High prevalence of Mycoplasma genitalium infection and macrolide resistance in patients enrolled in HIV pre-exposure prophylaxis program

Deborde, M.; Pereyre, Sabine; Pugès, Mathilde; Bebear, Cécile; Desclaux, A.; Hessamfar, Mojgan; Roy, Chloé Le; Marec, Fabien Le; Dabis, François; Cazanave, Charles

doi:10.1016/j.medmal.2019.03.007

Cited by 22 publications

(19 citation statements)

References 14 publications

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“…The baseline resistance for macrolides was 44% in our cohort, whereas others reported resistance rates in asymptomatic screened MSM between 58% and 70% 7 10. We observed a non-significant trend of increased macrolide resistance after PrEP initiation.…”

Section: Discussioncontrasting

confidence: 75%

“…Baseline screening showed that 6.9% of our cohort was positive for M. genitalium . Other studies which screened asymptomatic HIV-negative MSM reported a prevalence between 2.1% and 10% 7 9 10. After PrEP initiation, M. genitalium was the third most frequently observed STI, with the rates of chlamydia, gonorrhoea and syphilis being comparable with another large series of patients on PrEP 1.…”

Section: Discussionmentioning

confidence: 76%

“…Recent evidence points to an increased rate of bacterial STI after PrEP initiation1 and a high percentage of macrolide-resistant M. genitalium strains at baseline screening of MSM patients enrolled in PrEP programmes 7. Moreover, PrEP users are frequently exposed to a single 1 g dose of azithromycin, which was recently shown to be associated with an increased risk of future macrolide-resistant M. genitalium infection 6.…”

Section: Discussionmentioning

confidence: 99%

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Mycoplasma genitalium acquisition and macrolide resistance after initiation of HIV pre-exposure prophylaxis in men who have sex with men

et al. 2020

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ObjectivesRecent evidence shows that patients using HIV pre-exposure prophylaxis (PrEP) have an increased rate of bacterial STIs, including syphilis, chlamydia and gonorrhoea. Our study aimed to describe the acquisition and the susceptibility for macrolides of Mycoplasma genitalium in men who have sex with men (MSM) on PrEP.MethodsWe studied all MSM who started PrEP in the AZ Sint-Jan Hospital Bruges from 1 June 2017 to 31 March 2019 with at least one follow-up visit. Patients were screened for M. genitalium and other STIs with pooled rectal swabs, pharyngeal swabs and first-voided urine, and blood samples at baseline and quarterly intervals after initiating PrEP. TaqMan Array Card technology was used to detect M. genitalium and determine macrolide-resistance mediating mutations in region V of the 23S rRNA gene (A2058G, A2059G, A2058C and others). Patients with an STI were treated based on a national guideline.Results131 MSM (median age 40 years, range 20–79) were included in the study. The median follow-up time was 12 months (IQR 6.1–17). Baseline prevalence of M. genitalium was 6.9% and incidence rate after PrEP initiation was 28.8 per 100 person-years (95% CI 21.7 to 37.2), without significant differences in proportions between the first four quarterly intervals. All but one acquisitions were asymptomatic. Younger age and positivity for M. genitalium at baseline were significantly associated with incident M. genitalium acquisition. The observed proportion of macrolide resistance increased not significantly from 44% at baseline to 57%–86% after PrEP initiation. None of the 27 macrolide-resistant M. genitalium acquisitions could be linked to azithromycin exposure in the three preceding months.ConclusionsAfter initiation of PrEP, we found a stable incidence of almost exclusively asymptomatic M. genitalium. However, a non-significant trend of an increased percentage of macrolide-resistant strains was observed.

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Section: Discussioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Mycoplasma genitalium acquisition and macrolide resistance after initiation of HIV pre-exposure prophylaxis in men who have sex with men

et al. 2020

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“…In our study, 60% and 30% of 20 strains showed mutations associated with macrolide and quinolone resistance, and 25% with both. Prevalence of macrolide resistance of M. genitalium may now exceed 50% [3,24] and is reported to be even higher in HIV-positive patients [25] or HIV-PrEP users [26,27], which corresponds to our results. The study from Germany calculated a rate of 80% macrolide-resistant strains [22].…”

Section: Discussionsupporting

confidence: 90%

Prevalence and antibiotic resistance of rectal Mollicutes in HIV-infected men who have sex with men at the University Hospital of Dresden, Germany

Spornraft‐Ragaller

Dumke

2020

Infection

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Background Rectal sexually transmitted infections (STI) are common in men having sex with men (MSM). Mycoplasma genitalium is increasingly being reported in this localization, but due to frequent lack of symptoms at this site, clinical significance is still unclear. Rectal prevalence of Mycoplasma hominis and Ureaplasma species is not well studied so far. We aimed to investigate the prevalence and antibiotic sensitivity of rectal Mollicutes in our HIV-cohort. Methods In 227 MSM presenting for annual STI-screening, 317 anorectal swabs were collected from January 2017 to December 2018. PCR was performed for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, M. genitalium and also culture for M. hominis and Ureaplasma spec. Results Prevalence for M. genitalium, M. hominis, Ureaplasma spec., C. trachomatis and N. gonorrhoeae was 8.2%, 7.3%, 12.0%, 5.1% and 1.9%, respectively. Patients were asymptomatic with few exceptions. Seroprevalence of syphilis in 227 MSM was 41.9%. In 20 strains of M. genitalium, resistance-associated mutations to macrolides and quinolones were found in 60% and 30%, respectively; in five strains (25%) to both. M. hominis and Ureaplasma spec. frequently occurred combined, mostly in significant quantity consistent with infection. M. hominis and Ureaplasma spec. regularly showed sensitivity to tetracycline. Conclusion At screening, rectal colonization with Mollicutes was common in our patients, but rarely caused symptoms. Due to rising antibiotic resistance of M. genitalium against quinolones, therapeutic options are increasingly limited. Treatment should be guided by antibiotic resistance testing including quinolones. In persisting anorectal symptoms, M. hominis and Ureaplasma spec. should also be taken into account.

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“…Different detection methods have varying levels of sensitivity, limiting scientific understanding of its epidemiology. High-income countries report rates of M. genitalium infection ranging from 0.3%-3.3% (11,13,25) in the general population, with higher estimates in certain populations (26,27). Fewer data are available from low-and middle-income countries (LMICs) but prevalence appears to be higher, ranging from 3% in the general population in Tanzania (13) to 8%-9% in Honduras and South Africa (13,28).…”

Section: Discussionmentioning

confidence: 99%

Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015–2017

Scoullar¹,

Boeuf²,

Peach³

et al. 2021

Emerg. Infect. Dis.

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Much about the range of pathogens, frequency of coinfection, and clinical effects of reproductive tract infections (RTIs) among pregnant women remains unknown. We report on RTIs ( Mycoplasma genitalium , Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis , Treponema pallidum subspecies pallidum , bacterial vaginosis, and vulvovaginal candidiasis) and other reproductive health indicators in 699 pregnant women in Papua New Guinea during 2015–2017. We found M. genitalium , an emerging pathogen in Papua New Guinea, in 12.5% of participants. These infections showed no evidence of macrolide resistance. In total, 74.1% of pregnant women had > 1 RTI; most of these infections were treatable. We detected sexually transmitted infections (excluding syphilis) in 37.7% of women. Our findings showed that syndromic management of infections is greatly inadequate. In total, 98.4% of women had never used barrier contraception. These findings will inform efforts to improve reproductive healthcare in Papua New Guinea.

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High prevalence of Mycoplasma genitalium infection and macrolide resistance in patients enrolled in HIV pre-exposure prophylaxis program

Cited by 22 publications

References 14 publications

Mycoplasma genitalium acquisition and macrolide resistance after initiation of HIV pre-exposure prophylaxis in men who have sex with men

Mycoplasma genitalium acquisition and macrolide resistance after initiation of HIV pre-exposure prophylaxis in men who have sex with men

Prevalence and antibiotic resistance of rectal Mollicutes in HIV-infected men who have sex with men at the University Hospital of Dresden, Germany

Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015–2017

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