Distribution of Macrolide Resistant Mycoplasma genitalium in Urogenital Tract Specimens From Women Enrolled in a US Clinical Study Cohort

Abstract

Background This study evaluated the distribution of macrolide-resistant Mycoplasma genitalium in multiple urogenital specimens collected from women enrolled in a prospective multi-center US clinical study. Methods Four female urogenital specimens (vaginal swab, urine, endocervical swab, ectocervical brush/spatula) collected from each subject were tested using a transcription-mediated amplification (TMA) assay for M. genitalium. TMA-positive specimens were evaluated by reverse transcription-PCR and bi-directional Sanger sequencing of M. genitalium 23S rRNA to identify the presence of macrolide resistance-mediating mutations (MRM) at base positions 2058/2059. Results Of 140 women with one or more TMA-positive specimens, 128 (91.4%) yielded M. genitalium 23S rRNA sequence. MRM were found in 52% of vaginal specimens, 46.3% of urine specimens, 37.8% of endocervical specimens, and 46% of ectocervical specimens. There were 44 unique specimen type/sequence phenotype combinations of M. genitalium infection. The majority (81, 63.3%) of women had single specimen-sequence phenotype (macrolide-susceptible, MRM, or both) infections, while 24 (18.8%) women had multiple specimen-sequence phenotype concordant infections, and 23 (17.9%) women had multiple specimen-sequence phenotype discordant infections. The sensitivity for any single specimen type to detect overall urogenital tract macrolide-resistant M. genitalium infection status was 96.3% for vaginal swab samples, 82.6% for urine samples, 70.8% for endocervical swab samples, and 82.1% for ectocervical brush/spatula liquid Pap samples. Conclusions The distribution of M. genitalium infections in female urogenital tract specimens is highly complex, with multiple phenotypic combinations of the organism infecting a significant proportion of women at different anatomic specimen collection sites. Vaginal swab sampling yielded the highest sensitivity for identifying women with macrolide resistant M. genitalium urogenital tract infections.

High macrolides and fluoroquinolones resistance rate in Mycoplasma genitalium in southern Tenerife

“…Históricamente, la presencia de requerimientos especiales en el cultivo y su lento crecimiento dificultan su identificación y la realización del antibiograma. En la actualidad, las técnicas de amplificación de ácidos nucleicos han supuesto una revolución en el diagnóstico de este patógeno [ 2 ].…”

Optimization and Clinical Evaluation of an Automated Commercial Analyte-Specific Reagent Assay for Mycoplasmoides genitalium Macrolide Resistance Detection in Primary Clinical Specimens

“…Of 95 untreated primary clinical specimens submitted for confirmatory Sanger sequencing, 88 (92.6%) yielded sufficient nucleic acid for analysis. One recent publication ( 21 ) reported a similar 89.4% rate of valid sequencing result using the same methodology. The 7 specimens failing to yield sufficient targets (including 3 first-void urine specimens) generated Mgen MacR ASR C T values ranging from 38.1 to 42.2 (median 40.2, mean 40.1; data not illustrated).…”

“…Point mutation-conferred macrolide resistance, as detected within M. genitalium 23S rRNA base positions 2058 and 2059 ( Escherichia coli numbering), has been associated with azithromycin treatment failure ( 19 , 20 ). Global surveys of primary clinical specimens with detectable M. genitalium nucleic acid have revealed increased frequency of macrolide resistance determinants, including data from North America reporting a 45% resistance rate in female urogenital specimens ( 21 ), a 64% rate in male urethral specimens from a United States multicenter study (range 60 to 76% by location) ( 22 ), and an approximate 70% rate in heterosexual couple urogenital, pharyngeal, and rectal specimens ( 23 ). As a result, the 2021 revised United States Centers for Disease Control and Prevention STI treatment guidelines ( 24 ) for M. genitalium are predicated based on availability of macrolide resistance detection assays, following a positive molecular diagnostic test result.…”

Mycoplasmoides genitaliumMacrolide Resistance Detection is Needed in University Settings

“…Earlier reports documented 40-60% macrolide resistance rates in Western Europe. [24][25][26] In North America, contemporary data have reported 45% macrolide resistance in the context of female urogenital infection 27 and 70% resistance in one study of heterosexual couple urogenital, pharyngeal, and rectal specimens. 28 As a result, the latest CDC STI treatment guidelines for M. genitalium 29 are algorithm-based and largely incumbent on access to macrolide resistance data derived from primary clinical specimens.…”