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Published on: February 24, 2023
Mycoplasma genitalium screening in a specialized French unit: A retrospective study
F Herms1, F Poizeau2, V Anyfantakis1
1Department of Dermatology, Genital Diseases and STIs unit, Saint-Louis Hospital, 1, avenue Claude Vellefaux, 75010 Paris, France.
Objective:
Mycoplasma genitalium (MG) infection accounts for 10-35% of non-gonococcal non-chlamydial (NGNC) urethritis. However, given that most people infected with MG do not develop symptoms and that antimicrobial resistance is increasing worldwide, there is no evidence of any benefits of screening asymptomatic individuals. We conducted this study to describe MG screening practices and outcomes at a French Sexually Transmitted Infections (STI) center in which MG testing was performed selectively and multiplex assays were not carried out [i.e., simultaneous screening for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and MG].
Methods:
A retrospective, observational, single-center study was conducted at the STI unit of Saint-Louis Hospital in Paris. The records of all patients undergoing MG testing from January 1st, 2017, to December 31st, 2018, were reviewed. The primary aim of the study was to describe and evaluate the proportion of MG-positive (MG+) patients among those tested. Secondary objectives were determination of the prevalence of MG+ status among symptomatic patients, risk factors associated with MG infection, and therapeutic modalities and efficacy.
Results:
Two hundred and forty-nine patients underwent MG testing, 28 (11%) of whom were positive (MG+). The prevalence of MG+ status among symptomatic NGNC patients was 12%. HIV-positive (HIV+) status was significantly associated with MG+ status in univariate and multivariate analyses (Odds Ratio=7.3, 95% Confidence Interval 1.3-41.7; P=0.02). Twenty-three patients (85%) received antibiotics. Eighteen (67%) received azithromycin for 5 days, but 7 had clinical resistance. No quinolone resistance was reported.
Conclusion:
Despite unavailability of multiplex testing at our facility, which led to targeted-only screening for MG, its relatively high local prevalence is in keeping with what is generally observed at similar facilities across the world, where use of multiplex tests enables systematic screening for MG alongside NG and CT. This reinforces the current recommendations in Europe, France and the US against systematic MG testing or treatment in asymptomatic patients.
Insights
Mycoplasma genitalium (MG) infection is prevalent in STI centers, with 11% of tested patients positive. HIV-positive status was linked to MG infection, and azithromycin resistance was noted.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Mycoplasma genitalium (MG) is a significant cause of non-gonococcal, non-chlamydial (NGNC) urethritis, accounting for 10-35% of cases.
- Increasing antimicrobial resistance and the asymptomatic nature of MG infections raise concerns about the benefits of widespread screening.
- Current European, French, and US recommendations advise against routine screening and treatment for asymptomatic individuals.
Purpose of the Study:
- To describe Mycoplasma genitalium (MG) screening practices and outcomes at a French Sexually Transmitted Infections (STI) center.
- To evaluate the prevalence of MG infection among patients tested, particularly symptomatic individuals.
- To identify risk factors, therapeutic approaches, and treatment efficacy for MG infections.
Main Methods:
- A retrospective, observational, single-center study was conducted at the STI unit of Saint-Louis Hospital in Paris.
- Patient records from January 2017 to December 2018 were reviewed for all individuals undergoing MG testing.
- Data collected included MG positivity rates, prevalence in symptomatic NGNC patients, associated risk factors, and treatment outcomes.
Main Results:
- Of 249 patients tested, 28 (11%) were positive for MG.
- The prevalence of MG positivity among symptomatic NGNC patients was 12%.
- HIV-positive status was significantly associated with MG infection (OR=7.3). Azithromycin was the primary antibiotic, with 7 of 18 patients showing clinical resistance; no quinolone resistance was reported.
Conclusions:
- Despite selective screening without multiplex assays, the local prevalence of MG aligns with global observations.
- The findings support current recommendations against systematic screening and treatment for asymptomatic MG infections.
- The study highlights the importance of targeted testing and monitoring antimicrobial resistance patterns.
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