Prevalence ofMycoplasma genitaliuminfection among HIV PrEP users: a systematic review and meta-analysis

Abstract

ObjectivesTo summarise the prevalence ofMycoplasma genitalium(MG) and antibiotic-resistant MG infection among HIV pre-exposure prophylaxis (PrEP) users.MethodsWe searched MEDLINE, Embase, Web of Science and Global Index Medicus up to 30 September 2022. We included studies reporting the prevalence of MG and/or antibiotic-resistant MG infection among PrEP users. Two reviewers independently searched for studies and extracted data. A systematic review with random-effects meta-analysis was performed to quantitatively summarise the results of included studies. The critical appraisal of included studies was conducted with the Joanna Briggs Institute checklist for prevalence studies and the quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsA total of 15 studies were included in the systematic review, with 2341 individuals taking PrEP. Studies were conducted in high-income level countries between 2014 and 2019. Median age of participants varied from 23.5 to 40 years. The majority were men (85%) and among them, 93% were men who have sex with men. To identify MG, urine samples were analysed in 14 studies, rectal or anal swabs in 12 studies, oral or pharyngeal swabs in 9 studies, and urethral or vaginal in 3 studies. The pooled point prevalence of MG among PrEP users was 16.7% (95% CI 13.6% to 20.3%; 95% prediction interval (95% PI) 8.2% to 31.1%). The pooled point prevalence of macrolide-resistant infections was 82.6% (95% CI 70.1% to 90.6%; 95% PI 4.7% to 99.8%) and the prevalence of fluoroquinolone-resistant infections was 14.3% (95% CI 1.8% to 42.8%). Individuals taking PrEP have a higher chance of being infected with MG compared with those not taking PrEP (OR 2.30; 95% CI 1.6 to 3.4). The quality of evidence was very low to moderate.ConclusionWe observed a high prevalence of MG and its macrolide resistance among PrEP users, highlighting the need to reinforce prevention strategies against sexually transmitted infections in this population.PROSPERO registration numberCRD42022310597.

Prevalence ofMycoplasma genitaliuminfection and macrolide and fluoroquinolone resistance mutations among U.S. Air Force service members living with HIV, 2016-2020

“…[5][6][7][8] In clinic-based studies, the prevalence ranged from 28.7% among men with urethritis in the U.S., 20.8% among asymptomatic women with bacterial vaginosis enrolled from ten U.S. cities, 16.6% among attendees of sexual health clinics in six U.S. cities, and 16.7% among HIV pre-exposure prophylaxis (PrEP) users in high income countries. [9][10][11][12] HIV infection can increase susceptibility to sexually transmitted infections (STIs), and potentially complicate treatment due to compromised immune function.…”

Prevalence of Mycoplasma genitalium Infection and Macrolide and Fluoroquinolone Resistance Mutations Among US Air Force Service Members With HIV, 2016–2020

“…In the United States and Britain, the prevalence among men and women in the general population has been low, ranging from 1.0% to 1.7%, whereas in less developed countries the summary prevalence was 3.9% [ 5–8 ]. In clinic-based studies, the prevalence ranged from 28.7% among men with urethritis in the United States, 20.8% among asymptomatic women with bacterial vaginosis enrolled from 10 US cities, 16.6% among attendees of sexual health clinics in 6 US cities, and 16.7% among users of HIV preexposure prophylaxis in high-income countries [ 9–12 ]. HIV infection can increase susceptibility to STIs and potentially complicate treatment due to compromised immune function.…”