Retrospective analysis of infection and antimicrobial resistance patterns of Mycoplasma genitalium among pregnant women in the southwestern USA

Abstract

BackgroundMycoplasma genitalium is a sexually transmitted infection (STI) pathogen. There have been no published studies concerning symptomatology, prevalence data, antibiotic resistance profiling or reports of co-infection with other STI in pregnant women.ObjectiveTo describe these characteristics among pregnant women attending prenatal clinics in a large tertiary care centre.DesignRemnant genital samples collected from pregnant women between August 2018 and November 2019 were tested for M. genitalium and Trichomonas vaginalis by the transcription-mediated amplification technique. Specimens with detectable M. genitalium RNA were sequenced for 23S rRNA mutations associated with azithromycin resistance and parC and gyrA mutations associated with resistance to moxifloxacin. Demographic, obstetric and STI co-infection data were recorded.ResultsOf the 719 samples, 41 (5.7 %) were positive for M. genitalium. M. genitalium infection was associated with black race, Hispanic ethnicity and young age (p=0.003, p=0.008 and p=0.004, respectively). M. genitalium infection was also associated with T. vaginalis co-infection and Streptococcus agalactiae (group B Streptococcus) colonisation (p≤0.001 and p=0.002, respectively). Of the 41 positive samples, 26 (63.4%) underwent successful sequencing. Eight (30.8%) had 23S rRNA mutations related to azithromycin resistance. One of 26 (3.8%) positive samples with sequencing results had the gyrA gene mutation and 1 of 18 sequenced samples (5.6%) had the parC gene mutation associated with moxifloxacin resistance.ConclusionsPrevalence rates of M. genitalium in pregnant women was 5.7%. M. genitalium infection disproportionately affects young black women co-infected with T. vaginalis. Pregnant women remain at risk for persistent infection with M. genitalium due to decreased azithromycin susceptibility.

Prevalence of Mycoplasma genitalium infection and macrolide resistance in pregnant women receiving prenatal care

“…In the current prospective study, we found that 8% of pregnant women receiving prenatal care at OB clinics in a Southeastern US urban medical center tested positive for MG, and MG positivity was associated with younger maternal age, black race, and prior trichomoniasis. Frequency of MRMs was high (41%), which is similar to the 31% MRM frequency reported in MG‐infected pregnant women seen in Southwestern US sites 8 . The common detection of MG infection and high frequency of MRMs in this cohort underscores the great need for a better understanding of the clinical implications of untreated MG infection in pregnant women to guide screening and treatment recommendations; should treatment be necessary for MG infection in pregnant women in the United States, then additional MG treatment options that are safe in pregnancy will be needed.…”

“…Routine MG screening is not currently recommended 4 because of a lack of consistent evidence of reproductive sequelae from asymptomatic infection. Most MG prevalence estimates have come from nonpregnant populations; reported prevalence in pregnant women from a small number of studies ranges from 1% to 17% 5–8 . Limited studies evaluating the association of MG with adverse pregnancy outcomes have produced conflicting results 2 .…”

“…Frequency of MRMs was high (41%), which is similar to the 31% MRM frequency reported in MG-infected pregnant women seen in Southwestern US sites. 8 The common detection of MG infection and high frequency of MRMs in this cohort underscores the great need for a better understanding of the clinical implications of untreated MG infection in pregnant women to guide screening and treatment recommendations; should treatment be necessary for MG infection in pregnant women in the United States, then additional MG treatment options that are safe in pregnancy will be needed.…”

“…Most MG prevalence estimates have come from nonpregnant populations; reported prevalence in pregnant women from a small number of studies ranges from 1% to 17%. [5][6][7][8] Limited studies evaluating the association of MG with adverse pregnancy outcomes have produced conflicting results. 2 Macrolides are the only MG treatment available in the United States that can be safely used during pregnancy, and their efficacy is declining as a result of the emergence of strains containing macrolide resistance-associated gene mutations (MRMs).…”

Monitoring of macrolide resistanceassociated mutations in Mycoplasma genitalium in Russia

“…За последние годы наблюдается снижение эффектив ности препаратов данной группы, несмотря на различия в тактике назначения в разных странах. Случаи отсут ствия положительной динамики у пациентов после ре комендованных методов лечения были описаны иссле дователями в Европе, США и странах Азии [21][22][23]. В основе этой тревожной ситуации лежит несколько при чин: отсутствие международного консенсуса в отно шении стратегии обследования и лечения пациентов, необоснованное использование макролидов при респи раторных инфекциях, плохое соблюдение схем лечения пациентами и их партнерами, недостаточная доступ ность тестов для выявления устойчивости микоплазм, а также отсутствие мониторинга за распространением штаммов, несущих маркеры резистентности к антими кробным препаратам.…”