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Mycoplasma genitalium is increasingly recognised as a significant sexually transmitted pathogen. Increasing rates of antibiotic resistance pose a major concern. In August 2015–October 2018, we used reverse transcription PCR to detect M. genitalium in patients with suspected STIs (urethral, endocervical/vaginal, rectal swabs and urines) and with suspicion of urinary tract infection, leukocyturia and negative urine culture. Susceptibility to antibiotics was tested by sequencing 23S rRNA, parC and gyrA genes.
M. genitalium was detected in 191 samples from 173 patients with a mean age of 29 years (range 14–56 years), comprising 99/173 (57.2%) males. Coinfection with other STI-causing pathogen was observed in 28/173 (16.2%) patients (23 Chlamydia trachomatis; 5 Neisseria gonorrhoeae). Prevalence of positive samples for M. genitalium between November 2017 and October 2018 was 113/3541 (3.2%), 50/2463 (2%) in women and 63/1078 (5.8%) in men, which is similar to other Spanish areas.1 2
The 23S rRNA gene was amplified in 124/173 (71.7%) patients. Mutations associated with macrolide resistance were detected in 27/124 (21.8%) patients, comprising A2059G in 16/124 (12.9%) and A2058G in 11/124 (8.9%). A total of 22/124 (17.7%) patients had a resistant strain at the initial presentation, similar rate found in surrounding areas.1 2 Among the 102 patients with macrolide-sensitive M. genitalium at the initial presentation, 46 (37.1%) attended post-treatment follow-up and 5/46 (10.9%) showed macrolide resistance, indicating selection during azithromycin treatment. Resistance to fluoroquinolones was studied in strains from 128/173 (73.9%) patients and 32/128 (25.0%) showed at least one single nucleotide polymorphisms: 23/128 (18.0%) presented a silent mutation and 7/128 (5.5%) had one previously associated with potential resistance to fluoroquinolones.
Our data suggest that M. genitalium is an STI-causing microorganism which should be systematically and actively searched for in patients with genitourinary symptoms. Resistance detection assays can help promote guided therapy, limiting the spread of resistance and reducing patient morbidity.
Handling editor Anna Maria Geretti
Collaborators Alberto Gil-Setas, Ana Navascués, Maria Eugenia Portillo, Aitziber Aguinaga, Carmen Ezpeleta.
Contributors Study concept and design: Xabier Beristain, Alberto Gil-Setas, Ana Navascués, Marta Adelantado Lacasa.
Acquisition of the data: Xabier Beristain, Marta Adelantado Lacasa, Alberto Gil-Setas, Ana Navascués.
Analysis and interpretation of the data: Marta Adelantado Lacasa, Ana Navascués, Xabier Beristain, Alberto Gil-Setas.
Drafting of the manuscript: Marta Adelantado Lacasa.
Critical revision of the manuscript for important intellectual content: Maria Eugenia Portillo, Aitziber Aguinaga, Carmen Ezpeleta.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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