High prevalence of circulating dual-class resistant Mycoplasma genitalium in asymptomatic MSM in Tokyo, Japan

Abstract

Objectives To assess the prevalence and antibiotic resistance profile of Mycoplasma genitalium detected from urogenital/rectal swab samples obtained from MSM in Tokyo, Japan. Methods We performed PCR-based screening for M. genitalium urogenital/rectal infection in 982 asymptomatic MSM between 1 January 2019 and 5 November 2020. Mutations in the antibiotic resistance-associated genes gyrA and parC and the 23S rRNA of M. genitalium were analysed. Results The prevalence of M. genitalium infection was 6.1%: the prevalence of rectal and urogenital infection was 4.7% and 1.4%, respectively. Among the cases, 48 were successfully analysed for 23S rRNA, 41 for parC mutations and 37 for gyrA mutations. Macrolide- and quinolone-resistance associated mutations (23S rRNA and parC mutations) were observed in 43 (89.6%) and 28 (68.3%) cases, respectively. The quinolone-resistance associated mutation-harbouring variants also harboured macrolide-resistance associated mutations. The S83I mutation in the parC gene was most commonly identified (24 cases, 58.5%), and its combination with M95I or D99N mutation in the gyrA gene was observed in 9 of 36 successfully analysed cases (25.0%). No significant association was observed between the presence of antibiotic resistance and antibiotic exposure for either macrolides or fluoroquinolones (P = 0.785 and 0.402, respectively). Conclusions In Tokyo, there is an alarmingly high prevalence of M. genitalium harbouring macrolide and/or quinolone resistance-associated mutations in MSM, irrespective of antibiotic exposure. The high prevalence of M. genitalium strains with both parC and gyrA mutations limits the efficacy of sitafloxacin. Therefore, suitable alternatives are required to treat such M. genitalium infections.

Mycoplasma genitalium antibiotic resistance-associated mutations in genital and extragenital samples from men-who-have-sex-with-men attending a STI clinic in Verona, Italy

“…However, there is high variability among different populations and clinical settings worldwide. Focusing on the MSM population, our data are in line with the prevalence reported in Spain (13.2%) (Fernańdez-Huerta et al, 2019) and in Australia (13%) (Sweeney et al, 2022), although higher values (68.3%) are reported in Japan (Ando et al, 2021). Similarly, the prevalence of dual-class-resistance-associated mutations found in our study (17%) is higher than the one reported in the systematic review (2.8%) (Machalek et al, 2020), but similar to the prevalence found in STI clinic attendees in New Zealand (20%) (Vesty et al, 2020) and in the MSM population in Australia (13-16.4%) (Murray et al, 2020;Chua et al, 2021).…”

Molecular Characterization and Detection of Macrolide and Fluoroquinolone Resistance Determinants in Mycoplasma genitalium in South Africa, 2015 to 2018

“…The high prevalence of fluoroquinolone resistance–associated mutations in ParC in M. genitalium from Japan may be attributed to the frequent use of fluoroquinolones, such as levofloxacin, to treat urogenital infections 9 . In asymptomatic men who have sex with men (MSM) attending sexual health clinics in Tokyo (2019–2020), macrolide resistance–associated mutations and MDR were observed in 89.6% and 68.3% of M. genitalium strains, respectively, from first void urine and rectal swab specimens 25 . Current treatment guidelines do not recommend screening for M. genitalium in asymptomatic persons or extragenital specimens because the risk of escalating antimicrobial resistance with treatment will potentially outweigh any benefits 26 .…”

“…9 In asymptomatic men who have sex with men (MSM) attending sexual health clinics in Tokyo (2019-2020), macrolide resistance-associated mutations and MDR were observed in 89.6% and 68.3% of M. genitalium strains, respectively, from first void urine and rectal swab specimens. 25 Current treatment guidelines do not recommend screening for M. genitalium in asymptomatic persons or extragenital specimens because the risk of escalating antimicrobial resistance with treatment will potentially outweigh any benefits. 26 In Queensland, Australia, the prevalence of M. genitalium macrolide and fluoroquinolone resistance was 62% and 10%, respectively.…”

Prevalence of Mollicutes among men who have sex with men and transgender women aged 15 to 19 years in Salvador, North-eastern Brazil

“…Despite this, this species has been associated with several pathologies of the urogenital tract, such as non-chlamydial non-gonococcal urethritis [23][24][25], male infertility [26][27][28], an increased risk of HIV transmission [29,30], and antibiotic resistance [31]. This species is highly prevalent in MSM over the age of 18 [32][33][34][35][36], even in extragenital sites (i.e., oral and anal) [37,38], and is hard to identify in clinical practice due to the absence of symptoms, making them important extragenital reservoirs [37][38][39][40][41]. A missed diagnosis then leads to the persistence of these microorganisms and their potential transmittance to sexual partners [39][40][41][42].…”