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

Abstract

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.

Increased Risk of Sexually Transmitted Infections in Men Who Have Sex With Men Taking Preexposure Prophylaxis: A Meta-analysis

“…Finally, 20 studies met the inclusion criteria for the final analysis. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] From these studies, we extracted 19 groups of incidence data of syphilis, 19 of gonorrhea, and 18 of chlamydia infection during the PrEP period. Five of these studies investigated the incidence data before taking PrEP.…”

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

“…Previous reports from Belgium reported a lower prevalence of macrolide RAMs among female sex workers (6.9%) and MSM (44%). [6,16] It should be noted that in both studies another technique than the gold standard Sanger sequencing was used.…”

“…[2] The prevalence of Mg in MSM, is, however, now reaching 10% according to the most recent publications. [3–6]…”

Molecular epidemiology and antimicrobials resistance mechanism of Mycoplasma genitlaium

“…Так, в группе МСМ, согласно исследованию Bradley и соавт., проведенному в Австралии, частота выявления ректальной инфекции M. genitalium составляла 7,0% (95% ДИ: 5,3-9,1), при этом резистентность к макролидам была обнаружена в 75,0% (36/48; 95% ДИ: 60,4-86,4) [49]. В исследовании Van Praet и соавт., проведенном в Брюгге с июня 2017 по март 2019 г., в группе МСМ, принимающих предэкспозиционную профилактику ВИЧ, частота выявления M. genitalium составила 6,9%, при этом в период с начала терапии уровень резистентности к макролидам с 44% увеличился до 57-86% [50]. В Ирландии, в клинике, специализирующейся на ИППП, частота выявления M. genitalium среди МСМ пациентов составила 3% (12/400; 95% ДИ: 1,3-4,7), в то время как частота выявления резистентности к макролидам составила 75%, а резистентности к фторхинолонам -33,3% [51].…”