Mycoplasma genitalium Infections with Macrolide and Fluoroquinolone Resistance-Associated Mutations in Heterosexual African American Couples in Alabama.

BACKGROUND: Mycoplasma genitalium (MG) is a sexually transmitted pathogen associated with inflammatory syndromes in men and women. Macrolides and fluoroquinolones are recommended MG treatments. The frequency of MG strains with macrolide resistance-associated mutations (MRMs) and quinolone resistance-associated mutations (QRMs) is increasing worldwide, however these data are sparse in populations in the US.

METHODS: We investigated the prevalence of MG infections with MRMs and QRMs and MG infection concordance within African American couples in Birmingham, Alabama. We used a real-time PCR to detect MG and identify MRMs. QRMs were detected using traditional PCRs amplifying regions in gyrA, gyrB, parC and parE. MG concordance in couples was evaluated by MG positivity and MG genotypes.

RESULTS: Oral, anal, urine, and/or vaginal specimens were tested from 116 couples. Twenty-eight (12.1%) participants comprising 22 couples tested MG positive (11.2% in men and 12.9% in women). MRMs were detected in 17 (60.7%) MG positive participants, with gender-specific resistance rates of 69.2% for men and 53.3% for women. QRMs were detected in 3 (11.1%) MG positive participants, all of whom also had MRMs. By MG positivity status, 27.3% of couples were concordant. If MG strain genotypes are also considered, then concordance was 20.0%.

CONCLUSIONS: Among heterosexual African Americans with MG infection, about 60% had strains with MRMs and 11% had strains with both MRMs and QRMs, highlighting the potential for MG treatment failure to not only macrolides, but also quinolones. These findings may help to guide clinicians in MG testing and treatment decisions in the US.