Professor of Epidemiology University of Washington Seattle, Washington, United States
Background: Antimicrobial resistance (AMR) in Mycoplasma genitalium (MG) is high and MG is on the Watch List of AMR Threats. However, US sexual health clinics (SHCs) have only recently implemented MG testing and trend data are limited. We conducted surveillance of MG and AMR in 7 US cities from 2020-2022.
Methods: SHCs in Birmingham AL, Denver CO, Greensboro NC, Indianapolis IN, New York NY, Seattle WA, and St. Louis MO collected a quota sample of urogenital specimens from symptomatic and asymptomatic males and females each year. We detected MG and macrolide resistance mutations (MRMs) using the Aptima assay and analyte-specific reagents, respectively (Hologic, Inc). We calculated adjusted prevalence ratios (aPR) using Poisson regression with robust standard errors.
Results: Among 9,621 patients (2,638 asymptomatic/2,443 symptomatic males; 2,151 asymptomatic/2,389 symptomatic females), 53.0%, 21.6%, and 14.9% were Non-Hispanic (NH) Black, NH White, and Hispanic, respectively. Median age was 29 years [interquartile range=24-36]. Overall MG prevalence [16.6% (95%CI=15.9-17.4%)] did not differ by year (aPR=0.9; 0.88-1.01) but did differ across sites (range 9.5%-21.6%) and was significantly lower in Seattle (Table). Prevalence was highest in < 18 year-olds (28.7%) and declined by 3% for each increasing year of age (aPR=0.97; 0.962-0.973). Prevalence was 21.4% in NH Black, 10.0% in NH White and 10.8% in Hispanic persons (p< 0.001). MG prevalence was associated with female sex (aPR=1.5;1.29-1.68), same-sex partners (aPR=1.5; 1.29-1.72), symptoms (males only) (aPR=1.6; 1.38-1.79), male urethritis (aPR=1.6; 1.22-1.97), chlamydia (CT) (aPR=1.8; 1.56-2.16), gonorrhea (GC) (aPR=1.4; 1.10-2.16) and bacterial vaginosis (aPR=2.3; 1.54-3.51). MG was detected in 24.1% of CT/GC-negative-urethritis, 16.1% of CT/GC-negative-cervicitis, and 6.3% of CT/GC-negative-PID. MRM prevalence was 58.8% (56.2-61.3%) and did not vary by year (aPR=1.0; 0.91-1.03). Relative to Seattle, only St. Louis had significantly higher MRM prevalence (aPR=1.3; 1.06-1.52). MRM was associated with female sex (aPR=1.2; 1.02-1.33), symptoms (males) (aPR=1.2; 1.08-1.40), male urethritis (aPR=1.6; 1.22-1.97), and declined 1% for each increasing year of age (aPR=0.99; 0.982-0.994).
Conclusions: MG, including macrolide resistant-MG, is common among SHC patients and associated with STIs, STI syndromes, younger age, and same-sex partners. We saw no change over time in prevalence. These findings support making MG testing consistently available in SHCs.
.jpg "Lisa E. Manhart, MPH, PhD (she/her/hers) photo")