High Prevalence and High Rate of Antibiotic Resistance of Mycoplasma genitalium Infections in Men Who Have Sex With Men: A Substudy of the ANRS IPERGAY Pre-exposure Prophylaxis Trial
High Prevalence and High Rate of Antibiotic Resistance of Mycoplasma genitalium Infections in Men Who Have Sex With Men: A Substudy of the ANRS IPERGAY Pre-exposure Prophylaxis Trial
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DOI：
10.1093/cid/ciaa1832
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发表时间：
2021-10-01
影响因子：
11.8
通讯作者：
Molina, Jean-Michel
中科院分区：
文献类型：
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作者：
Bercot, Beatrice;Charreau, Isabelle;Molina, Jean-Michel
背景。生殖支原体（MG）是男男性行为者（MSM）中的一种新兴病原体，其抗生素耐药率呈上升趋势。本研究评估了ANRS IPERGAY试验开放标签期MSM中MG感染的患病率和发生率，按需使用富马酸替诺福韦二氧吡酯/恩曲他滨预防人类免疫缺陷病毒，以及多西环素暴露后预防（PEP）的影响。210名受试者在基线和6个月时通过实时PCR检测尿液样本和口咽和肛门拭子中MG的检测。在法国细菌性传播感染（STIs）国家参考中心调查了对阿奇霉素（AZM）、氟喹诺酮类药物（FQs）和多西环素的耐药性。基线时MG的全部位患病率为10.5%（尿液样本为6.3%，肛门拭子为4.3%，喉咙拭子为0.5%），无论是否使用PEP， 6个月时MG的患病率保持不变：总体为9.9%，使用PEP为10.2%，未使用PEP为9.6%。MG对AZM和FQs的总体耐药率（流行病例和偶发病例）分别为67.6%和9.1%，两组间无差异。在12.5%的检测标本中发现了可能与四环素耐药性相关的MG 16S rRNA体内突变。暴露前预防的MSM中MG感染的患病率很高，并且多西环素预防并没有降低其发病率，AZM和FQ耐药率也很高，这为治疗这种STI提出了具有挑战性的问题，并支持目前避免检测或治疗无症状MG感染的建议。
Background. Mycoplasma genitalium (MG) is an emerging pathogen among men who have sex with men (MSM) with raising rates of antibiotic resistance. This study assessed the prevalence and incidence of MG infection in MSM enrolled in the open-label phase of the ANRS IPERGAY trial with on-demand tenofovir disoproxil fumarate/emtricitabine for human immunodeficiency virus prevention and the impact of doxycycline post-exposure prophylaxis (PEP).Methods. 210 subjects were tested at baseline and at 6 months by real-time PCR assays for MG detection in urine samples and oropharyngeal and anal swabs. Resistance to azithromycin (AZM), to fluoroquinolones (FQs), and to doxycycline was investigated in the French National Reference Center of Bacterial Sexually Transmitted Infections (STIs).Results. The all-site prevalence of MG at baseline was 10.5% (6.3% in urine samples, 4.3% in anal swabs, 0.5% in throat swabs) and remained unchanged at 6 months whether or not PEP was used: 9.9% overall, 10.2% with PEP, 9.6% without. The overall rate of MG resistance (prevalent and incident cases) to AZM and FQs was 67.6% and 9.1%, respectively, with no difference between arms. An in vivo mutation of the MG 16S rRNA, which could be associated with tetracycline resistance, was observed in 12.5% of specimens tested.Conclusions. The prevalence of MG infection among MSM on pre-exposure prophylaxis was high and its incidence was not decreased by doxycycline prophylaxis with a similar high rate of AZM and FQ resistance, raising challenging issues for the treatment of this STI and supporting current recommendations to avoid testing or treatment of asymptomatic MG infection.