High Rates of Asymptomatic Mycoplasma genitalium Infections With High Proportion of Genotypic Resistance to First-Line Macrolide Treatment Among Men Who Have Sex With Men Enrolled in the Zurich Primary HIV Infection Study

Alexander Ring, Suraj Balakrishna, Frank Imkamp, Sara Burkard, Flurina Triet, Flurina Brunschweiler, Christina Grube, Rebecca Bodmer, Roger D Kouyos, Huldrych F Günthard, Dominique L Braun, Alexander Ring, Suraj Balakrishna, Frank Imkamp, Sara Burkard, Flurina Triet, Flurina Brunschweiler, Christina Grube, Rebecca Bodmer, Roger D Kouyos, Huldrych F Günthard, Dominique L Braun

Abstract

Background: Mycoplasma genitalium (Mg) is an emerging sexually transmitted pathogen among men who have sex with men (MSM). Resistance to recommended antimicrobial agents are of public health concern. Few data exist on Mg infections in MSM diagnosed with human immunodeficiency virus (HIV) during primary HIV infection.

Methods: Participants of the Zurich Primary HIV Study (ClinicalTrials.gov Identifier NCT00537966) were systematically offered screening for sexually transmitted infections (STIs) between April 2019 and September 2020. Screening was performed using an in-house polymerase chain reaction panel comprising Mg including genotypic resistance testing for macrolides and quinolones, Chlamydia trachomatis including serovars L1-L3, Neisseria gonorrhoeae, Treponema pallidum, and Hemophilus ducreyi.

Results: We screened 148 of 266 (55.6%) participants, with an overall total of 415 follow-up visits. Ninety-one percent were MSM. The incidence rate for all STIs was 47.0 (95% confidence interval [CI], 32.2-68.6) per 100 person-years. Mycoplasma genitalium was the most frequently detected pathogen: 30 participants (20%) presented with at least 1 Mg infection, corresponding to a period prevalence of 20.3% and incidence rate of 19.5 Mg infections (95% CI, 11.8-32.4). Most Mg infections (93%) were asymptomatic, and 9 (30%) participants showed spontaneous clearance. We detected high rates of antibiotic resistance: 73.3% to macrolides, 3.3% to quinolones, and 13.3% resistance to both antibiotics.

Conclusions: The high prevalence of mostly asymptomatic Mg infections and high rate of spontaneous clearance support cautious initiation for treatment. The high proportion of macrolide-resistant strains suggests that a genotypic determination of resistance should be standard of care. Moxifloxacin should be the preferred treatment option for symptomatic Mg infections among MSM if resistance testing is unavailable.

Keywords: Mycoplasma genitalium; antibiotic resistance; primary HIV-1-infection; screening; sexually transmitted infection.

© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Figures

Figure 1.
Figure 1.
Flow chart of the study population, study design, and prevalence of Mycoplasma genitalium infections. ZPHI, Zurich Primary HIV Infection Cohort.
Figure 2.
Figure 2.
Factors associated with any sexually transmitted infection (STI). (A) Generalized logistic mixed effect model. (B) Cox proportional hazard model. CD4, cluster of differentiation 4; HR, hazards ratio; nsP, nonsteady partner; RR, risk ratio; sP, steady partners.
Figure 3.
Figure 3.
Follow-up timeline of detected Mycoplasma genitalium (Mg) infection per participant and visit. Participants are stratified by disease characteristics (symptoms, treatment, resistance).

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Source: PubMed

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