Antimicrobial susceptibility of Mycoplasma genitalium isolates from Pretoria, South Africa in 2012 and 2016

Abstract

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.

Failure of syndromic management due to drug-resistant Mycoplasma genitalium infection in South Africa: a case report

“…In the absence of routine diagnostics, resistance data of M. genitalium in Africa are scarce and limited to small series of asymptomatic infections in women. 9,10 The case that we report highlights a potential limitation of syndromic management in the context of macrolide-resistant M. genitalium infection. As per guidelines, our patient was treated twice with azithromycin and ceftriaxone, but without success.…”

“…In the absence of routine diagnostics, resistance data of M. genitalium in Africa are scarce and limited to small series of asymptomatic infections in women. 9,10…”

Lack of resistance to macrolides in Mycoplasma genitalium detected in South African pregnant women

“…27,28,29,30 The emergence of macrolide resistance in M. genitalium has drawn recent attention. 18,20,21,22,23 The first study to report on macrolide resistance in M. genitalium in South Africa was conducted by Hay et al in the Limpopo province of rural South Africa in 2015. 20 In that study, the authors reported detecting macrolide resistance-associated mutations in 4 out of 41 (9.8%) of M. genitalium positive isolates obtained from http://www.sajid.co.za Open Access…”

“…15,16,17 In a study conducted in Pretoria, South Africa, in 2012 and 2016, the prevalence of M. genitalium in termination of pregnancy attendees was reported to be 6.0% in 2012 and 7.7% in 2016. 18 Current South African Sexually Transmitted Infections Management Guidelines (2015) recommend the administration of a single oral dose (1 g) of azithromycin for the treatment of http://www.sajid.co.za Open Access vaginal discharge syndrome and male urethritis syndrome. 19 However, recent years have seen the rapid emergence of macrolide resistance in M. genitalium as a result of this widespread administration of azithromycin.…”

“…19 However, recent years have seen the rapid emergence of macrolide resistance in M. genitalium as a result of this widespread administration of azithromycin. 18,20,21,22,23,24,25 The genetic basis for macrolide resistance was reported to be as a result of mutations occurring at positions 2058 and 2059 (E. coli numbering) within the V region of the 23S ribosomal ribonucleic acid (rRNA) gene of M. genitalium. 22 To date, there remains limited data available on the emergence of macrolide resistance in pregnant populations from KwaZulu-Natal (KZN).…”