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High prevalence of coinfection of azithromycin-resistant Mycoplasma genitalium with other STIs: a prospective observational study of London-based symptomatic and STI-contact clinic attendees.

Broad, CE; Furegato, M; Harrison, MA; Pond, MJ; Tan, N; Okala, S; Fuller, SS; Harding-Esch, EM; Sadiq, ST (2021) High prevalence of coinfection of azithromycin-resistant Mycoplasma genitalium with other STIs: a prospective observational study of London-based symptomatic and STI-contact clinic attendees. Sex Transm Infect, 97 (1). pp. 63-68. ISSN 1472-3263 https://doi.org/10.1136/sextrans-2019-054356
SGUL Authors: Fuller, Sebastian Suarez Sadiq, Syed Tariq

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Abstract

OBJECTIVES: Azithromycin treatment of Chlamydia trachomatis (CT) may not be adequate to treat concomitant Mycoplasma genitalium (MG) infection, and particularly if MG has macrolide resistance-associated mutations (MG-MRAMs). We estimated prevalence of coinfections of CT with MG carrying MRAM, and risk factors for MG-MRAM among a sexual health clinic population. STUDY DESIGN AND SETTING: Among symptomatic and STI-contact clinic attendees in London, prevalence of CT-MG coinfection and MG-MRAM were estimated using nucleic acid amplification testing and Sanger sequencing, respectively, and their associated risk factors analysed using logistic regression. RESULTS: MG prevalence was 7.5% (23/307), 17.3% (30/173), and 11.4% (8/70) in females, men who have sex with women (MSW) and men who have sex with men (MSM), respectively; MG coinfection in CT-infected participants represented 28.0% (7/25), 13.5% (5/37), 0.0% (0/0), respectively. Presence of MG-MRAM was 39.1% (9/23) in female swabs, 70.0% (21/30) in MSW urine and 83.3% (5/6) in MSM rectal swabs. In multivariate analyses, coinfection with another STI was strongly associated with MG-MRAM (OR: 7.19; 95% CI: 2.4 to 21.5). CONCLUSION: A significant proportion of participants in our study of symptomatic patients and STI contacts were infected with macrolide-resistant MG, suggesting that testing for MG and MRAM, for MG positives, might be clinically useful. The findings also suggest services explore potential benefits of testing CT positive samples for MG in these patient groups. Where MG testing is not available, potential high rates of MG coinfection should be borne in mind when considering azithromycin in the treatment of CT among STI contacts and symptomatic patients.

Item Type: Article
Additional Information: This article has been accepted for publication in Sexually Transmitted Infections, 2020 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/sextrans-2019-054356
Keywords: M. genitalium, antimicrobial resistance, azithromycin, chlamydia infection, gonorrhoea, 1103 Clinical Sciences, 1117 Public Health and Health Services, 1108 Medical Microbiology, Public Health
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Sex Transm Infect
ISSN: 1472-3263
Language: eng
Dates:
DateEvent
15 January 2021Published
11 May 2020Published Online
14 April 2020Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
II-LB-0214-20005National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
PubMed ID: 32393529
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111945
Publisher's version: https://doi.org/10.1136/sextrans-2019-054356

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