Distribution of Macrolide Resistant Mycoplasma genitalium in Urogenital Tract Specimens From Women Enrolled in a US Clinical Study Cohort

• Published in: Clinical infectious diseases Vol. 76; no. 3; pp. e776 - e782
• Main Authors: Getman, Damon, Cohen, Seth, Jiang, Alice
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 08.02.2023
• Subjects: Anti-Bacterial Agents - pharmacology; Drug Resistance, Bacterial; Female; Humans; Macrolides - pharmacology; Major; Mycoplasma genitalium - genetics; Mycoplasma Infections - diagnosis; Mycoplasma Infections - epidemiology; Prevalence; Prospective Studies; RNA, Ribosomal, 23S - genetics; sexually transmitted infection; macrolide-resistance mutations; urogenital infection; Mycoplasma genitalium
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1093/cid/ciac602

Abstract Background This study evaluated the distribution of macrolide-resistant Mycoplasma genitalium in multiple urogenital specimens collected from women enrolled in a prospective multicenter US clinical study. Methods Four female urogenital specimens (vaginal swab, urine, endocervical swab, ectocervical brush/spatula) collected from each subject were tested using a transcription-mediated amplification (TMA) assay for M. genitalium. TMA-positive specimens were evaluated by reverse transcription–polymerase chain reaction and bidirectional Sanger sequencing of M. genitalium 23S rRNA to identify the presence of macrolide-resistance–mediating mutations (MRMs) at base positions 2058/2059. Results Of 140 women with ≥1 TMA-positive specimens, 128 (91.4%) yielded M. genitalium 23S rRNA sequence. MRMs were found in 52% of vaginal specimens, 46.3% of urine specimens, 37.8% of endocervical specimens, and 46% of ectocervical specimens. There were 44 unique specimen type/sequence phenotype combinations of M. genitalium infection. Most (81; 63.3%) women had single specimen-sequence phenotype (macrolide-susceptible, MRM, or both) infections, while 24 (18.8%) women had multiple specimen-sequence phenotype concordant infections, and 23 (17.9%) women had multiple specimen-sequence phenotype discordant infections. The sensitivity for any single specimen type to detect overall urogenital tract macrolide-resistant M. genitalium infection status was 96.3% for vaginal swab samples, 82.6% for urine samples, 70.8% for endocervical swab samples, and 82.1% for ectocervical brush/spatula liquid Pap samples. Conclusions The distribution of M. genitalium infections in female urogenital tract specimens is highly complex, with multiple phenotypic combinations of the organism infecting a significant proportion of women at different anatomic specimen collection sites. Vaginal swab sampling yielded the highest sensitivity for identifying women with macrolide-resistant M. genitalium urogenital tract infections. Mycoplasma genitalium rRNA sequencing of multiple urogenital specimens collected from women seeking care revealed complex patterns of macrolide-susceptible and -resistant strains at single and multiple anatomic sampling sites. Vaginal sampling yielded the highest sensitivity for detecting macrolide-resistant urogenital tract infections.