Li W N, Shi L, Long X Y, Li Y, Zhu W B, Liu G
Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, China.
Institute of Reproduction and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, Hunan, China.
Andrology. 2020 Jan;8(1):91-100. doi: 10.1111/andr.12646. Epub 2019 Jun 12.
Mycoplasma genitalium infection is significantly associated with an increased risk of male infertility. To date, few large M. genitalium studies have been conducted in China.
This study aimed to estimate the M. genitalium incidence and treatment failure and to provide information regarding the resistance of M. genitalium to macrolide and tetracycline antibiotics among men of infertile couples in China.
This study was performed as a retrospective survey of seminal and meatus urinarius secreta specimens of 30,094 men of infertile couples collected and used for microbiological tests for the evaluation of genital tract infections (Mycoplasma genitalium, Chlamydia trachomatis, and Neisseria gonorrhoeae) between October 2016 and December 2017. Mycoplasma genitalium RNA was detected using novel simultaneous amplification testing. Macrolide and tetracycline resistance screening was introduced using polymerase chain reaction (PCR) and Sanger sequencing.
The incidence of M. genitalium was 2.49% (749 of 30,094; 95% confidence interval (CI), 2.31-2.66%). After antibiotic treatment, the mean values of semen parameters increased from those measured before treatment. The overall incidence of treatment failure was 17.56% (82/467; 95% CI, 14.10%-21.02%) (112-26-4 = 82), irrespective of the drug used. Resistance to macrolide and tetracycline antibiotics was detected in 58 samples (58/60, 96.67%; 95% CI, 91.99-101.34%) and 27 samples (27/60, 45.00%; 95% CI, 32.04-57.96%), respectively.
Although the M. genitalium incidence was relatively low, the detection of macrolide antibiotic resistance in >96.67% of the treatment failure samples most likely explained the high azithromycin treatment failure rate (73/195, 37.44%) in our study. These findings indicate the need to provide resistance testing and to reappraise the recommended antimicrobial options in China.
生殖支原体感染与男性不育风险增加显著相关。迄今为止，中国很少开展关于生殖支原体的大型研究。
本研究旨在评估生殖支原体的发病率和治疗失败率，并提供中国不育夫妇男性中生殖支原体对大环内酯类和四环素类抗生素耐药性的相关信息。
本研究是一项回顾性调查，收集了2016年10月至2017年12月期间30094对不育夫妇男性的精液和尿道口分泌物标本，用于微生物学检测以评估生殖道感染（生殖支原体、沙眼衣原体和淋病奈瑟菌）。使用新型同步扩增检测法检测生殖支原体RNA。采用聚合酶链反应（PCR）和桑格测序法进行大环内酯类和四环素类耐药性筛查。
生殖支原体的发病率为2.49%（30094例中的749例；95%置信区间（CI），2.31 - 2.66%）。抗生素治疗后，精液参数的平均值较治疗前有所增加。无论使用何种药物，治疗失败的总体发生率为17.56%（467例中的82例；95%CI，14.10% - 21.02%）（112 - 26 - 4 = 82）。分别在58份样本（58/60，96.67%；95%CI，91.99 - 101.34%）和27份样本（27/60，45.00%；95%CI，32.04 - 57.96%）中检测到对大环内酯类和四环素类抗生素的耐药性。
尽管生殖支原体的发病率相对较低，但在超过96.67%的治疗失败样本中检测到大环内酯类抗生素耐药性，这很可能解释了我们研究中阿奇霉素治疗失败率较高（73/195，37.44%）的原因。这些发现表明在中国需要提供耐药性检测并重新评估推荐的抗菌药物选择。
