The Population-Level Effect of Screening for Mycoplasma genitalium on Antimicrobial Resistance: A Quasi-Experimental
Chris Kenyon, Irith De Baetselier1, Thibaut Vanbaelen1
1From the HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium.
Background:
No studies have evaluated the utility and risks of screening for Mycoplasma genitalium in men who have sex with men taking preexposure prophylaxis (PrEP). We made use of a quasi-experimental design to evaluate the effect of screening for M. genitalium in a demonstration PrEP cohort with 3-monthly follow-up.
Methods:
We compared the proportion of PrEP participants with M. genitalium clearance, the duration of persistence, proportion with incident symptoms, the incidence of fluoroquinolone and macrolide resistance, and the proportion of noncleared infections with resistance-associated mutations between 2 groups: those in whom the first episode of M. genitalium was treated and those in whom it was not treated.
Results:
M. genitalium was detected in 70 of 179 individuals. The first episode of infection was treated in 46 individuals. Treatment was not significantly associated with the incidence of symptomatic infections or the acquisition of genotypic resistance. Treatment was associated with a higher probability of clearance of infection but at the expense of increasing the proportion of remaining infections that were resistant. In the nontreated group, the infections that did not clear were less likely to be fluoroquinolone resistant (1/6 [16.7%]) than those that did clear (4/4 [100%]; P = 0.048). In contrast, in the treated group, there was no significant difference in the proportion of fluoroquinolone resistance between the infections that persisted and cleared.
Conclusions:
If screening and treatment increase the ratio of resistant to susceptible M. genitalium in a population, then this could play a role in the spread of antimicrobial resistance.
Insights
Screening for Mycoplasma genitalium in men on PrEP showed treatment increased clearance but also resistance. This screening and treatment strategy may contribute to antimicrobial resistance spread.
Area of Science:
- Infectious Diseases
- Public Health
- Antimicrobial Resistance
Background:
- Mycoplasma genitalium screening and risks in men on pre-exposure prophylaxis (PrEP) remain unevaluated.
- A quasi-experimental design was used to assess M. genitalium screening in a PrEP demonstration cohort.
Purpose of the Study:
- To evaluate the impact of M. genitalium screening and treatment on clearance, resistance, and symptoms in men on PrEP.
- To compare outcomes between treated and untreated M. genitalium infections.
Main Methods:
- Compared M. genitalium clearance, persistence duration, symptomatic infections, and resistance incidence between treated and untreated groups.
- Assessed genotypic resistance in non-cleared infections.
Main Results:
- M. genitalium detected in 70/179 individuals; 46 treated.
- Treatment increased clearance probability but raised resistance in remaining infections.
- Untreated non-cleared infections were less fluoroquinolone resistant than cleared ones.
Conclusions:
- Screening and treatment may increase the ratio of resistant to susceptible M. genitalium.
- This could potentially contribute to the spread of antimicrobial resistance within the population.
