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Mycoplasma genitalium macrolide resistance in Stockholm, Sweden
Eva Björnelius1, Charlotta Magnusson2, Jørgen Skov Jensen3
1Section of Dermatology I 43, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Objectives:
Mycoplasma genitalium is an important cause of STI in men and women. Worldwide evidence suggests a reduction in efficacy of azithromycin treatment due to the prevalence of macrolide resistant M. genitalium. The aim of this study was to describe the prevalence of macrolide resistance in patients with a positive test for M. genitalium within our setting.
Methods:
Two STI clinics in Stockholm offered tests for M. genitalium as part of a routine care pathway. Positive specimens were analysed for macrolide resistance mediating mutations by sequencing.
Results:
During the study period, 171 (7.5%) of 2276 patients had a positive M. genitalium test; 7% of women and 8% of men. Macrolide resistance was detected in 31 (18%) of the M. genitalium positive; treatment with azithromycin within the previous 6 months was strongly associated with macrolide resistance.
Conclusions:
The prevalence of macrolide resistance was lower in Sweden than in other Northern European settings. We hypothesise that this observation may be due to use of doxycycline as primary treatment of Chlamydia trachomatis. The efficacy of empirical treatment is challenged by azithromycin resistant M. genitalium. Clinically available and enhanced diagnostics targeting this pathogen are urgently required. We suggest a test of cure 3-4 weeks after start of azithromycin therapy since macrolide resistance develop during treatment.
Insights
Macrolide resistance in Mycoplasma genitalium is a growing concern, impacting azithromycin treatment efficacy. This study found 18% resistance in Stockholm, linked to prior azithromycin use, highlighting the need for better diagnostics and treatment strategies.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Mycoplasma genitalium is a significant cause of sexually transmitted infections (STIs).
- Increasing macrolide resistance in M. genitalium compromises azithromycin treatment effectiveness globally.
- Understanding local resistance patterns is crucial for effective STI management.
Purpose of the Study:
- To determine the prevalence of macrolide resistance in Mycoplasma genitalium in Stockholm.
- To identify factors associated with macrolide resistance in M. genitalium infections.
Main Methods:
- Testing for M. genitalium was conducted in routine care at two Stockholm STI clinics.
- Positive specimens underwent sequencing to detect macrolide resistance mutations.
- Patient data, including previous antibiotic use, was collected.
Main Results:
- 171 (7.5%) of 2276 patients tested positive for M. genitalium.
- Macrolide resistance was detected in 31 (18%) of M. genitalium-positive cases.
- Previous azithromycin treatment within six months was strongly associated with macrolide resistance.
Conclusions:
- The prevalence of macrolide resistance in Stockholm was lower than in other Northern European settings.
- The use of doxycycline for Chlamydia trachomatis may influence M. genitalium resistance rates.
- Enhanced diagnostics and alternative treatment strategies are needed, along with a test of cure post-azithromycin therapy.
