Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia.
Marie Bashir Institute for Infectious Diseases and Biosecurity and Sydney Medical School-Westmead, University of Sydney, Sydney, New South Wales, Australia.
Sex Transm Infect. 2018 Sep;94(6):406-410. doi: 10.1136/sextrans-2017-053480. Epub 2018 Mar 22.
We aimed to estimate the prevalence of infection and of mutations linked to macrolide resistance using the ResistancePlus MG assay (SpeeDx, Sydney, New South Wales, Australia) in first-void urine (FVU), anorectal and oropharyngeal samples from men who have sex with men (MSM) attending Western Sydney Sexual Health Centre (WSSHC).
Consecutive symptomatic and asymptomatic MSM attending for STI testing were prospectively enrolled. testing using the ResistancePlus MG assay was performed on FVU, anorectal and oropharyngeal samples routinely collected for and assays.
Overall, the prevalence of infection in the study group was 13.4% (68/508). Most (79.4%, 54/68) harboured macrolide resistance mutations (87.5% of urethral and 75.6% of anorectal infections). The anorectum was the most commonly infected site (45/505, 8.9%), followed by the urethra (24/508, 4.7%). No oropharyngeal infections were detected (0/508). Most of the anorectal (93.3%) and urethral (79.2%) infections were asymptomatic.MSM who were taking HIV pre-exposure prophylaxis (PrEP) were twice as likely to be infected with compared with MSM who were not on PrEP (OR 2.1, 95% CI 1.3 to 3.6; P=0.0041). Always using condoms for anal sex in the last 3 months was protective of infection (OR 0.8, 95% CI 0.6 to 1.0; P=0.0186).
We demonstrated a high prevalence of and very high levels of macrolide resistance among MSM attending WSSHC. Our findings support the routine use of an assay to detect macrolide resistance mutations in infections. This will ensure, in regions or populations with high rates of macrolide resistance among strains, that first-line treatment with azithromycin will only be used if a macrolide-sensitive strain is identified.
我们旨在使用 ResistancePlus MG 检测（澳大利亚新南威尔士州悉尼的 SpeeDx）评估在悉尼西部性健康中心（WSSHC）就诊的男男性行为者（MSM）的首段尿液（FVU）、肛门直肠和咽拭子样本中 感染的流行率和与大环内酯类耐药相关的突变率。
我们前瞻性地招募了连续出现症状和无症状的 MSM 进行性传播感染检测。在 WSSHC，常规收集 FVU、肛门直肠和咽拭子样本，同时使用 ResistancePlus MG 检测进行 检测。
研究组的 感染总流行率为 13.4%（68/508）。大多数（79.4%，54/68）的样本中存在大环内酯类耐药突变（尿道感染中有 79.2%，肛门直肠感染中有 75.6%）。肛门直肠是最常见的感染部位（45/505，8.9%），其次是尿道（24/508，4.7%）。未检测到咽拭子中的 感染（0/508）。大多数肛门直肠（93.3%）和尿道（79.2%）感染是无症状的。正在服用 HIV 暴露前预防（PrEP）的 MSM 感染 的可能性是未服用 PrEP 的 MSM 的两倍（OR 2.1，95%CI 1.3 至 3.6；P=0.0041）。过去 3 个月内肛交时始终使用安全套可预防感染（OR 0.8，95%CI 0.6 至 1.0；P=0.0186）。
我们发现 WSSHC 就诊的 MSM 中 感染和大环内酯类耐药水平很高。我们的研究结果支持在 感染患者中常规使用检测大环内酯类耐药突变的检测。这将确保在大环内酯类耐药率较高的地区或人群中，只有在鉴定出对大环内酯类敏感的菌株时，才使用阿奇霉素作为一线治疗。
