Mycoplasma genitalium and Antimicrobial Resistance Among a Cohort of West African Men Who Have Sex With Men Using Preexposure Prophylaxis (CohMSM-PrEP ANRS 12369-Expertise France Study)

Abstract

Background Antimicrobial resistance to macrolides and fluoroquinolones in Mycoplasma genitalium among men who have sex with men (MSM) is worryingly high in high-resource countries. Data in Africa are lacking. We aimed to assess the burden of M. genitalium including the presence of resistance associated mutations (RAMs) in M. genitalium among MSM using HIV pre-exposure prophylaxis in Burkina Faso, Côte d’Ivoire, Mali and Togo. Methods MSM were included in a prospective cohort study (2017-2021). Molecular detection of M. genitalium in urine, anorectal, and pharyngeal samples was performed at baseline and after 6 and 12 months. Detection of RAMs to macrolides and fluoroquinolones was performed by sequencing the 23S rRNA, the parC and gyrA gene. A sample was found to be possibly resistant to fluoroquinolones if alterations were found in ParC position 83/87. Results Of 598 participants, 173 (28.9%) were positive at least once for M. genitalium and global point-prevalence was 19.4%. Interestingly, 238/250 (95.2%) infections were asymptomatic and 72/138 M. genitalium infections with follow-up data (52.2%) cleared during the study. Only one macrolide RAM was found (0.6%). Prevalence of fluoroquinolones RAMs was 11.3% overall, ranging from 2.4% in Burkina Faso to 17.5% in Mali. Conclusions Although M. genitalium was highly prevalent in these MSM, macrolide resistance was almost non-existent. Nevertheless, more than 10% of the samples was possibly resistant to fluoroquinolones. Heterogeneity in the prevalence of fluoroquinolone RAMs between countries may be explained by different antimicrobial consumption in humans and animals.

Extragenital Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men in Johannesburg, South Africa

“…4 A recent study conducted in 4 West African countries, described higher anorectal MG infection rates (12%) among predominantly asymptomatic MSM using HIV preexposure prophylaxis (PrEP). 26 Importantly, 80% (4 of 5) of the asymptomatic MG infections detected in the present study were monoinfections, with current guidelines advising against treatment for such infections in an attempt to reduce antimicrobial selection pressure on this emerging pathogen. 10,27…”

“…Studies investigating rectal MG infection among MSM in South Africa are rare, with one study failing to detect rectal infection among symptomatic MSM in Johannesburg 13 and the other reporting a prevalence of 4% in asymptomatic participants 4 . A recent study conducted in 4 West African countries, described higher anorectal MG infection rates (12%) among predominantly asymptomatic MSM using HIV preexposure prophylaxis (PrEP) 26 . Importantly, 80% (4 of 5) of the asymptomatic MG infections detected in the present study were monoinfections, with current guidelines advising against treatment for such infections in an attempt to reduce antimicrobial selection pressure on this emerging pathogen 10,27 …”