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Prevalence of macrolide and fluoroquinolone resistance-associated mutations in Mycoplasma genitalium in metropolitan and overseas France
  1. Sabine Pereyre1,2,
  2. Cécile Laurier-Nadalié2,
  3. Chloé Le Roy1,
  4. Jennifer Guiraud1,2,
  5. Amandine Dolzy2,
  6. Nadege Hénin1,
  7. Marie Gardette2,
  8. Cécile Bébéar1,2
  9. for the investigator group
    1. 1 UMR5234 Fundamental Microbiology and Pathology, University of Bordeaux, Bordeaux, France
    2. 2 Bacteriology Department, National Reference Centre for Bacterial Sexually Transmitted Infections, Bordeaux, France
    1. Correspondence to Dr Sabine Pereyre, UMR5234 Fundamental Microbiology and Pathology, University of Bordeaux, Bordeaux, Aquitaine, France; sabine.pereyre{at}


    Objective Limited macrolide and fluoroquinolone resistance data are available in France for Mycoplasma genitalium. We performed a multicentre cross-sectional study to investigate the prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium-positive patients in metropolitan France between 2018 and 2020 and in overseas France in 2018 and 2019.

    Methods Each year, a 1-month prospective collection of M. genitalium-positive specimens was proposed to metropolitan French microbiology diagnostic laboratories, and a similar 3-month collection was proposed to overseas French laboratories. Resistance-associated mutations were detected using commercial kits and sequencing.

    Results A total of 1630 M. genitalium-positive specimens were analysed. In metropolitan France, the prevalence of macrolide resistance-associated mutations ranged between 34.7% (95% CI 29.4% to 40.4%) and 42.9% (95% CI 37.1% to 49.0%) between 2018 and 2020 and was significantly higher in men (95% CI 52.4% to 60.2%) than in women (95% CI 15.9% to 22.2%) (p<0.001). These prevalences were significantly higher than those of 6.1% (95% CI 3.7% to 10.3%) and 14.7% (95% CI 10.9% to 19.6%) observed in overseas France in 2018 and 2019 (p<0.001), where no difference between genders was noted. The prevalence of fluoroquinolone resistance-associated mutations was also significantly higher in metropolitan France (14.9% (95% CI 11.2% to 19.5%) to 16.1% (95% CI 12.1% to 21.2%)) than in overseas France (1.3% (95% CI 0.4% to 3.7%) and 2.6% (95% CI 1.3% to 5.3%) in 2018 and 2019, respectively) (p<0.001), with no difference between men and women regardless of the location.

    Conclusion This study reports the high prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium in metropolitan France and highlights the contrast with low prevalence in overseas France. In metropolitan France, macrolide resistance-associated mutation prevalence was three times higher in men than in women, which was likely to be driven by the proportion of men who have sex with men. This suggests that gender and sexual practice should also be taken into account for the management of M. genitalium infections.

    • resistance
    • mycoplasma genitalium
    • azithromycin
    • molecular epidemiology

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    • Handling editor Nigel Field

    • Collaborators The following are members of the investigator group: Corentine Alauzet (Nancy), Gabriel Auger (Rennes), Julien Bador (Dijon), Guilène Barnaud (Colombes), Agnès Beby-Defaux (Poitiers), Emmanuel Beillard (Cayenne, Guyane), Béatrice Berçot (Paris), Patrick Blanco (Nouméa New Caledonia), Lucas Bonzon (Montpellier), Nadège Bourgeois (Clamart), Sylvie Charachon (Nîmes), Louis Collet (Mamoudzou, Mayotte), Marie Coude (Le Mans), Julien Delmas (Clermont-Ferrand), Caroline Domergue (Toulouse), Stéphane Elaerts (Saint-Denis), Pauline Floch (Toulouse), Anne Grob (Marseille), Sébastien Hantz (Limoges), Philippe Lanotte (Tours), Stéphane Lastère (Tahiti, French Polynesia), Julien Loubinoux (Paris), Léa Luciani (Marseille), Marie Mari (Nice), Stéphanie Marque-Juillet (Versailles), Grégoire Potiron (La Roche sur Yon), Anais Potron (Besançon), Anne-Laure Roux (Boulogne-Billancourt), Hélène Salord (Lyon), Cécile Schanen (Caen), Nathan Tetart (Ste Clotilde, La Réunion), Anne-Lise Toyer (Toulon), Nicolas Traversier (St Denis de la Réunion), Anne Trens (Strasbourg) and Sabine Trombert (St Ouen L’Aumone).

    • Contributors SP and CB conceived and designed the study. All authors and members of the investigator group collected the specimens. CLR, JG, AD, NH and MG performed the research. SP, CL-N, JG and MG analysed the data. SP wrote the manuscript. CB critically revised the manuscript and is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

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