High prevalence and resistance rates of Mycoplasma genitalium among patients visiting two sexually transmitted infection clinics in the Netherlands

Abstract

Mycoplasma genitalium is a well-known cause of urethritis in men and has been associated with cervicitis, pelvic inflammatory disease, and adverse obstetric outcomes in women. In this cross-sectional study, we determined the current prevalence of M. genitalium infection and the rate of macrolide resistance in M. genitalium isolates, in patients visiting two large Dutch sexually transmitted infection (STI) clinics, to evaluate whether the recommendations in Dutch guidelines should be revised. In addition, risk factors for M. genitalium were identified. In total, 3225 patients were included. M. genitalium prevalence rates were 13.8% for all patients; 20.1% for men who have sex with men, 8.2% for men who have sex with women, and 12.6% for women. Macrolide resistance-associated mutations were detected in 66% of the patients infected with M. genitalium. Age, educational level, country of origin, number of sexual partners, HIV-positivity, infection with Neisseria gonorrhoeae, and urethral symptoms in men were independently associated with M. genitalium infection. In conclusion, we found very high prevalence rates and macrolide resistance rates of M. genitalium in patients visiting STI clinics.

Pooling Rectal, Pharyngeal, and Urine Samples to Detect Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium Using Multiplex Polymerase Chain Reaction Is as Effective as Single-Site Testing for Men Who Have Sex With Men

“…Moreover, the resistance prevalence was significantly higher in men's anal samples (75.8%) versus other samples (54%) [ 23 ]. Recent studies in England and the Netherlands [ 24 , 25 ] highlight a prevalence of resistance to macrolides of 69% and 66%, respectively, in patients similar to patients in our study.…”

Macrolide-Resistant Mycoplasma genitalium Impairs Clinical Improvement of Male Urethritis After Empirical Treatment

“…This suggests that MG infection in urethritis is of less clinical importance in the presence of NG. Although asymptomatic MG infections are common, 13 it is striking that, in this symptomatic patient group, clinical treatment failure was so limited, considering the amount of MG coinfections found in the gonococcal urethritis cases in this study (19% [121 of 633]).…”

“… 12 , 13 Among the MG positive samples in the recent study, MG macrolide resistance-associated mutations (MRAM) was detected in 66%. 13 …”

“…7 According to a recent study performed at the STI clinics in Amsterdam and The Hague in 2018, the prevalence of MG among men with urogenital symptoms at the STI clinic in Amsterdam is 29%, whereas it was only 6% in 2014. 12,13 Among the MG positive samples in the recent study, MG macrolide resistanceassociated mutations (MRAM) was detected in 66%. 13 A review showed that there is a correlation between MG infection and persistent or recurrent NGU.…”

“…12,13 Among the MG positive samples in the recent study, MG macrolide resistanceassociated mutations (MRAM) was detected in 66%. 13 A review showed that there is a correlation between MG infection and persistent or recurrent NGU. 14 Read et al 15 observed that recurrent or persistent urethral symptoms were more common in patients without microbiological cure (34 of 44 [77%]; 95% confidence interval [CI], 62%-89%) compared with those who were cured (10 of 63 [16%]; 95% CI, 8%-28%; P < 0.001) after azithromycin treatment.…”