Antimicrobial resistance of Mycoplasma genitalium in Korea for two decades
Gilho Lee1, Heeyoon Park2, Yumi Seo2
1Department of Urology, Dankook University College of Medicine, Cheonan, Korea. multiorigins@yahoo.com.
Purpose:
Antimicrobial-resistant (AMR) Mycoplasma genitalium has become a global concern. To assess AMR patterns in Korea, we analyzed the genetic diversity of the AMR-determining sites (ARDS) in M. genitalium across in 285 samples collected over two decades.
Materials And Methods:
Mycoplasma-positive samples were collected from various groups: males at one referral center (ORC) from 2014 to 2019 (G1; 43) and from 2020 to 2023 (G2; 54), males at primary care clinics (PCCs) in 2018-2019 (G3; 84), female sex workers at a regional healthcare center in 2004 (G4; 51), and females at PCCs in 2018-2019 (G5; 53). Sanger sequencing was performed at positions 2058/2059 in the 23S rRNA gene and positions GyrA95, GyrA99, ParC83, and ParC87 of topoisomerase IV genes in M. genitalium.
Results:
In 2004, mutations were rare with S83I (0.0%), M95I (3.4%), and A2059G (10.5%). By 2020-2023, ARDS mutations had become common, peaking at S83I (83.3%) and A2059G (70.4%). No sex differences were observed in ARDS mutations between G3 and G5. A comparison of mutations in males at the ORC showed significant differences in A2059G and S83I between pre-2020 (G1) and post-2020 (G2). Males at the ORC (G1) had higher mutation rates in A2059G, GyrA95, and GyrA99 compared to males at PCCs (G3).
Conclusions:
Currently, referred males exhibit a rapid increase in AMR, and the synergy between A2059G and S83I/R/N mutations raises concerns regarding the emergence of pan-drug-resistant M. genitalium, potentially leading to an irreversible crisis in treatment options in Korea.
Insights
Antimicrobial resistance in Mycoplasma genitalium is increasing rapidly in Korea, particularly in referred males. Emerging mutations raise concerns for pan-drug resistance and treatment challenges.
Area of Science:
- Microbiology
- Genetics
- Public Health
Background:
- Antimicrobial-resistant (AMR) *Mycoplasma genitalium* is a growing global health issue.
- Understanding AMR patterns is crucial for effective treatment strategies.
Purpose of the Study:
- To investigate the genetic diversity of AMR-determining sites (ARDS) in *M. genitalium* in Korea over two decades.
- To assess the prevalence and trends of AMR mutations in *M. genitalium*.
Main Methods:
- Analysis of 285 *M. genitalium*-positive samples collected between 2004 and 2023.
- Sanger sequencing of key ARDS in 23S rRNA and topoisomerase IV genes.
Main Results:
- ARDS mutations were rare in 2004 but became common by 2020-2023, with significant increases in specific mutations (e.g., S83I, A2059G).
- Referred males showed a rapid rise in AMR post-2020.
- No significant sex differences in mutations were observed between male and female primary care patients.
Conclusions:
- A rapid increase in AMR is observed in referred males in Korea.
- Synergistic mutations (A2059G with S83I/R/N) suggest a potential emergence of pan-drug-resistant *M. genitalium*.
- This trend poses a significant challenge to current treatment options in Korea.
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