Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Amsterdam, The Netherlands.
Department of Medical Microbiology, Haaglanden Medical Center, The Hague, The Netherlands.
PLoS One. 2020 Oct 20;15(10):e0240836. doi: 10.1371/journal.pone.0240836. eCollection 2020.
Mycoplasma genitalium (MG) is a sexually transmitted bacterium in which macrolide resistance is rapidly increasing, limiting treatment options. We validated a new assay to detect the presence of macrolide resistance-associated mutations in MG (MG-MRAM). In 2018, symptomatic and asymptomatic clients visiting sexually transmitted infections (STI) clinics in Amsterdam or The Hague were tested for MG using transcription mediated amplification (TMA) assays. The sensitivity to detect MG of the newly developed MG-MRAM qPCR was compared to the MgPa qPCR, both in relation to the TMA assay. For the sensitivity and specificity to detect relevant mutations the MG-MRAM qPCR was compared to 23SrRNA sequencing analysis. The qPCR was subsequently used to determine the presence of MG-MRAM at different anatomical locations and to identify risk factors for MG-MRAM. MG-positive clients (402) providing 493 MG-positive samples were included. In total 309/493 (62.7%) samples from 291 (72.4%) clients were successfully typed with the MG-MRAM qPCR. The MG-MRAM qPCR had a sensitivity of 98.6% (95%CI 91.1%-99.9%) and specificity of 94.1% (95%CI 78.9%-99.0%) to detect MG-MRAM compared to sequencing analysis. Infection with MG-MRAM was detected in 193/291 (66.3%) clients: in 129/178 (72.5%) men and 64/113 (56.6%) women (p = 0.005). Prevalence of MG-MRAM was significantly higher in men, clients with a higher education, HIV-positive clients and clients with >10 sexual partners in the previous six months, but in multivariable analysis no factor was significantly associated with MG-MRAM presence. Since MG-MRAM prevalence was very high, testing for MG-MRAM is essential if treatment for MG is considered, and can be performed with this sensitive and specific qPCR test in routine diagnostics.
生殖道支原体（MG）是一种性传播细菌，其大环内酯类耐药性迅速增加，限制了治疗选择。我们验证了一种新的检测生殖道支原体（MG-MRAM）中存在大环内酯类耐药相关突变的方法。2018 年，阿姆斯特丹或海牙性传播感染（STI）诊所就诊的有症状和无症状患者使用转录介导扩增（TMA）检测法检测 MG。新开发的 MG-MRAM qPCR 检测 MG 的灵敏度与 MgPa qPCR 进行了比较，均与 TMA 检测法相关。为了检测相关突变的灵敏度和特异性，将 MG-MRAM qPCR 与 23SrRNA 测序分析进行了比较。随后使用 qPCR 确定了不同解剖部位 MG-MRAM 的存在情况，并确定了 MG-MRAM 的危险因素。共纳入 402 例 MG 阳性患者，提供 493 例 MG 阳性样本。使用 MG-MRAM qPCR 成功对 291 例（72.4%）患者的 309/493（62.7%）样本进行了分型。与测序分析相比，MG-MRAM qPCR 检测 MG-MRAM 的灵敏度为 98.6%（95%CI 91.1%-99.9%），特异性为 94.1%（95%CI 78.9%-99.0%）。在 291 例患者中检测到 MG-MRAM 感染：178 例男性患者中 129 例（72.5%），113 例女性患者中 64 例（56.6%）（p=0.005）。在男性、高学历患者、HIV 阳性患者和过去 6 个月有>10 个性伴侣的患者中，MG-MRAM 的患病率明显较高，但多变量分析显示，没有一个因素与 MG-MRAM 的存在显著相关。由于 MG-MRAM 的患病率非常高，如果考虑治疗 MG，则必须进行 MG-MRAM 检测，并且可以使用这种敏感和特异的 qPCR 试验在常规诊断中进行。
