Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden, Dresden, Germany.
Infection. 2020 Apr;48(2):259-265. doi: 10.1007/s15010-019-01386-3. Epub 2020 Jan 28.
Rectal sexually transmitted infections (STI) are common in men having sex with men (MSM). Mycoplasma genitalium is increasingly being reported in this localization, but due to frequent lack of symptoms at this site, clinical significance is still unclear. Rectal prevalence of Mycoplasma hominis and Ureaplasma species is not well studied so far. We aimed to investigate the prevalence and antibiotic sensitivity of rectal Mollicutes in our HIV-cohort.
In 227 MSM presenting for annual STI-screening, 317 anorectal swabs were collected from January 2017 to December 2018. PCR was performed for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, M. genitalium and also culture for M. hominis and Ureaplasma spec.
Prevalence for M. genitalium, M. hominis, Ureaplasma spec., C. trachomatis and N. gonorrhoeae was 8.2%, 7.3%, 12.0%, 5.1% and 1.9%, respectively. Patients were asymptomatic with few exceptions. Seroprevalence of syphilis in 227 MSM was 41.9%. In 20 strains of M. genitalium, resistance-associated mutations to macrolides and quinolones were found in 60% and 30%, respectively; in five strains (25%) to both. M. hominis and Ureaplasma spec. frequently occurred combined, mostly in significant quantity consistent with infection. M. hominis and Ureaplasma spec. regularly showed sensitivity to tetracycline.
At screening, rectal colonization with Mollicutes was common in our patients, but rarely caused symptoms. Due to rising antibiotic resistance of M. genitalium against quinolones, therapeutic options are increasingly limited. Treatment should be guided by antibiotic resistance testing including quinolones. In persisting anorectal symptoms, M. hominis and Ureaplasma spec. should also be taken into account.
直肠性传播感染（STI）在男男性行为者（MSM）中很常见。生殖道支原体越来越多地在该部位被报道，但由于该部位经常无症状，其临床意义仍不清楚。目前，直肠人型支原体和脲原体属的流行率尚未得到充分研究。我们旨在调查我们的 HIV 队列中直肠 Mollicutes 的流行率和抗生素敏感性。
在 2017 年 1 月至 2018 年 12 月期间，对 227 名接受年度性传播感染筛查的 MSM 进行了 317 次直肠拭子采集。进行了聚合酶链反应（PCR）检测沙眼衣原体、淋病奈瑟菌、生殖道支原体，还进行了培养检测人型支原体和脲原体属。
生殖道支原体、人型支原体、脲原体属、沙眼衣原体和淋病奈瑟菌的流行率分别为 8.2%、7.3%、12.0%、5.1%和 1.9%。除了少数例外，患者均无症状。227 名 MSM 的梅毒血清学阳性率为 41.9%。在 20 株生殖道支原体中，大环内酯类和喹诺酮类耐药相关突变分别在 60%和 30%的菌株中发现，在 5 株（25%）中同时存在这两种突变。人型支原体和脲原体属经常同时存在，且通常以大量存在，提示存在感染。人型支原体和脲原体属通常对四环素敏感。
在筛查中，我们的患者直肠 Mollicutes 定植很常见，但很少引起症状。由于生殖道支原体对喹诺酮类的耐药性不断上升，治疗选择越来越有限。治疗应根据包括喹诺酮类在内的抗生素耐药性检测结果来指导。在持续存在的直肠症状时，也应考虑到人型支原体和脲原体属。
