Division of Sexually Transmitted Diseases Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Clin Infect Dis. 2020 Dec 17;71(10):e624-e632. doi: 10.1093/cid/ciaa293.
Antimicrobial resistance in Mycoplasma genitalium (MG), a cause of urethritis, is a growing concern. Yet little is known about the geographic distribution of MG resistance in the United States or about its associated clinical outcomes. We evaluated the frequency of MG among men with urethritis, resistance mutations, and posttreatment symptom persistence.
We enrolled men presenting with urethritis symptoms to 6 US sexually transmitted disease (STD) clinics during June 2017-July 2018; men with urethritis were eligible for follow-up contact and, if they had persistent symptoms or MG, a chart review. Urethral specimens were tested for MG and other bacterial STDs. Mutations in 23S ribosomal ribonucleic acid (rRNA) loci (macrolide resistance-associated mutations [MRMs]) and in parC and gyrA (quinolone-associated mutations) were detected by targeted amplification/Sanger sequencing.
Among 914 evaluable participants, 28.7% (95% confidence interval [CI], 23.8-33.6) had MG. Men with MG were more often Black (79.8% vs 66%, respectively), <30 years (72.9% vs 56.1%, respectively), and reported only female partners (83.7% vs 74.2%, respectively) than men without MG. Among MG-positive participants, 64.4% (95% CI, 58.2-70.3%) had MRM, 11.5% (95% CI, 7.9-16.0%) had parC mutations, and 0% had gyrA mutations. Among participants treated with azithromycin-based therapy at enrollment and who completed the follow-up survey, persistent symptoms were reported by 25.8% of MG-positive/MRM-positive men, 13% of MG-positive/MRM-negative men, and 17.2% of MG-negative men.
MG infection was common among men with urethritis; the MRM prevalence was high among men with MG. Persistent symptoms following treatment were frequent among men both with and without MG.
生殖道支原体（MG）耐药性是引起尿道炎的一个日益严重的问题。然而，人们对美国 MG 耐药性的地理分布及其相关临床结果知之甚少。我们评估了尿道炎男性 MG 的发病率、耐药突变以及治疗后症状持续存在的情况。
我们招募了 2017 年 6 月至 2018 年 7 月期间在美国 6 家性传播疾病（STD）诊所就诊的出现尿道炎症状的男性；患有尿道炎的男性有随访接触的资格，如果他们有持续的症状或 MG，则进行病历回顾。对尿道标本进行 MG 和其他细菌性 STD 的检测。通过靶向扩增/桑格测序检测 23S 核糖体核糖核酸（rRNA）基因座（大环内酯类耐药相关突变[MRMs]）和 parC、gyrA 中的突变（喹诺酮类相关突变）。
在 914 名可评估的参与者中，28.7%（95%置信区间[CI]，23.8-33.6）患有 MG。MG 阳性的男性更常为黑人（分别为 79.8%和 66%）、<30 岁（分别为 72.9%和 56.1%），且报告仅有女性伴侣（分别为 83.7%和 74.2%）。在 MG 阳性的参与者中，64.4%（95%CI，58.2-70.3%）有 MRM，11.5%（95%CI，7.9-16.0%）有 parC 突变，且无 gyrA 突变。在招募时接受阿奇霉素为基础的治疗并完成随访调查的参与者中，25.8%的 MG 阳性/MRM 阳性男性、13%的 MG 阳性/MRM 阴性男性和 17.2%的 MG 阴性男性报告有持续症状。
尿道炎男性中 MG 感染很常见；MG 阳性男性的 MRM 发生率较高。治疗后持续存在症状在 MG 阳性和阴性的男性中都很常见。
