Background: Mycoplasma genitalium is a sexually transmitted pathogen associated with non-gonococcal urethritis and cervicitis. Azithromycin regimens have been considered first-line treatment for M. genitalium infections, with fluoroquinolone regimens effective as second-line treatments. However, the proportion of M. genitalium harbouring macrolide or fluoroquinolone resistance-associated mutations has been increasing worldwide. This study was done to compare the genotypic macrolide and fluoroquinolone resistance of M. genitalium strains obtained from women attending a termination of pregnancy clinic five years apart.Methods: M. genitalium was detected by PCR in vaginal swab samples from 100 and 104 termination of pregnancy attendees at a tertiary hospital in Pretoria, South Africa during 2012 and 2016 respectively. Genes associated with macrolide and fluoroquinolone resistance in the M. genitalium isolates were sequenced and analysed.Results: The prevalence of M. genitalium was 6.0% (6/100) in 2012 and 7.7% (8/104) in 2016. No resistance-associated mutations were seen in the 2012 isolates. Among the 2016 M. genitalium isolates, two (25%) harboured a macrolide-associated resistance mutation and one (12.5%) a fluoroquinolone resistance-associated mutation in the parC gene.Conclusions: There is an increase in macrolide and fluoroquinolone resistance among local M. genitalium strains. This highlights the need for improved surveillance.

The objective was to determine the occurrence of four urethral pathogens in urine specimens from symptomatic men using transcription mediated amplification (TMA) assay. Urethral swab and urine specimens from 300 men presenting to a family practitioner were Gram stained and tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium using three TMA assays respectively. Except for T. vaginalis, the other recognized pathogens viz. N. gonorrhoeae, C. trachomatis and M. genitalium were detected in significantly larger numbers of patients with urethral discharge than in those with burning on micturition (BOM). The overall prevalences were 16.7% for N. gonorrhoeae, 12.3% C. trachomatis, 8.0% T. vaginalis and 17.3% M. genitalium. With regard to microscopic evidence of urethritis, significant associations were found for N. gonorrhoeae and C. trachomatis, but not for M. genitalium and T. vaginalis. This study demonstrated that in symptomatic men attending family practice, M. genitalium and T. vaginalis are also important aetiological agents of urethritis and hence treatment strategies be they syndromic management or laboratory directed should cover for these causative agents. The microscopic diagnosis of urethritis may not be important for treatment strategies. The current syndromic treatment guidelines for developing countries including South Africa need modification.

This study confirms the high prevalence of M. genitalium among men with urethritis in South Africa and demonstrates that there is a strong association with M. genitalium bacterial load and clinical urethritis. As the number of organisms increased, the severity of the symptoms increased, an indication of the role that the organism plays in disease progression.

Background: Mycoplasma genitalium is a sexually transmitted pathogen associated with non-gonococcal urethritis and cervicitis. Azithromycin regimens have been considered first-line treatment for M. genitalium infections, with fluoroquinolone regimens effective as second-line treatments. However, the proportion of M. genitalium harbouring macrolide or fluoroquinolone resistance-associated mutations has been increasing worldwide. This study was done to compare the genotypic macrolide and fluoroquinolone resistance of M. genitalium strains obtained from women attending a termination of pregnancy clinic five years apart. Methods: M. genitalium was detected by PCR in vaginal swab samples from 100 and 104 termination of pregnancy attendees at a tertiary hospital in Pretoria, South Africa during 2012 and 2016 respectively. Genes associated with macrolide and fluoroquinolone resistance in the M. genitalium isolates were sequenced and analysed. Results: The prevalence of M. genitalium was 6.0% (6/100) in 2012 and 7.7% (8/104) in 2016. No resistance-associated mutations were seen in the 2012 isolates. Among the 2016 M. genitalium isolates, two (25%) harboured a macrolide-associated resistance mutation and one (12.5%) a fluoroquinolone resistance-associated mutation in the parC gene. Conclusions: There is an increase in macrolide and fluoroquinolone resistance among local M. genitalium strains. This highlights the need for improved surveillance.

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