@article {Pittsextrans-2019-054129, author = {Rachel Pitt and Magnus Unemo and Pam Sonnenberg and Sarah Alexander and Simon Beddows and Michelle Jayne Cole and Soazig Clifton and Catherine H Mercer and Anne M Johnson and Catherine A Ison and Nigel Field}, title = {Antimicrobial resistance in Mycoplasma genitalium sampled from the British general population}, elocation-id = {sextrans-2019-054129}, year = {2020}, doi = {10.1136/sextrans-2019-054129}, publisher = {The Medical Society for the Study of Venereal Disease}, abstract = {Background Mycoplasma genitalium is a common sexually transmitted infection. Treatment guidelines focus on those with symptoms and sexual contacts, generally with regimens including doxycycline and/or azithromycin as first-line and moxifloxacin as second-line treatment. We investigated the prevalence of antimicrobial resistance (AMR)-conferring mutations in M. genitalium among the sexually-active British general population.Methods The third national survey of sexual attitudes and lifestyles (Natsal-3) is a probability sample survey of 15 162 men and women aged 16{\textendash}74 years in Britain conducted during 2010{\textendash}12. Urine test results for M. genitalium were available for 4507 participants aged 16{\textendash}44 years reporting \>1 lifetime sexual partner. In this study, we sequenced regions of the 23S rRNA and parC genes to detect known genotypic determinants for resistance to macrolides and fluoroquinolones respectively.Results 94\% (66/70) of specimens were re-confirmed as M. genitalium positive, with successful sequencing in 85\% (56/66) for 23S rRNA and 92\% (61/66) for parC genes. Mutations in 23S rRNA gene (position A2058/A2059) were detected in 16.1\% (95\%CI: 8.6\% to 27.8\%) and in parC (encoding ParC D87N/D87Y) in 3.3\% (0.9\%{\textendash}11.2\%). Macrolide resistance was more likely in participants reporting STI diagnoses (past 5 years) (44.4\% (18.9\%{\textendash}73.3\%) vs 10.6\% (4.6\%{\textendash}22.6\%); p=0.029) or sexual health clinic attendance (past year) (43.8\% (23.1\%{\textendash}66.8\%) vs 5.0\% (1.4\%{\textendash}16.5\%); p=0.001). All 11 participants with AMR-conferring mutations had attended sexual health clinics (past 5 years), but none reported recent symptoms.Conclusions This study highlights challenges in M. genitalium management and control. Macrolide resistance was present in one in six specimens from the general population in 2010{\textendash}2012, but no participants with AMR M. genitalium reported symptoms. Given anticipated increases in diagnostic testing, new strategies including novel antimicrobials, AMR-guided therapy, and surveillance of AMR and treatment failure are recommended.}, issn = {1368-4973}, URL = {https://sti.bmj.com/content/early/2020/01/10/sextrans-2019-054129}, eprint = {https://sti.bmj.com/content/early/2020/01/10/sextrans-2019-054129.full.pdf}, journal = {Sexually Transmitted Infections} }