High prevalence of coinfection of azithromycin-resistant Mycoplasma genitalium with other STIs: a prospective observational study of London-based symptomatic and STI-contact clinic attendees

Abstract

ObjectivesAzithromycin treatment of Chlamydia trachomatis (CT) may not be adequate to treat concomitant Mycoplasma genitalium (MG) infection, and particularly if MG has macrolide resistance-associated mutations (MG-MRAMs). We estimated prevalence of coinfections of CT with MG carrying MRAM, and risk factors for MG-MRAM among a sexual health clinic population.Study design and settingAmong symptomatic and STI-contact clinic attendees in London, prevalence of CT-MG coinfection and MG-MRAM were estimated using nucleic acid amplification testing and Sanger sequencing, respectively, and their associated risk factors analysed using logistic regression.ResultsMG prevalence was 7.5% (23/307), 17.3% (30/173), and 11.4% (8/70) in females, men who have sex with women (MSW) and men who have sex with men (MSM), respectively; MG coinfection in CT-infected participants represented 28.0% (7/25), 13.5% (5/37), 0.0% (0/0), respectively. Presence of MG-MRAM was 39.1% (9/23) in female swabs, 70.0% (21/30) in MSW urine and 83.3% (5/6) in MSM rectal swabs. In multivariate analyses, coinfection with another STI was strongly associated with MG-MRAM (OR: 7.19; 95% CI: 2.4 to 21.5).ConclusionA significant proportion of participants in our study of symptomatic patients and STI contacts were infected with macrolide-resistant MG, suggesting that testing for MG and MRAM, for MG positives, might be clinically useful. The findings also suggest services explore potential benefits of testing CT positive samples for MG in these patient groups. Where MG testing is not available, potential high rates of MG coinfection should be borne in mind when considering azithromycin in the treatment of CT among STI contacts and symptomatic patients.

The Expanded Role of Chitosan in Localized Antimicrobial Therapy

“…The lack of treatment or unsuccessful therapy can lead to reproductive health consequences and complications in pregnancy, as well as increased risk of acquiring other STIs, including HIV [10,269,279]. A vaginal infection is often accompanied by coinfection with other sexually transmitted pathogens, especially in female populations, such as high coinfection rates by mycoplasma and chlamydia [280]. This further complicates the successful elimination of infections and contributes to the development of AMR.…”

HIV pre-exposure prophylaxis was associated with no impact on sexually transmitted infection prevalence in a high-prevalence population of predominantly men who have sex with men, Germany, 2018 to 2019

“…Co-infection with multiple STI was less common in our study than in similar cohorts elsewhere: In a study of MSM in Australia, 13% of participants with CT also had MG and 14% were coinfected with MG and NG [ 24 ]. Among care-seeking MSM in London, 7% had CT/NG coinfections [ 25 ]. The difference in prevalence in these various groups may be due to the criteria for inclusion in the studies as some involved only care-seeking or symptomatic individuals.…”

Associação entre Mycoplasma genitalium e doença inflamatória pélvica: revisão sistemática

“…Outrossim, Shilling et al (2022), em investigação de análise retrospectiva de dados coletados em 17.573 mulheres, entre 2009 e 2019, mostrou coinfecção de Chlamydia trachomatis e Mycoplasma genitalium, em mais de 10% dos casos. A coinfecção dos microrganismos também foi destaque em estudos conduzidos em Cingapura (8,1%), Estados Unidos (7,3%; 38%) e Inglaterra (28%) (Hart et al, 2020;Harrison et al, 2019;Khosropour et al, 2020;Broad et al, 2021).…”