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Prevalence of Mycoplasma genitalium Infection and Macrolide and Fluoroquinolone Resistance Mutations Among US Air
Shilpa Hakre1,2,3, Eric Sanders-Buell2,3, Rosemary O Casimier1,3
1Emerging Infectious Diseases Branch, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
Background:
Mycoplasma genitalium (MG) infection is a public health concern due to antimicrobial resistance (AMR). Data are limited on repeat MG infection and AMR among US Air Force service members with HIV.
Methods:
US Air Force service members seeking HIV care were screened for MG infection during the surveillance period (16 May 2016-16 March 2020). Baseline and repeat MG prevalence rates were estimated. An extended Cox proportional hazards regression model evaluated characteristics associated with repeat MG infection. MG-positive rectal samples were tested for macrolide or fluoroquinolone resistance.
Results:
Among 299 male patients from a total of 308 patients followed during the surveillance period, baseline prevalence of MG infection was 19.7% (n = 59); among the 101 patients who screened positive for MG at any time during the surveillance period, repeat MG was 35% (n = 36). Characteristics independently associated with increased risk of repeat infection were sexually transmitted infection history vs none (adjusted hazard ratio [aHR], 2.33; 95% CI, 1.26-4.31), a sexually transmitted infection coinfection vs no positive test result in the medical records (aHR, 5.13; 95% CI, 2.78-9.49), and a new HIV diagnosis (<1 vs ≥1 year; aHR, 2.63; 95% CI, 1.45-3.73). AMR in MG-positive rectal specimens was 88% (43/49) indicating macrolide resistance, 18% (10/56) quinolone resistance, and 18% (10/56) both.
Conclusions:
Macrolide and fluoroquinolone resistance mutations were common. Testing for co-occurring MG infection and AMR mutations may be warranted in guiding treatment for sexually transmitted infections such as chlamydia or gonorrhea detected at HIV diagnosis.
Insights
Mycoplasma genitalium (MG) infections are common in US Air Force service members with HIV, with high rates of repeat infections and significant antimicrobial resistance (AMR). Early testing for MG and AMR is crucial for effective STI treatment in this population.
Area of Science:
- Infectious Diseases
- Public Health
- Antimicrobial Resistance (AMR)
Background:
- Mycoplasma genitalium (MG) infection presents a significant public health challenge due to rising antimicrobial resistance (AMR).
- Limited data exist on the prevalence of repeat MG infections and associated AMR among US Air Force service members diagnosed with HIV.
Purpose of the Study:
- To estimate the prevalence of baseline and repeat Mycoplasma genitalium (MG) infections in US Air Force service members receiving HIV care.
- To identify factors associated with repeat MG infections.
- To determine the prevalence of antimicrobial resistance (AMR) in MG isolates from this population.
Main Methods:
- A surveillance study screened US Air Force service members with HIV for MG infection between May 2016 and March 2020.
- Prevalence rates for baseline and repeat MG infections were calculated.
- An extended Cox proportional hazards regression model was used to analyze factors linked to repeat infections, and MG-positive rectal samples were tested for macrolide and fluoroquinolone resistance.
Main Results:
- The baseline prevalence of MG infection was 19.7% (59/299) among male service members.
- Among those with any positive MG test, 35% (36/101) experienced repeat infection.
- Factors associated with repeat infection included prior STI history (aHR=2.33), STI coinfection (aHR=5.13), and recent HIV diagnosis (aHR=2.63). Antimicrobial resistance was high: 88% macrolide resistance, 18% quinolone resistance.
Conclusions:
- Macrolide and fluoroquinolone resistance mutations are prevalent in Mycoplasma genitalium (MG) infections within this cohort.
- The high rates of repeat infections and antimicrobial resistance (AMR) underscore the need for targeted interventions.
- Testing for co-occurring MG infection and AMR mutations is recommended to guide effective treatment strategies for sexually transmitted infections (STIs) in individuals diagnosed with HIV.
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