Objectives Although rapid screening and treatment programmes have been recently implemented to tackle STIs, testing Mycoplasma genitalium (MG) among asymptomatic populations is not currently recommended due to the lack of scientific evidence and the emergence of antibiotic resistance. The main objective of this study was to estimate the prevalence of MG and macrolide resistance among asymptomatic people visiting a point of care service for rapid STI screening and to identify risk factors associated with the acquisition of this infection.
Methods Between October 2017 and January 2018, a total of 890 asymptomatic individuals attending to the STI screening service Drassanes Exprés in Barcelona, Spain, were tested for MG and macrolide resistance using the molecular ResistancePlus MG assay (SpeeDx, Australia). Asymptomatically infected individuals were invited to attend the STI Unit for resistance-guided antimicrobial therapy.
Results Overall, the prevalence of MG was 7.4% (66/890; 95% CI 5.8% to 9.3%), being higher among men who have sex with men (MSM) (46/489) compared with heterosexual men and women (20/401; p=0.012). Macrolide resistance was found in 32/46 (69.6%; 95% CI 54.2% to 82.3%) MSM, while only 2/20 (10.0%; 95% CI 1.2% to 31.7%) infections among heterosexuals presented macrolide resistance-mediated mutations (p<0.001). MSM behaviour, receptive anal intercourse, HIV positive status, syphilis history and high-risk sexual activity (more than five sexual partners in the last 3 months) were significantly associated with MG infection. Furthermore, the resistance-guided therapy approach was implemented in 36/66 (54.6%) individuals.
Conclusions The research provides further data regarding the prevalence of MG and macrolide resistance among asymptomatic individuals. It also identifies higher risk subpopulations which might be targets for MG screening. Nevertheless, there is insufficient data to justify MG testing among asymptomatic individuals and current STI guidelines should be followed until evidence shows the cost and effectiveness of screening.
- antimicrobial resistance
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Handling editor Catherine A Ison
Contributors ME led the design and conduct of the study. MF-H and CFN contributed to design the study and performed the experimental work. MF-H, AR and ME analysed the results. MF-H wrote the initial draft with ME. MJ-B, JE, CF-N, MV-M, MA, JS-P, CB, FZ, AR and TP reviewed and commented on the manuscript.
Funding SpeeDx Pty Ltd supplied all the reagents for molecular testing of Mycoplasma genitalium.
Disclaimer The conclusions in this report are those of the authors and do not represent the official position of any national/international institution. The funders had no role in study design, data collection and analyses, decision to publish or preparation of the manuscript.
Competing interests CFN is a researcher who has received partial salary support from SpeeDx Pty Ltd. MF-H and ME have participated in symposiums organised by SpeeDx Pty Ltd.
Patient consent for publication Not required.
Ethics approval Ethical approval for the study was obtained from the Vall d’Hebron University Hospital Ethics Committee (209/2017).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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