<i>Mycoplasma genitalium</i> Infection in Adults Reporting Sexual Contact with Infected Partners, Australia, 2008–2016

Slifirski, Josephine B.; Vodstrcil, Lenka A; Fairley, Christopher K.; Ong, Jason J.; Chow, Eric P F; Chen, Marcus Y; Read, Timothy Richard; Bradshaw, Catriona

doi:10.3201/eid2311.170998

Cited by 23 publications

(22 citation statements)

References 32 publications

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“…Furthermore, the study showed that MSW and bisexual men had a similar prevalence of urethral MG infection, much higher when compared with MSM with no female sexual partners. Several studies have reported that urethral MG infection is more associated with unprotected vaginal sex rather than anal sex 28 29. Behavioural patterns, but also a better environment for MG fitness in vagina, resulting in higher bacterial loads, could explain this fact.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Mycoplasma genitalium and macrolide resistance among asymptomatic people visiting a point of care service for rapid STI screening: a cross-sectional study

et al. 2019

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ObjectivesAlthough rapid screening and treatment programmes have been recently implemented to tackle STIs, testing Mycoplasma genitalium (MG) among asymptomatic populations is not currently recommended due to the lack of scientific evidence and the emergence of antibiotic resistance. The main objective of this study was to estimate the prevalence of MG and macrolide resistance among asymptomatic people visiting a point of care service for rapid STI screening and to identify risk factors associated with the acquisition of this infection.MethodsBetween October 2017 and January 2018, a total of 890 asymptomatic individuals attending to the STI screening service Drassanes Exprés in Barcelona, Spain, were tested for MG and macrolide resistance using the molecular ResistancePlus MG assay (SpeeDx, Australia). Asymptomatically infected individuals were invited to attend the STI Unit for resistance-guided antimicrobial therapy.ResultsOverall, the prevalence of MG was 7.4% (66/890; 95% CI 5.8% to 9.3%), being higher among men who have sex with men (MSM) (46/489) compared with heterosexual men and women (20/401; p=0.012). Macrolide resistance was found in 32/46 (69.6%; 95% CI 54.2% to 82.3%) MSM, while only 2/20 (10.0%; 95% CI 1.2% to 31.7%) infections among heterosexuals presented macrolide resistance-mediated mutations (p<0.001). MSM behaviour, receptive anal intercourse, HIV positive status, syphilis history and high-risk sexual activity (more than five sexual partners in the last 3 months) were significantly associated with MG infection. Furthermore, the resistance-guided therapy approach was implemented in 36/66 (54.6%) individuals.ConclusionsThe research provides further data regarding the prevalence of MG and macrolide resistance among asymptomatic individuals. It also identifies higher risk subpopulations which might be targets for MG screening. Nevertheless, there is insufficient data to justify MG testing among asymptomatic individuals and current STI guidelines should be followed until evidence shows the cost and effectiveness of screening.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Mycoplasma genitalium and macrolide resistance among asymptomatic people visiting a point of care service for rapid STI screening: a cross-sectional study

et al. 2019

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“…A recent meta-analysis, including five studies mostly testing urine, estimated the prevalence of Mgen in MSM in the community at 3.2% (95% CI 2.1 to 5.1) at any site 2. Studies have shown Mgen to be most commonly detected in the rectum of MSM, with 40.7% of contacts of the infection positive in the rectal sites 17. Mgen was detected in 7% of rectal samples from asymptomatic MSM in a recent study of 1001 asymptomatic MSM at MSHC,4 and 9% of consecutive asymptomatic and symptomatic anorectal samples from 505 MSM in Sydney 3.…”

Section: Discussionmentioning

confidence: 99%

Extragenital Mycoplasma genitalium infections among men who have sex with men

et al. 2019

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ObjectivesThere are limited data on the prevalence of Mycoplasma genitalium (Mgen) coinfection with rectal chlamydia (Chlamydia trachomatis (CT)) and rectal gonorrhoea (Neisseria gonorrhoeae (NG)) infections and few studies examining the prevalence of pharyngeal Mgen in men who have sex with men (MSM). Using transcription-mediated amplification assay, this study aimed to determine the proportion of rectal CT and rectal NG infections in MSM who are coinfected with rectal Mgen, and the proportion of MSM with Mgen detected in the pharynx in order to inform clinical practice.MethodsThis was a cross-sectional study conducted at Melbourne Sexual Health Centre in Australia. Consecutively collected rectal swabs from MSM that tested positive for CT (n=212) or NG (n=212), and consecutively collected pharyngeal samples (n=480) from MSM were tested for Mgen using the Aptima Mycoplasma genitalium Assay (Hologic, San Diego). Samples were linked to demographic data and symptom status.ResultsRectal Mgen was codetected in 27 of 212 rectal CT (13%, 95% CI 9 to 18) and in 29 of 212 rectal NG (14%, 95% CI 9 to 19) samples, with no difference in the proportion positive for Mgen. MSM with rectal CT/Mgen coinfection had more sexual partners than those with rectal CT monoinfection (mean 6 vs 11, p=0.06). MSM with rectal NG/Mgen coinfection were more likely to be HIV-positive than those with rectal NG monoinfection (OR=2.96, 95% CI 1.21 to 7.26, p=0.023). MSM with rectal CT/Mgen coinfection were more likely to be using pre-exposure prophylaxis than MSM with rectal NG/Mgen coinfection (OR 0.25, 95% CI 0.10 to 0.65, p=0.002). Pharyngeal Mgen was uncommon and detected in 8 of 464 samples (2%, 95% CI 1% to 3%). Pharyngeal Mgen was associated with having a rectal STI (OR=10.61, 95% CI 2.30 to 48.87, p=0.002), and there was a borderline association with being HIV-positive (p=0.079).ConclusionThese data indicate one in seven MSM treated for rectal CT or rectal NG will have undiagnosed Mgen that is potentially exposed to azithromycin during treatment of these STIs. Rectal Mgen coinfection was associated with specific risk factors which may inform testing practices. Pharyngeal Mgen was uncommon.

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“…genitalium infection from an M. genitalium -positive partner has been demonstrated in 48.2 % of women, 31 % of heterosexual men and 41.7 % of MSM in a cross-sectional analysis of patients attending a Melbourne sexual health clinic with symptoms [14, 67]. Current guidance recommends [65, 66] testing and treating only current partners in order to prevent re-infection of the index case [68, 69].…”

Section: Clinical Featuresmentioning

confidence: 99%

Mycoplasma genitalium: A Review

Gnanadurai

Fifer

2020

Microbiology

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Mycoplasma genitalium is a fastidious organism of the class Mollicutes, the smallest prokaryote capable of independent replication. First isolated in 1981, much is still unknown regarding its natural history in untreated infection. It is recognized as a sexually transmitted pathogen causing acute and chronic non-gonococcal urethritis (NGU) in men, with a growing body of evidence to suggest it also causes cervicitis and pelvic inflammatory disease in women. Its role in several other clinical syndromes is uncertain. The majority of people infected remain asymptomatic and clear infection without developing disease; asymptomatic screening is therefore not recommended. Prevalence rates are higher in patients attending sexual health clinics and in men with NGU. Limited availability of diagnostics has encouraged syndromic management, resulting in widespread antimicrobial resistance and given that few antimicrobial classes have activity against M. genitalium , there is significant concern regarding the emergence of untreatable strains. There is a need for wider availability of testing, which should include detection of macrolide resistance mediating mutations. Expertise in interpretation of microbiological results with clinical correlation ensures targeted treatment avoiding unnecessary antibiotic exposure. Public health surveillance nationally and internationally is vital in monitoring and responding to changing epidemiology trends. In this review, we summarize current knowledge of M. genitalium , including epidemiology, clinical and microbiological data, and discuss treatment challenges in the era of rising multidrug resistance.

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Mycoplasma genitalium Infection in Adults Reporting Sexual Contact with Infected Partners, Australia, 2008–2016

Cited by 23 publications

References 32 publications

Prevalence of Mycoplasma genitalium and macrolide resistance among asymptomatic people visiting a point of care service for rapid STI screening: a cross-sectional study

Prevalence of Mycoplasma genitalium and macrolide resistance among asymptomatic people visiting a point of care service for rapid STI screening: a cross-sectional study

Extragenital Mycoplasma genitalium infections among men who have sex with men

Mycoplasma genitalium: A Review

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