Mycoplasma genitalium in Symptomatic Male Urethritis: Macrolide Use Is Associated With Increased Resistance

Abstract

Background Mycoplasma genitalium (MG) causes symptomatic urethritis in men, and can infect alone or together with other sexually transmitted infection (STI) agents. Methods The prevalence of MG and other STIs was determined in 1816 men with symptomatic urethritis. Resistance of MG to macrolides and fluoroquinolones was determined by sequencing; the impact of recent antimicrobial usage on the distribution of MG single or mixed infections was determined. Results Overall, prevalence of MG infection was 19.7% (358/1816). Fifty-four percent (166/307) of MG infections occurred alone in the absence of other STI agents. Men with single MG infection self-administered or were prescribed antibiotics more often in the 30 days prior to enrollment than subjects with urethritis caused by MG coinfection (P < .0001). Higher rates (96.7%) of infection with macrolide resistance in MG were identified in men who had taken macrolides prior to enrollment (P < .03). Overall, 88.9% (303/341) of 23S ribosomal RNA (rRNA) genes contained mutations responsible for macrolide resistance; 89.5% (308/344) of parC and 12.4% (42/339) of gyrA genes had mutations responsible for fluoroquinolone resistance. Approximately 88% (270/308) of MG had combined mutations in 23S rRNA and parC genes; 10.4% (32/308) had mutations in all 3 genes. Conclusions MG was the single pathogen identified in 11% of men with symptomatic urethritis. Overall, nearly 90% of MG infections were resistant to macrolides and fluoroquinolones. Men who took macrolides in the 30 days prior to enrollment had higher rates (97%) of macrolide-resistant MG. Resistance was associated with numerous mutations in 23SrRNA, parC, and gyrA genes.

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

“…The study from Germany calculated a rate of 80% macrolide-resistant strains [22]. Quinolone resistance and treatment failures are being reported especially from the Asian Pacific region [28][29][30] reaching nearly 90% in China [31]. So far, data from Europe on quinolone resistance are relatively limited.…”

Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at an STI Clinic in Guangzhou, China, 2016-2018.

“…Although many published reports focus on M. genitalium prevalence and risk-factors across diverse sub-populations, at the time of this study, there are only three locations actively conducting AMRrelated research in clinical settings in China. There are two published reports, one study of macrolide and quinolone resistant among men attending an STI center in the Nanjing vicinity, a city on the coastline central coastline, near the China Centers for Disease Control and Prevention [58,59], published in Chinese and English. The second study is on macrolide and tetracycline mutations among men seeking care at an infertility clinic in Changsha, in the interior of China [60], published in English.…”

“…9%, with A2059G being the most common (61.9%), A2058G being second most (17.6%) no doublemutations were detectable[59]. The parC mutation rate was 90.4%, with Ser83→Ile being the most common (83.7%), a double mutation in G248A + G259T were detectable[59]. The gyrA mutation rate was 13.0%, with Met95→Ile being the most common (5.3%), three double-mutations in G244A + G285A, G285A + A309G, and G285A + A317G were detectable[59].…”

“…The parC mutation rate was 90.4%, with Ser83→Ile being the most common (83.7%), a double mutation in G248A + G259T were detectable[59]. The gyrA mutation rate was 13.0%, with Met95→Ile being the most common (5.3%), three double-mutations in G244A + G285A, G285A + A309G, and G285A + A317G were detectable[59]. In comparison to the Nanjing study, the Changsha study conducted macrolide and tetracycline associated mutations on samples…”

“…9%, with A2059G being the most common (61.9%), A2058G being second most (17.6%) no doublemutations were detectable[59]. The parC mutation rate was 90.4%, with Ser83→Ile being the most common (83.7%), a double mutation in G248A + G259T were detectable[59].…”