Antimicrobial-resistant sexually transmitted infections: gonorrhoea and Mycoplasma genitalium

Abstract

The emergence of antimicrobial resistance (AMR) is a major concern worldwide and already compromises treatment effectiveness and control of several bacterial sexually transmitted infections (STIs). Neisseria gonorrhoeae and Mycoplasma genitalium are evolving into so-called superbugs that can become resistant, both in vitro and clinically, to essentially all antimicrobials available for treatment, causing exceedingly difficult-to-treat or untreatable STIs and threatening global public health. Widespread AMR in these bacteria is likely to persist and even worsen in the future, owing to the high number of infections, widespread and uncontrolled use of antimicrobials, limited surveillance of AMR and clinical failures, as well as the extraordinary capacity of these bacteria to develop AMR. This development would not only result in an increased prevalence of N. gonorrhoeae and M. genitalium infections but also in a considerably increasing number of severe complications affecting reproductive health. To combat this threat, clinicians need to be aware of the current guidelines on diagnostic procedures, recommended treatment regimens, as well as therapeutic options for multidrug-resistant bacteria. AMR testing needs to be more frequently performed, inform treatment decisions and elucidate how AMRs compromise treatment effectiveness, guiding research for effective future therapies.

Rapid accurate point-of-care tests combining diagnostics and antimicrobial resistance prediction forNeisseria gonorrhoeaeandMycoplasma genitalium

“…Concerning M. genitalium , a common cause of non-gonococcal genital discharge syndromes, which often require empirical therapy, resistance to recommended first-line treatment with macrolides (azithromycin or josamycin in some countries) has rapidly increased during the last decade; moreover, resistance to second-line therapy with fluoroquinolones (moxifloxacin) has emerged and is spreading internationally 2 10 20. The 2016 European guideline on M. genitalium infections recommends that all M. genitalium NAAT-positive samples should ideally be examined for macrolide resistance before treatment is initiated 2…”

Evaluation of the Mycoplasma genitalium Resistance Plus kit for the detection of M. genitalium and mutations associated with macrolide resistance

“…Mycoplasma genitalium is a cause of urethritis in men and cervicitis in women1 and has been increasingly associated with upper genital tract infection and pelvic inflammatory disease 1 2. In patients with non-gonococcal urethritis (NGU) and in the absence of M. genitalium diagnostic testing, UK guidelines3 recommended treatment with 1 g azithromycin until earlier this year.…”

“…This does not appear to select for resistance in M. genitalium to the same extent,1 7 likely due to the intracellular and extracellular tissue concentrations both remaining above the therapeutic threshold for longer. Where diagnostic tests are available, M. genitalium -positive specimens should ideally be tested for macrolide resistance-associated mutations to aid patient management 1. Hence, we evaluated the M. genitalium ResistancePlus kit (SpeeDx, Australia), which simultaneously detects M. genitalium- specific DNA and mutations that have been associated with resistance to macrolide antibiotics 8…”

Epithelial stratification shapes infection dynamics

“…They also estimate that 417 million people carry Herpes simplex virus type 2 (HSV-2) and 291 million women have ano-genital infections by Human papillomaviruses worldwide (HPVs) [3], however, due to the asymptomatic nature of many of these infections the global prevalence is likely higher. In addition, Mycoplasma genitalium and N. gonorrhoeae are increasingly becoming resistant to antibiotics [4], thus causing rising morbidity, mortality and costs [2]. Facing these challenges requires a better understanding of epithelial dynamics.…”