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Selection of Mycoplasma genitalium strains harbouring macrolide resistance-associated 23S rRNA mutations by treatment with a single 1 g dose of azithromycin
  1. Shin Ito1,
  2. Yasushi Shimada2,3,
  3. Yuko Yamaguchi2,
  4. Mitsuru Yasuda2,
  5. Shigeaki Yokoi2,
  6. Shin-ichi Ito2,
  7. Masahiro Nakano2,
  8. Hiroaki Ishiko4,
  9. Takashi Deguchi2
  1. 1iClinic, 7-19-26 Naga-Machi, Taihaku-Ku, Sendai, Japan
  2. 2Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan
  3. 3Research and Development, Narita R&D Department, POCT Group, Mitsubishi Chemical Medience Corporation, Tago-Cho, Katori-Gun, Chiba, Japan
  4. 4Host Defense Laboratory, Mitsubishi Chemical Medience Corporation, Minato-Ku, Tokyo, Japan
  1. Correspondence to Takashi Deguchi, Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu 501-1194, Japan; deguchit{at}


Objective A single 1 g dose regimen of azithromycin has been recommended for the treatment of Mycoplasma genitalium infections. The authors evaluated whether this regimen could select M genitalium strains with macrolide resistance after treatment for M genitalium-positive non-gonococcal urethritis.

Methods In seven men with non-gonococcal urethritis, who were infected with M genitalium without macrolide resistance-associated mutations but experienced microbiological azithromycin treatment failure, M genitalium DNAs in their post-treatment urine specimens were examined for mutations in the 23S rRNA gene and the ribosomal protein genes of L4 and L22. To assess the relatedness of M genitalium strains before and after treatment, their DNAs in pretreatment and post-treatment urine were genotyped by analysing short tandem repeats of an AGT/AAT unit in the MG309 gene and single nucleotide polymorphisms in the MG191 gene.

Results In four of seven patients, M genitalium in post-treatment urine had an A-to-G transition at nucleotide position 2071 or 2072, corresponding to 2058 or 2059 in the 23S rRNA gene of Escherichia coli. In one of the four strains, Pro81Ser in the ribosomal protein L4 accompanied the mutation in the 23S rRNA gene. The genotyping of M genitalium DNAs suggested that these four post-treatment strains were selected from the respective closely related or identical pretreatment strains without macrolide resistance-associated mutations by the treatment.

Conclusions The single 1 g dose treatment of azithromycin could select M genitalium strains harbouring macrolide resistance-associated mutations. For M genitalium, this regimen might increase the risk of macrolide resistance selection after treatment.

  • Mycoplasma genitalium
  • azithromycin
  • macrolide resistance
  • 23S rRNA

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  • Funding This study was supported in part by the Japan Society for the Promotion of Science (JSPS), Japan (Grant-in-Aid for Scientific Research (C) 22591788).

  • Competing interests None.

  • Ethics approval This study was approved by the Institutional Review Board of the Graduate School of Medicine, Gifu University, Gifu, Japan (reference number 22-11).

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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