Prevalence of fluoroquinolone resistance-associated mutations inMycoplasma genitaliumamong clients of two sexual health centres in the Netherlands: a cross-sectional study

Abstract

ObjectiveThis study aimed to determine the prevalence of fluoroquinolone resistance-associated mutations (QRAMs) inMycoplasma genitalium(MG) among clients of two sexual health centres (SHCs) in the Netherlands.DesignA cross-sectional study.Setting and participantsBetween 2018 and 2019, 669 clients with MG were included from two previous studies: 375 male clients with urethritis from the SHC in Amsterdam; and 294 clients (male and female) from the SHC in Amsterdam and The Hague. Urogenital and anal samples (705 in total) that tested positive for MG by nucleic acid amplification tests were selected.Outcome measuresThe presence of QRAM was detected by an MG-QRAM PCR targeting four mutations in theparCgene and investigated by sequence analysis of relevant regions of thegyrAandparCgenes. Possible risk factors for the presence of QRAM were investigated.ResultsWe found QRAM in 58 of 669 (9%) clients with an MG infection: 36 of 375 (10%) in the study population of men with urethritis and 22 of 294 (7%) in the study population of other clients (including both men and women; p=0.334). Most prevalent mutations in theparCgene were S83I and D87N, occurring in 31 of 60 (52%) and 20 of 60 (33%) samples, respectively. Factors associated with the presence of QRAM were: men who have sex with men (adjusted OR (aOR) 3.4, 95% CI 1.7 to 6.9) and Asian origin (aOR 2.5, 95% CI 1.2 to 5.6). Multidrug resistance (QRAM plus macrolide resistance-associated mutations) was found in 46 of 669 (7%) clients.ConclusionsNine per cent of MG-positive clients from two Dutch SHCs had QRAM. New treatment strategies and antibiotics are needed to treat symptomatic patients with multidrug-resistant MG.

Detection of resistance to macrolides and fluoroquinolones in Mycoplasma genitalium by targeted next-generation sequencing

“…We cannot speculate at this time whether these two gyr A nonsynonymous mutations are part of multidrug resistance phenotypes. Of note, none of the two samples with gyr A amino acid substitutions harbored par C mutations, a prerequisite for increased fluoroquinolone MICs, as suggested in references ( 16 ) and ( 17 ). Three other samples had silent mutations in the gyr A locus: Phe89Phe (TTC >TTT, n = 1) and Gln106Gln (CAA >CAG, n = 2).…”

Detection of Macrolide and/or Fluoroquinolone Resistance Genes in Mycoplasma genitalium Strains Isolated from Men in the Northwest Region of Croatia in 2018–2023

“…Our results can be compared to recent research endeavours in Europe that covered similar time periods. Among male clients diagnosed with urethritis at the Sexual Health Centre in Amsterdam during the period spanning 2018 to 2019 and with a positive test result for M. genitalium, the prevalence rates were high, with 63% exhibiting mutations associated with macrolide resistance, 1% showing mutations linked to fluoroquinolone resistance, and 8% demonstrating multidrug resistance (being resistant to both macrolides and fluoroquinolones) [12]. These figures are substantially higher when compared to the resistance rates observed during the same period in Croatia.…”

Testing for Mycoplasma genitalium in women with vaginal symptoms should not be performed routinely

“…10,[20][21][22][23][24] Moxifloxacin efficacy may also be diminishing, as fluoroquinolone resistance has been reported. [25][26][27] Treatment comes with concerns for drug interactions and toxicities (e.g., QT interval prolongation, arthropathy). Doxycycline and moxifloxacin are not recommended for use in pregnancy because of infant tooth discoloration and birth defects in animal studies, respectively.…”

“…Cephalosporins are not active against Mycoplasmas , 18 the efficacy of doxycycline alone is approximately 30%, 19 and rates of resistance to azithromycin range from 40% to 90% 10,20–24 . Moxifloxacin efficacy may also be diminishing, as fluoroquinolone resistance has been reported 25–27 . Treatment comes with concerns for drug interactions and toxicities (e.g., QT interval prolongation, arthropathy).…”