Work

Multi-anatomical site prevalence of Mycoplasma genitalium infection, resistance and association with coinfections: a prospective study in MSM with HIV

Year: 2025

Type: article

Abstract: Background Mycoplasma genitalium is a cause of sexually transmitted infections (STIs). This study assessed its prevalence, resistance and coinfection with Chlamydia trachomatis/Neisseria gonorrhoeae infections in MSM with HIV. Methods MSM in HIV care in Hong Kong were recruited during 2023–24 for completion of an online survey, and self-collection of urine specimens, rectal and pharyngeal swabs, which were tested for C. trachomatis, N. gonorrhoeae, M. genitalium and M. genitalium resistance-associated mutations (RAMs). The main outcome variables included M. genitalium infection and RAMs at individual and anatomic-site levels. Findings Among 562 MSM with HIV aged 20–71 years, all-site prevalence was 20% for M. genitalium, 19% for C. trachomatis and 10% for N. gonorrhoeae. Among C. trachomatis/N. gonorrhoeae infections, 28% were coinfected with M. genitalium. The prevalence was highest at the rectal site for M. genitalium (14%), C. trachomatis (17%) and N. gonorrhoeae (8%). M. genitalium infection was associated with N. gonorrhoeae (OR = 3.29 at the individual level, OR = 4.76 at pharyngeal sites and OR = 4.00 at rectal sites) but not C. trachomatis infection. Among 102 typeable M. genitalium-positive samples, 88 (86%) had RAMs—macrolides (78%), fluoroquinolones (49%) and both (41%). Recent sexualized drug use was a significant predictor for urethral M. genitalium RAMs [adjusted OR (aOR) = 3.21], while prolonged symptoms (aOR = 4.82), N. gonorrhoeae coinfection (aOR = 3.19) and HIV diagnosis in 2015–19 (aOR = 6.20) were predictors for rectal RAMs. The cure rate for non-susceptible M. genitalium infection was satisfactory with moxifloxacin or minocycline but not with azithromycin. Conclusions M. genitalium RAM prevalence is high in MSM with HIV, in whom rectal infection and C. trachomatis/N. gonorrhoeae coinfections are common.

Source: JAC-Antimicrobial Resistance

DOI: 10.1093/jacamr/dlaf158