Impact of mass drug administration of azithromycin for trachoma elimination on prevalence and azithromycin resistance of genitalMycoplasma genitaliuminfection

Abstract

BackgroundMass drug administration (MDA) of 20 mg/kg (maximum 1 g in adults) azithromycin for ocular Chlamydia trachomatis (CT) infection is a key component of the WHO trachoma elimination strategy. However, this dose may be suboptimal in Mycoplasma genitalium infection and may encourage emergence of antimicrobial resistance (AMR) to azithromycin.ObjectivesTo determine the effect of MDA for trachoma elimination on M. genitalium prevalence, strain type and azithromycin resistance.MethodsA secondary analysis of CT-negative vulvovaginal swabs from three outpatient antenatal clinics (Honiara, Solomon Islands) from patients recruited either pre-MDA, or 10 months post-MDA in two cross-sectional surveys was carried out. Swabs were tested for M. genitalium infection using Fast Track Diagnostics Urethritis Plus nucleic acid amplification assay. M. genitalium-positive samples were subsequently tested for azithromycin resistance by sequencing domain V of the 23S rRNA DNA region of M. genitalium and underwent phylogenetic analysis by dual locus sequence typing.Results M. genitalium prevalence was 11.9% (28/236) in women pre-MDA and 10.9% (28/256) 10 months post-MDA (p=0.7467). Self-reported receipt of azithromycin as part of MDA was 49.2% in women recruited post-MDA and 17.9% (5/28) in those who tested M. genitalium positive. Of samples sequenced (21/28 pre-MDA, 22/28 post-MDA), all showed a macrolide susceptible genotype. Strain typing showed that sequence types diverged into two lineages, with a suggestion of strain replacement post-MDA.ConclusionA single round of azithromycin MDA in an island population with high baseline M. genitalium prevalence did not appear to impact on either prevalence or azithromycin resistance, in contrast to reported decreased genital CT prevalence in the same population. This may be due to limitations such as sample size, including CT-negative samples only, and low MDA coverage. Further investigation of the impact of multiple rounds of MDA on M. genitalium azithromycin AMR in antibiotic experienced and naïve populations is warranted.

Single gene targeted nanopore sequencing enables simultaneous identification and antimicrobial resistance detection of sexually transmitted infections

“…34 However, we did not find macrolide resistance associated mutations in 23S rRNA gene of MG strains, even though macrolide-resistance of MG was prevalent in the U.S. 35 and common worldwide. 36 Interestingly, we also previously described lack of macrolide resistant MG in the Solomon islands 37 despite a high prevalence of infection in the islands. Among the TV strains detected, 2/10 had the A238T SNP which results in a premature stop codon in the ntr6 gene that is associated with metronidazole resistance.…”

Genomics of OcularChlamydia trachomatisafter 5 years of SAFE interventions for trachoma in Amhara, Ethiopia

“…Almost 900 million doses of azithromycin have been distributed by trachoma control programmes since 1999 42 and in Amhara alone 15 million doses are administered every year. 3 Mass distribution of azithromycin is likely to become more common as more evidence emerges of off-target effects such as reducing infectious diseases, 23,[43][44][45] diarrheal diseases 46 and childhood mortality. 22,[47][48][49][50] There is concern about the impact of these programmes on development of antimicrobial resistance in Ct and other bacteria.…”

Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015–2017

“…The highest prevalence has been reported among sex workers: 16% in Kenya ( 29 ) and 26% in Uganda ( 30 ). Data on M. genitalium infection among pregnant women remains limited despite the disease’s association with adverse pregnancy outcomes ( 26 ); available estimates range from 0.7%–0.9% in the United Kingdom and France ( 14 , 31 ) to 6.2% in Guinea-Bissau ( 32 ) and 11.9% in the Solomon Islands ( 15 ). More data on the prevalence and consequences of M. genitalium infection among pregnant women are needed.…”

“…Regional data on M. genitalium in LMICs are limited. One study from the Solomon Islands examined the effects of mass drug administration (MDA) using 1 g of oral azithromycin for eliminating ocular C. trachomatis on M. genitalium infection rates ( 15 ). Before MDA, the study found an 11.9% (95% CI 8.3%–16.6%; n = 236) prevalence of M. genitalium among pregnant women.…”

“…Limited data exists on M. genitalium prevalence, although estimates range from <1.0% in the general adult population to 15.9% in groups at high risk, such as female commercial sex workers ( 12 , 13 ). In pregnant women, estimates range from 0.7% in the United Kingdom ( 14 ) to 11.9% in the Solomon Islands ( 15 ). During 2010–2019, global macrolide resistance to M. genitalium increased from 10% to >50% ( 16 ).…”