IQR), 20–79)) were included in the study. All men were gay or bisexual. The median follow-up time was 11.3 months (IQR, 4.7–15.3). In total, 117 patients (85%) used PrEP daily at their last visit. The estimated proportion of patients with M. genitalium at baseline, 3 months, 6 months, 9 months, and 12 months was 7% (95% CI 4–13), 12% (95% CI 7–20), 7% (95% CI 4–15), 6% (3–15), and 6% (2–15). Thirty-two patients (23%) tested at least once positive for M. genitalium during the study period. The estimated percentage of macrolide resistance increased from 40% (95% CI 16–70) at baseline to 71% (95% CI 44–89), 67% (95% CI 27–92), 80% (95% CI 31–97), and 75% (95% CI 24–97) at 3 months, 6 months, 9 months, and 12 months, respectively. Conclusion After initiation of PrEP, the prevalence of M. genitalium in our cohort at quarterly screening was not increased compared with baseline. However, a nonsignificant trend of an increased percentage of macrolide-resistant strains was observed. Disclosures All Authors: No reported Disclosures.

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Prevalence and Determinants of Sexually Transmitted Infections in Women at Risk Undergoing Abortion in a Swiss Primary Care Setting

Praxis ◽

10.1024/1661-8157/a001724 ◽

2014 ◽

Vol 103 (15) ◽

pp. 875-882 ◽

Cited By ~ 1

Author(s):

Jana Wesbonk ◽

Corinne Chmiel ◽

Thomas Rosemann ◽

André Seidenberg ◽

Oliver Senn

Keyword(s):

Primary Care ◽

At Risk ◽

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Sexually Transmitted Infections ◽

Care Setting ◽

Primary Care Setting ◽

Mycoplasma Genitalium ◽

Sexually Transmitted ◽

Swiss Primary Care

Hintergrund: Schwangerschaftsabbrüche können in der Schweiz auch ambulant in der Hausarztpraxis durchgeführt werden. Daten zur Prävalenz von sexuell übertragbaren Infektionen (STI) bei dieser Patientenpopulation sind nur spärlich vorhanden. Unser Ziel war die Erhebung der Prävalenz und der prädisponierenden Faktoren für sexuell übertragbare Infektion bei Frauen mit erhöhtem Risiko (pathologischer Zervixabstrich), die sich in einer Schweizer Hausarztpraxis einer Abruptio unterzogen. Methode: Querschnittsstudie bei 620 Frauen, die sich in einer Hausarztpraxis in Zürich für eine Abruptio Beratung vorstellten. Im Falle eines pathologischen Zervixabstriches erfolgte zur Abschätzung der STI Prävalenz ein PCR-basierendes Screening bezüglich Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) und Neisseria gonorrhoeae (NG). Resultate: Bei 585 der 620 Frauen resultierte eine Abruptio. Verfügbar waren 581 (93,7%) Zervixabstriche wovon 272 (46,8%) pathologische Zeichen aufwiesen und demnach als eine Risikokonstellation für STI betrachtet wurden. Unter 192 gescreenten Proben fanden sich 28 STI (14,6%) (95% CI: 10,3–20,3%), vorherrschend waren CT-Infektionen (17 Fälle) gefolgt von MG (9 Fälle) und NG (2 Fälle). Frauen mit Migrationshintergrund waren häufiger von einer STI betroffen (OR 2,63; p=0,037 im Vergleich zu Schweizerinnen). Fazit: Frauen, die sich einer Abruptio in der Praxis unterzogen, zeigten hohe STI-Prävalenz. Patientinnen mit einem Migrationshintergrund scheinen eine vulnerable Untergruppe darzustellen. Bemühungen sind notwendig, damit diese Risikogruppe mit kosteneffizientem Screening und Behandlungskonzepten erreicht werden können.

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Prevalence and health care seeking behaviour for sexually transmitted infections among in-school adolescents in Ado-Ekiti, South-Western Nigeria

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2016-0011 ◽

2016 ◽

Vol 29 (6) ◽

Author(s):

Patrick T. Adegun ◽

Eyitope O. Amu

Keyword(s):

Health Care ◽

Sexually Transmitted Infections ◽

Health Care Seeking ◽

Care Seeking ◽

Self Medication ◽

Cross Sectional ◽

Sexually Transmitted ◽

Stomach Pain ◽

Health Care Seeking Behaviour ◽

Care Seeking Behaviour

Abstract Background: In Nigeria, adolescents are highly vulnerable to sexually transmitted infections (STIs) which have the potential of jeopardising their future reproductive lives if poorly treated. Objective: To determine the prevalence and health care seeking behaviour for STIs among secondary school adolescents in Ado, South-Western Nigeria. Subjects: Male and female adolescents aged 10–19 years. Methods: The study employed a descriptive cross-sectional design. A pre-tested, self-administered, semi-structured questionnaire was used to elicit information from 560 adolescents selected from public and private secondary schools in Ado Local Government Area (LGA) of Ekiti State, using a multistage sampling technique. The data were analyzed using descriptive and inferential statistics. Analyzed data were presented in the form of tables and charts. Results: Two hundred and fifty-one (47.1%) respondents had previous symptoms of STIs. The commonest symptoms among the males were penile discharge (30.5%), painful micturition (30.5%) and stomach pain with swollen testes (25.4%). The commonest symptoms among the females were genital itching (27.6%), genital sores (14.1%) and painful micturition (13.1%). Only 26.7% sought treatment from a health facility; 37.0% did nothing; 15.9% went to patent medicine stores, 10.0% used herbs; the rest did self-medication or prayed. Conclusion: The prevalence of STI symptoms among adolescents in Ado-Ekiti is high but their health care seeking behaviour is poor. Health education about the dangers of untreated STI and the importance of seeking treatment early, targeted at adolescents, should be intensified.

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Molecular pathways to high-level azithromycin resistance in Neisseria gonorrhoeae

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkab084 ◽

2021 ◽

Cited By ~ 1

Author(s):

J G E Laumen ◽

S S Manoharan-Basil ◽

E Verhoeven ◽

S Abdellati ◽

I De Baetselier ◽

...

Keyword(s):

Neisseria Gonorrhoeae ◽

Ribosomal Proteins ◽

Efflux Pump ◽

23S Rrna ◽

Rrna Gene ◽

23S Rrna Gene ◽

Evolution Of Resistance ◽

High Level ◽

Azithromycin Resistance ◽

Level Resistance

Abstract Background The prevalence of azithromycin resistance in Neisseria gonorrhoeae is increasing in numerous populations worldwide. Objectives To characterize the genetic pathways leading to high-level azithromycin resistance. Methods A customized morbidostat was used to subject two N. gonorrhoeae reference strains (WHO-F and WHO-X) to dynamically sustained azithromycin pressure. We tracked stepwise evolution of resistance by whole genome sequencing. Results Within 26 days, all cultures evolved high-level azithromycin resistance. Typically, the first step towards resistance was found in transitory mutations in genes rplD, rplV and rpmH (encoding the ribosomal proteins L4, L22 and L34 respectively), followed by mutations in the MtrCDE-encoded efflux pump and the 23S rRNA gene. Low- to high-level resistance was associated with mutations in the ribosomal proteins and MtrCDE efflux pump. However, high-level resistance was consistently associated with mutations in the 23S ribosomal RNA, mainly the well-known A2059G and C2611T mutations, but also at position A2058G. Conclusions This study enabled us to track previously reported mutations and identify novel mutations in ribosomal proteins (L4, L22 and L34) that may play a role in the genesis of azithromycin resistance in N. gonorrhoeae.

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Use of Protection for Unwanted Pregnancy and Sexually Transmitted Infections in Six Birth Cohorts in Norway 2020: A Descriptive Study

Sexuality & Culture ◽

10.1007/s12119-021-09879-w ◽

2021 ◽

Author(s):

Bente Træen ◽

Nantje Fischer

Keyword(s):

General Population ◽

Sexually Transmitted Infections ◽

Emergency Contraception ◽

Unwanted Pregnancy ◽

Hormonal Contraception ◽

Descriptive Study ◽

Panel Survey ◽

Birth Cohorts ◽

Significant Drop ◽

Sexually Transmitted

AbstractThis study describes the use of contraception and protection for sexually transmitted infections (STIs) in six different birth cohorts of the general population in Norway. The results are based on a 2020 national web panel survey among 18–89 year-olds in Norway (n = 4160). For respondents born within 1931–1950 versus those born within 1990–2002, there was a significant increase in the use of protection against unwanted pregnancy and STIs during sexual intercourse, and a significant drop in the proportion of those who did not use any protection at all. More women today (than in previous decades) are using hormonal contraception. The main reason for not using condoms during intercourse was both parties felt safe that they were healthy, especially those born within 1990–2002. To prevent unwanted pregnancy and STIs, it is beneficial to continue to increase the availability of free or subsidized hormonal contraception, including emergency contraception, and free condoms in public arenas that people frequent and where they meet their partners.

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