远北昆士兰背包客人群中的生殖支原体：患病率和阿奇霉素耐药性的观察性研究。
Mycoplasma genitalium in the Far North Queensland backpacker population: An observational study of prevalence and azithromycin resistance.
机构信息
James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia.
Norwegian University of Science and Technology, Faculty of Medicine, Trondheim, Norway.
出版信息
PLoS One. 2018 Aug 28;13(8):e0202428. doi: 10.1371/journal.pone.0202428. eCollection 2018.
BACKGROUND
Mycoplasma genitalium is a sexually transmitted infection (STI), and a common cause of non-gonococcal urethritis (NGU). There is concern regarding the rise in prevalence of M. genitalium and rates of resistance to macrolide antibiotics. International backpackers represent a unique population that may be at an increased risk of STIs. The purpose of this study was to determine the prevalence of M. genitalium and antibiotic resistance in international backpackers.
METHODS
First void urine samples were obtained utilising opportunistic sampling from 294 non-treatment-seeking international backpackers at a variety of hostels in Cairns, Queensland Australia. Participants also answered a fixed-answer survey regarding sociodemographic characteristics and sexual risk behaviours. Samples were tested for M. genitalium, Chlamydia trachomatis and Neisseria gonorrhoeae using polymerase chain reaction (PCR). Samples positive for M. genitalium were investigated for macrolide resistance-associated mutations in the 23S rRNA genome at positions A2058G, A2058C, A2058T, A2059G and A2059C (Escherichia coli numbering).
RESULTS
Of the 294 samples, 23 failed the internal control. The prevalence of M. genitalium was 1.8% (5/271, 95% confidence interval [CI] ± 1.58), C. trachomatis was 4.1% (11/271, 95% CI ± 2.36) and N. gonorrhoeae was not detected. Macrolide resistance-associated mutations were identified in 40% (2/5) of M. genitalium-positive samples. M. genitalium infection was associated with reporting symptoms (odds ratio [OR] 14.36, 95% CI 2.17-94.94, p < 0.05).
CONCLUSIONS
M. genitalium and C. trachomatis are relatively common amongst non-treatment seeking international backpackers, but may not differ from Australian population prevalence. This article provides evidence to further support the increased utilisation of M. genitalium PCR in the diagnosis of NGU, and for macrolide resistance testing for all identified M. genitalium infections.
背景
支原体生殖器是一种性传播感染（STI），也是非淋球菌性尿道炎（NGU）的常见病因。人们对支原体生殖器的流行率上升以及对大环内酯类抗生素的耐药率感到担忧。国际背包客是一个独特的群体，他们可能面临更高的性传播感染风险。本研究旨在确定国际背包客中支原体生殖器的流行率和抗生素耐药性。
方法
利用机会性采样，从澳大利亚昆士兰州凯恩斯的各种旅馆中采集了 294 名未接受治疗的国际背包客的首次尿液样本。参与者还回答了一份关于社会人口统计学特征和性行为风险的固定答案调查。使用聚合酶链反应（PCR）检测样本中的支原体生殖器、沙眼衣原体和淋病奈瑟菌。对支原体生殖器阳性样本进行 23S rRNA 基因组中位置 A2058G、A2058C、A2058T、A2059G 和 A2059C（大肠杆菌编号）的大环内酯类药物耐药相关突变检测。
结果
在 294 个样本中，有 23 个内部对照失败。支原体生殖器的流行率为 1.8%（5/271，95%置信区间[CI]±1.58），沙眼衣原体为 4.1%（11/271，95%CI±2.36），淋病奈瑟菌未检出。在 40%（2/5）的支原体生殖器阳性样本中发现了大环内酯类药物耐药相关突变。报告症状与支原体生殖器感染相关（比值比[OR]14.36，95%CI 2.17-94.94，p<0.05）。
结论
支原体生殖器和沙眼衣原体在未接受治疗的国际背包客中相对常见，但与澳大利亚人群的流行率可能没有差异。本文提供的证据进一步支持了在 NGU 的诊断中增加使用支原体生殖器 PCR，以及对所有鉴定出的支原体生殖器感染进行大环内酯类药物耐药性检测。
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