Clinical, epidemiological and therapeutic characteristics of Mycoplasma genitalium infection in a French STI center

•Mycoplasma genitalium (MG) infection was highly prevalent in PrEP (HIV pre-exposure prophylaxis) users and HIV-positive patients with a rate of 17% and 25%, respectively.•Nearly 90% of the MG positive patients were asymptomatic, while nearly 20% were coinfected with Chlamydiatrachomatis or Neisseri...

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Published in:Infectious diseases now (Online) 2022-02, Vol.52 (1), p.13-17
Main Authors: Brin, Cécile, Palich, Romain, Godefroy, Nagisa, Simon, Anne, Robert, Jérôme, Bébéar, Cécile, Sougakoff, Wladimir, Agher, Rachid, Caumes, Eric, Monsel, Gentiane
Format: Article
Language:English
Subjects:
Coinfection - epidemiology
Female
Gonorrhea - diagnosis
Gonorrhea - drug therapy
Gonorrhea - epidemiology
Humans
Male
Management
Mycoplasma genitalium
Mycoplasma Infections - diagnosis
Mycoplasma Infections - drug therapy
Mycoplasma Infections - epidemiology
Mycoplasmagenitalium
PrEP
Sexual Behavior
STI
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Summary:•Mycoplasma genitalium (MG) infection was highly prevalent in PrEP (HIV pre-exposure prophylaxis) users and HIV-positive patients with a rate of 17% and 25%, respectively.•Nearly 90% of the MG positive patients were asymptomatic, while nearly 20% were coinfected with Chlamydiatrachomatis or Neisseriagonorrhoeae.•MG treatment was challenging for patients with high risk of reinfection, with therapeutic failure rates above 50% after first-line and second-line treatments. We report the characteristics of Mycoplasmagenitalium (MG) infection in patients from a STI center in Paris. We evaluated outcomes after treatment. We included all patients tested for MG, Chlamydiatrachomatis (CT) and Neisseria gonorrhoeae (NG) infection in our center from January 2017 to December 2018, using multiplex PCR on urine specimen, vaginal or rectal swabs. We collected data regarding sex, age, HIV status, PrEP use, sexual behavior, NG and CT co-infection, symptoms and treatment. MG infection prevalence was 7% (397/5586) (95% CI 6.4–7.8). It ranged from 4.6% in patients consulting for routine STI testing (3.9% in women, 5% in men), to 16% in HIV-positive patients and 25% in PrEP users. Among the 397 MG infected patients, 351 (88%) were asymptomatic and 87 (22%) were co-infected with NG or CT. Among the 270 (68%) treated patients, 249 (92%) received azithromycin. Failure rate was 74% in the 103 patients tested post-treatment. Treatment failure tended to be higher with azithromycin single dose than with 5-day azithromycin (88% vs. 70%; P=0.07). Azithromycin and moxifloxacin were used as second-line treatment in 24 and 23 patients, respectively. Post-treatment PCR remained positive in 55% of the 44 tested patients with a better eradication rate with moxifloxacin than with azithromycin (70% vs. 33%; P=0.04). MG infection is highly prevalent in PrEP users and HIV-positive patients and is mostly asymptomatic. Management of MG infection should be tailored and adapted to the risk of antibiotic resistance and reinfection.
ISSN:2666-9919
2666-9919
DOI:10.1016/j.idnow.2021.09.003