Prevalence of Mycoplasma genitalium fluoroquinolone-resistance markers, and dual-class-resistance markers, in asymptomatic men who have sex with men

Abstract

Introduction. Failure of fluoroquinolones, the principal treatment option for macrolide-resistant Mycoplasma genitalium infections, has recently emerged. This is of particular concern for men who have sex with men (MSM), who have high proportions of macrolide-resistant M. genitalium infections. Treatment failure with moxifloxacin is likely the result of single nucleotide polymorphisms (SNPs) in parC, whilst concurrent gyrA mutations may play a role. Gap Statement. The levels of fluoroquinolone resistance and dual-class (i.e. macrolide and fluoroquinolone) resistance in M. genitalium among asymptomatic MSM is unknown. Aim. To (i) determine the proportion of fluoroquinolone resistance and dual-class resistance in M. genitalium infections among asymptomatic MSM, (ii) explore any clinical and behavioural associations with fluoroquinolone resistance, and (iii) determine the distribution of antibiotic resistance among M. genitalium mgpB sequence types (STs). Methodology. M. genitalium positive samples (N=94) were obtained from 1001 asymptomatic MSM enrolled in a study at Melbourne Sexual Health Centre (Carlton, Australia) between August 2016 and September 2017. Sanger sequencing was performed to determine the proportion of M. genitalium infections with SNPs in parC that have previously been associated with failure of moxifloxacin (corresponding to amino changes S83I, D83R, D87Y and D87N) and in gyrA (corresponding to amino acid changes M95I, D99N, D99Y and D99G). Associations between clinical/behavioural factors and parC SNPs were examined. Strain typing was performed by sequencing a portion of the mgpB gene. Results. The proportion of MSM with infections harbouring parC and gyrA SNPs was 13.0 % [95 % confidence interval (CI): 6.8–23.2 %] and 4.7 % (95 % CI: 1.1–13.4 %), respectively; dual-class resistance was 13.0 %. No significant clinical/behavioural associations were found. Antibiotic resistance was not restricted to specific mgpB STs. Conclusion. One in eight (13 %) of asymptomatic MSM with M. genitalium had an infection with dual-class-resistance mutations. Typing by mgpB sequence suggested fluoroquinolone resistance is arising from independent mutation events. This study illustrates that asymptomatic MSM may act as a reservoir for antibiotic-resistant M. genitalium .

Increases in the Macrolide Resistance of Mycoplasma genitalium and the Emergence of the A2058T Mutation in the 23S rRNA Gene: Clonal Spread?

“…On the other hand, previous treatment with macrolides can also favour the selection of resistant strains as well as the development of resistance by antibiotic selection pressure [ 21 , 22 ]. In line with this, rates of macrolide resistance described in patients seen in STI clinics, with a greater risk of STIs and more previous antibiotic treatments especially MSM, are higher than in the general population seen in primary care centres [ 2 , 3 , 21 , 23 , 24 ]. Additionally, treatment with an adequate regimen of azithromycin in cases of infection of M. genitalium susceptible to macrolides can sometimes induce resistance that may lead to recurrence [ 11 , 25 , 26 ].…”

Prevalence ofMycoplasma genitaliuminfection among HIV PrEP users: a systematic review and meta-analysis

“…One study with 14 participants evaluated the point prevalence of fluoroquinolone-resistant MG infection (figure 4B). 45 The estimated prevalence was 14.3% (95% CI 1.8% to 42.8%). The quality of evidence was as very low due to serious risk of bias and very serious imprecision (online supplemental material 5).…”

“…Regarding the mechanism of resistance against fluoroquinolones, the studies by Chua et al 45 and Guiraud et al 40 reported mutations in the parC gene of the samples, specifically changes in the amino acid S83I, while the study by Berçot et al 32 reported mutations in the amino acid position S83I and D87Y. These mutations are associated with resistance against fluoroquinolones 49 50…”

“…The database search yielded 1964 unique references. A total of 15 studies, reported in 17 publications, fulfilled the inclusion criteria and were included 32–48. The list of studies excluded after the full-text evaluation is presented in online supplemental material 3.…”

Molecular Tools for Typing Mycoplasma pneumoniae and Mycoplasma genitalium

“… Regional distribution of mgpB types (A) and association between mgpB type and resistance (B) among strains in selected studies included mainly men who have sex with men (MSM; Dumke et al, 2016 , 2020 ; Fernandez-Huerta et al, 2020b ; Chua et al, 2021 ; Dumke and Spornraft-Ragaller, 2021 ; Guiraud et al, 2021 ). Strains with S83N change of ParC are not included.…”