Background Rates of macrolide resistance (MR) in Mycoplasma genitalium (Mgen) globally remain alarmingly high (30-100%) and quinolone resistance (QR) is now an increasing concern. In the UK, testing for Mgen is in its infancy and data for MR and QR are therefore lacking. The recent publication of guidelines by British Association for Sexual Health and HIV (BASHH) delivers hope that testing and experience in managing Mgen infection will increase. We aimed to measure infection rates and to determine the prevalence of MR and QR in men with urethritis and women with pelvic inflammatory disease (PID) attending a UK sexual health clinic.

Methods Men with urethritis, women with PID and current sexual partners of Mgen-infected patients were tested for Mgen (BASHH guidelines). The samples were tested using the Fast-Track Urethritis Basic assay for detection. Positive samples were tested by the SpeeDx ResistancePlus® MG assay to detect the presence of MR-mutations and the SpeeDx MG+ParC (beta) assay determined QR-mutations.

Results Forty-five patients tested positive for Mgen—53% of cases were men with urethritis; 29% were women with PID and 18% were asymptomatic patients. The prevalence of Mgen in men with urethritis was 18%, and in women with PID was also 18%. The prevalence of MR was 69% (31/45). The prevalence of QR was 7% (3/45); all 3 patients also had MR.

Conclusion These are the first UK data for MR and QR in Mgen from attendees to clinic at a single centre. MR was higher than previously reported in the UK and Europe. Reassuringly, QR is still low—however, this is likely to rise with increasing quinolone use. Patients with dual-class resistance pose a significant challenge as subsequent treatment options are limited. All testing for Mgen should include the detection of resistance-associated mutations so that the most appropriate agent can be used.

Disclosure No significant relationships.