Extragenital Mycoplasma genitalium infections among men who have sex with men

Abstract

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.

Prevalence of Chlamydia trachomatis and Mycoplasma genitalium coinfections and M. genitalium antimicrobial resistance in rectal specimens

“…trachomatis coinfections in this study (9.2%) was slightly lower than has been previously reported (13%). 1 However, a high prevalence of macrolide resistance was detected, comparable with that detected by the PHE reference service overall in 2018 (table 1). Further to this, evidence of resistance to fluoroquinolones was also found.…”

“…To the Editor-in-Chief It has recently been reported that 13% of men who have sex with men (MSM) attending a sexual health clinic were coinfected with Chlamydia trachomatis and Mycoplasma genitalium in the rectum, 1 a site that has been described as a reservoir for asymptomatic M. genitalium infection. 2 Public (table 1).…”

Prevalence of Mycoplasma genitalium fluoroquinolone-resistance markers, and dual-class-resistance markers, in asymptomatic men who have sex with men

“…Consequently, there is uncertainty around the need to treat asymptomatic MSM, particularly as extended-spectrum fluoroquinolones are costly, often hard to access in the community, and may cause severe side effects [7,28]. However, asymptomatic carriage of M. genitalium, particularly at the rectum, and exposure to antibiotics for treatment of other sexually transmitted infections can contribute to the development and spread of resistant M. genitalium [7,42]. The period of time for asymptomatic infections in men to resolve spontaneously is also unknown, but infections may persist for prolonged periods even after symptom resolution [2,43].…”

An alarming high prevalence of resistance associated mutations to macrolides and fluoroquinolones in Mycoplasma genitalium in Belgium: Results from samples collected between 2015-2018

“…[19,20] Individuals with chlamydia or gonorrhoea are frequently co-infected with Mg (as was the case for 20% in our study), which increases the probability of bystander antimicrobial selection pressure and which, in part, may explain the high prevalence of macrolide RAMs found in MSM. [4,21,22]…”

“…A systematic review and meta-analysis up to 2017 found the prevalence of Mg to be 0.9% in pregnant women, 3.2% in MSM and 15.9% in female sex workers. [2] The prevalence of Mg in MSM, is, however, now reaching 10% according to the most recent publications. [3][4][5][6] Mg is a cause of non-gonococcal urethritis in men and cervicitis in women, but Mg is also frequently found in asymptomatic individuals.…”