Hart Tim, Tang Wen Ying, Mansoor Siti Aminah Bte, Chio Martin T W, Barkham Timothy
Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
Department of Sexually Transmitted Infections Control Clinic, 31 Kelantan Ln, Singapore, 200031, Singapore.
BMC Infect Dis. 2020 Apr 28;20(1):314. doi: 10.1186/s12879-020-05019-1.
Mycoplasma genitalium is an emerging sexually transmitted infection, with increasing rates of resistance to fluroquinolones and macrolides, the recommended treatments. Despite this, M. genitalium is not part of routine screening for Sexually Transmitted Infections (STIs) in many countries and the prevalence of infection and patterns of disease remain to be determined in many populations. Such data is of particular importance in light of the reported rise in antibiotic resistance in M. genitalium isolates.
Urine and urethral swab samples were collected from the primary public sexual health clinic in Singapore and tested for C. trachomatis (CT) or N. gonorrhoeae (NG) infection and for the presence of M. genitalium. Antibiotic resistance in M. genitalium strains detected was determined by screening for genomic mutations associated with macrolide and fluroquinolone resistance.
We report the results of a study into M. genitalium prevalence at the national sexual health clinic in Singapore. M. genitalium was heavily associated with CT infection (8.1% of cases), but present in only of 2.4% in CT negative cases and not independently linked to NG infection. Furthermore, we found high rates of resistance mutations to both macrolides (25%) and fluoroquinolones (37.5%) with a majority of resistant strains being dual-resistant. Resistance mutations were only found in strains from patients with CT co-infection.
Our results support targeted screening of CT positive patients for M. genitalium as a cost-effective strategy to reduce the incidence of M. genitalium in the absence of comprehensive routine screening. The high rate of dual resistance also highlights the need to ensure the availability of alternative antibiotics for the treatment of multi-drug resistant M. genitalium isolates.
生殖支原体是一种新出现的性传播感染病原体，对推荐治疗药物氟喹诺酮类和大环内酯类的耐药率不断上升。尽管如此，在许多国家，生殖支原体并非性传播感染（STIs）常规筛查的一部分，许多人群中该感染的患病率和疾病模式仍有待确定。鉴于报道的生殖支原体分离株抗生素耐药性上升，此类数据尤为重要。
从新加坡主要的公共性健康诊所收集尿液和尿道拭子样本，检测沙眼衣原体（CT）或淋病奈瑟菌（NG）感染情况以及生殖支原体的存在情况。通过筛查与大环内酯类和氟喹诺酮类耐药相关的基因突变，确定检测到的生殖支原体菌株的抗生素耐药性。
我们报告了一项关于新加坡全国性健康诊所生殖支原体患病率的研究结果。生殖支原体与CT感染密切相关（占病例的8.1%），但在CT阴性病例中仅占2.4%，且与NG感染无独立关联。此外，我们发现对大环内酯类（25%）和氟喹诺酮类（37.5%）的耐药突变率很高，大多数耐药菌株为双重耐药。耐药突变仅在CT合并感染患者的菌株中发现。
我们的结果支持对CT阳性患者针对性筛查生殖支原体，作为在缺乏全面常规筛查情况下降低生殖支原体发病率的一种具有成本效益的策略。高双重耐药率也凸显了确保有替代抗生素可用于治疗多重耐药生殖支原体分离株的必要性。
