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Systematic review
Prevalence of Mycoplasma genitalium infection among HIV PrEP users: a systematic review and meta-analysis
  1. Paulo Roberto Sokoll1,
  2. Celina Borges Migliavaca2,
  3. Uwe Siebert1,
  4. Daniela Schmid3,
  5. Marjan Arvandi1
  1. 1Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
  2. 2Health Technology Assessment Institute (IATS), Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA). Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
  3. 3Division for Quantitative Methods in Public Health and Health Services Research, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
  1. Correspondence to Paulo Roberto Sokoll, Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, 6060, Austria; paulo.sokoll88{at}outlook.de

Abstract

Objectives To summarise the prevalence of Mycoplasma genitalium (MG) and antibiotic-resistant MG infection among HIV pre-exposure prophylaxis (PrEP) users.

Methods We searched MEDLINE, Embase, Web of Science and Global Index Medicus up to 30 September 2022. We included studies reporting the prevalence of MG and/or antibiotic-resistant MG infection among PrEP users. Two reviewers independently searched for studies and extracted data. A systematic review with random-effects meta-analysis was performed to quantitatively summarise the results of included studies. The critical appraisal of included studies was conducted with the Joanna Briggs Institute checklist for prevalence studies and the quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results A total of 15 studies were included in the systematic review, with 2341 individuals taking PrEP. Studies were conducted in high-income level countries between 2014 and 2019. Median age of participants varied from 23.5 to 40 years. The majority were men (85%) and among them, 93% were men who have sex with men. To identify MG, urine samples were analysed in 14 studies, rectal or anal swabs in 12 studies, oral or pharyngeal swabs in 9 studies, and urethral or vaginal in 3 studies. The pooled point prevalence of MG among PrEP users was 16.7% (95% CI 13.6% to 20.3%; 95% prediction interval (95% PI) 8.2% to 31.1%). The pooled point prevalence of macrolide-resistant infections was 82.6% (95% CI 70.1% to 90.6%; 95% PI 4.7% to 99.8%) and the prevalence of fluoroquinolone-resistant infections was 14.3% (95% CI 1.8% to 42.8%). Individuals taking PrEP have a higher chance of being infected with MG compared with those not taking PrEP (OR 2.30; 95% CI 1.6 to 3.4). The quality of evidence was very low to moderate.

Conclusion We observed a high prevalence of MG and its macrolide resistance among PrEP users, highlighting the need to reinforce prevention strategies against sexually transmitted infections in this population.

PROSPERO registration number CRD42022310597.

  • Mycoplasma genitalium
  • Drug Resistance
  • ANTIMICROBIAL RESISTANCE
  • Pre-Exposure Prophylaxis
  • PREP

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

http://dx.doi.org/10.1136/sextrans-2022-055687

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information.

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    Footnotes

    • Handling editor Jason J Ong

    • Correction notice This article has been corrected since it was first published online. The affiliations of the authors have been updated.

    • Contributors PRS—project ideation, study design, data extraction, data analysis, interpretation of results, manuscript writing, final review and guarantor of this manuscript. CBM—study design, data extraction, data analysis, interpretation of results, manuscript writing and final review. US—interpretation of results, manuscript writing and final review. DS—interpretation of results, manuscript writing and final review. MA—data extraction, data analysis, interpretation of results, manuscript writing and final review.

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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