Changes in prevalence of Mycoplasma genitalium macrolide and fluoroquinolone resistance: notes from a 13-year retrospective survey in Dalarna County, Sweden.

OBJECTIVE: Macrolide and fluoroquinolone resistance in Mycoplasma genitalium (MG) is of emerging global concern. Compared with neighbouring countries such as Denmark, Sweden has had lower rates of macrolide resistance while fluoroquinolone resistance rates are less well documented. This study retrospectively examined macrolide, fluoroquinolone and multidrug resistance rates from Dalarna County, Sweden over a 13-year period. METHODS: MG-positive samples from 2006 to 2018 from patients examined at the Department of Venereology, Central Hospital, Falun, Sweden were tested by sequencing for macrolide resistance mutations (MRM) and fluoroquinolone resistance-associated mutations (QRAM) in the parC and gyrA subunit regions. A subset of these samples from 2006 to 2011 have been reported on previously, although only for MRM. RESULTS: Of 874 samples, 98 (11.2%, 95% CI 9.1% to 13.6%) had mutations associated with resistance to macrolides and 19 of 828 (2.3%, 95% CI 8.9% to 23.1%) to quinolones. Mutations associated with resistance to both drugs were detected in 5 of 828 (0.6%, 95% CI 0.1% to 1.4%) samples overall. A significant positive linear trend (p=0.004) for an increase in the rate of macrolide resistance was observed (from 0% in 2006 to 31% in 2018) while the increase in QRAM from 0% in 2006 to 12.3% in 2018 was not statistically significant. CONCLUSIONS: Despite a decrease in macrolide and fluoroquinolone consumption in Sweden, there was an overall increase in MG macrolide, fluoroquinolone and dual resistance from 2006 to 2018, although the difference in fluoroquinolone resistance rates was not statistically significant. In order to maintain comparably low resistance rates, resistance-guided therapy for MG infections will be crucial.

Treatment of Mycoplasma genitalium. Observations from a Swedish STD clinic.

OBJECTIVES: To evaluate therapy for Mycoplasma genitalium infection with doxycycline or azithromycin 1 g compared to five days of azithromycin (total dose 1.5 g). METHODS: A retrospective case study was performed among patients attending the STD-clinic in Falun, Sweden 1998-2005. All patients with a positive PCR test for M. genitalium were routinely offered a test of cure (toc). Response to doxycycline for 9 days, azithromycin 1 g single dose and extended azithromycin (500 mg on day 1 followed by 250 mg o.d. for 4 days) was determined. In patients with treatment failure after azithromycin, macrolide resistance was monitored before and after treatment. Furthermore, the rate of macrolide resistance was monitored for positive specimens available from 2006-2011. RESULTS: The eradication rate after doxycycline was 43% (48% for women and 38% for men), for azithromycin 1 g 91% (96% for women and 88% for men) and for extended azithromycin 99% (100% for women and 93% for men). Macrolide resistance developed in 7/7 examined (100%) of those testing positive after azithromycin 1 g, but in none of those treated with extended azithromycin. Macrolide resistance before treatment increased from 0% in 2006 and 2007 to 18% in 2011. CONCLUSIONS: These findings confirm the results from other studies showing that doxycycline is inefficient in eradicating M. genitalium. Although azithromycin 1 g was not significantly less efficient than extended dosage, it was associated with selection of macrolide resistant M. genitalium strains and should not be used as first line therapy for M. genitalium. Monitoring of M. genitalium macrolide resistance should be encouraged.

[Chlamydia-like symptoms can have another etiology. Mycoplasma genitalium--an important and common sexually transmitted disease]. / Klamydialiknande symtom kan ha annan bakgrund. Mycoplasma genitalium--en viktig och vanlig sexuellt överförd sjukdom.

The aetiological importance of Chlamydia (C.) trachomatis in non-gonococcal urethritis (NGU) is undisputed. Mycoplasma (M.) genitalium has been shown to be strongly associated with NGU and with mucopurulent cervicitis and also with acute endometritis independent of C. trachomatis. In this prevalence study we examined 946 patients, 445 women and 501 men, attending the STD clinic, for M. genitalium as well as C. trachomatis and Neisseria gonorrhoeae. M. genitalium was detected in urethral samples from 17 (13.4 per cent) of 127 men with both symptoms and signs of urethritis and from 2 (1.3 per cent) of 160 men without (p < 0.001). Corresponding figures for M. genitalium in the women were 15 (11 per cent) of 136 women with symptoms and signs of urethritis or cervicitis compared to 3 (2.2 per cent) of 139 women without (p = 0.005). Examinations of partners of female and male index patients indicated that M. genitalium is sexually transmitted. Some M. genitalium infected patients had a history of irregular vaginal bleeding, lower genital tract pain, epididymitis and arthritis. Investigation of the aetiological role of M. genitalium in salpingitis, epididymitis and sexually acquired arthritis is urgently needed.