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. 2024 Oct;52(5):1921-1930.
doi: 10.1007/s15010-024-02261-6. Epub 2024 Apr 22.

High cure rates of Mycoplasma genitalium following empiric treatment with azithromycin alongside frequent detection of macrolide resistance in Austria

David Chromy  1   2 , Lisa Starossek  1 , Katharina Grabmeier-Pfistershammer  1 , Sarah Adamek  1 , Felix Maischack  2 , Stefanie Sammet  2 , Birgit Sadoghi  3 , Georg Stary  1 , Birgit Willinger  4 , Wolfgang Weninger  1 , Stefan Esser  2 , Athanasios Makristathis  4 , Wolfgang Michael Bauer  5
Affiliations

High cure rates of Mycoplasma genitalium following empiric treatment with azithromycin alongside frequent detection of macrolide resistance in Austria

David Chromy et al. Infection. 2024 Oct.

Abstract

Background: Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, often harboring resistance-associated mutations to azithromycin (AZM). Global surveillance has been mandated to tackle the burden caused by MG, yet no data are available for Austria. Thus, we aimed to investigate the prevalence of MG, disease characteristics, and treatment outcomes at the largest Austrian HIV-and STI clinic.

Methods: All MG test results at the Medical University of Vienna from 02/2019 to 03/2022 were evaluated. Azithromycin resistance testing was implemented in 03/2021.

Results: Among 2671 MG tests, 199 distinct and mostly asymptomatic (68%; 135/199) MG infections were identified, affecting 10% (178/1775) of all individuals. This study included 83% (1479/1775) men, 53% (940/1775) men who have sex with men (MSM), 31% (540/1754) HIV+, and 15% (267/1775) who were using HIV pre-exposure prophylaxis (PrEP). In logistic regression analysis, 'MSM' (aOR 2.55 (95% CI 1.65-3.92)), 'use of PrEP' (aOR 2.29 (95% CI 1.58-3.32)), and 'history of syphilis' (aOR 1.57 (95% CI 1.01-2.24) were independent predictors for MG infections. Eighty-nine percent (178/199) received treatment: 11% (21/178) doxycycline (2 weeks), 52% (92/178) AZM (5 days), and 37% ( 65/178) moxifloxacin (7-10 days) and 60% (106/178) had follow-up data available showing negative tests in 63% (5/8), 76% (44/58) and 85% (34/40), respectively. AZM resistance analysis was available for 57% (114/199)) and detected in 68% (78/114). Resistance-guided therapy achieved a cure in 87% (53/61), yet, empiric AZM-treatment (prior to 03/2021) cleared 68% (26/38).

Conclusions: Mycoplasma genitalium was readily detected in this Austrian observational study, affected predominantly MSM and often presented as asymptomatic disease. We observed a worryingly high prevalence of AZM resistance mutations; however, empiric AZM treatment cleared twice as many MG infections as expected.

Keywords: Mycoplasma genitalium; Azithromycin; Macrolide resistance; Men who have sex with men.

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Conflict of interest statement

DC served as a speaker and/or advisory board member for Gilead, ViiV Healthcare, and MSD and received travel support from MSD, ViiV Healthcare, and Gilead. LS has nothing to disclose. KGP served as a speaker and/or consultant and/or advisory board member for ViiV Healthcare and Gilead and received travel support from ViiV Healthcare and Gilead. SA has nothing to disclose. FM has nothing to disclose. SS served as advisory board member for MSD and received travel support from Gilead. BS received industry grants/royalties from Abbott/AbbVie, Almirall, Celgene, Eli Lilly, Galderma, Novartis, Pfizer, Trevi Therapeutics, UCB, Janssen Cilag. GS has nothing to disclose. BW served as a speaker for Gilead and advisory board member for MSD. WW served as a speaker, consultant, and/or advisory board member for LEO Pharma, Pfizer, Sanofi Genzyme, Eli Lilly, Novartis, Boehringer Ingelheim, AbbVie, and Janssen. SE served as a speaker and/or advisory board member for Gilead, GSK, Janssen, MSD, ViiV Healthcare, and MSD and received travel support from Gilead, Janssen, MSD, and ViiV Healthcare and research grant from Gilead, Janssen, MSD, and ViiV Healthcare. AM has nothing to disclose. WMB served as a speaker and/or consultant and/or advisory board member for AbbVie, ViiV Healthcare, and Takeda and received travel support from AbbVie, MSD, ViiV Healthcare, and Gilead.

Figures

Fig. 1
Fig. 1
Flow chart. AZM, azithromycin; DXY, doxycycline; HIV, human immunodeficiency virus; MOX, moxifloxacin; STI, sexually transmitted infection
Fig. 2
Fig. 2
Mycoplasma genitalium test results per month. Each column denotes the absolute number of performed tests for Mycoplasma genitalium positivity (A) and Mycoplasma genitalium azithromycin resistance analysis (B), respectively. The line in A provides details on the proportion of positive tests per month. Notably, limited access to sexually transmitted infection screening followed by temporary non-availability of Mycoplasma genitalium PCR test kits led to a dramatic decrease in diagnosed infections from 02/2020 to 09/2020
See this image and copyright information in PMC

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