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

Xiao, Li PhD*; Waites, Ken B. MD; Van Der Pol, Barbara PhD, MPH; Aaron, Kristal J. PhD, MPH; Hook, Edward W. III MD; Geisler, William M. MD, MPH

Sexually Transmitted Diseases: January 2019 - Volume 46 - Issue 1 - p 18–24
doi: 10.1097/OLQ.0000000000000891
Original Studies

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 United States.

Methods We investigated the prevalence of MG infections with MRMs and qRMs and MG infection concordance within African American couples in Birmingham, AL. We used a real-time polymerase chain reaction to detect MG and identify MRMs. quinolone resistance-associated mutations were detected using traditional polymerase chain reactions amplifying regions in gyrA, gyrB, parC, and parE. The 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). Macrolide resistance-associated mutations were detected in 17 (60.7%) MG-positive participants, with gender-specific resistance rates of 69.2% for men and 53.3% for women. quinolone resistance-associated mutations 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 United States.

From the * Division of Clinical Immunology and Rheumatology, Department of Medicine,

Department of Pathology, and

Department of Medicine, Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL

Correspondence: Li Xiao, PhD, 1720 2nd Ave South, SHEL 206, Birmingham, AL 35294. E-mail:

Acknowledgments: The authors thank all the University of Alabama at Birmingham STD Program clinicians and clinical and laboratory support staff who contributed to the study completion, as well as the Jefferson County Department of Health clinicians and clerical staff for their support. The authors thank Alexander Boutwell for his statistical support.

Conflicts of Interest: L.X. reports receiving research support paid to her institution from Roche Molecular. B.V.D.P. reports receiving honorarium, consulting fees or research support paid to her institution from Abbott Molecular, Atlas Genetics, BD Diagnostics, Click Diagnostics, Cepheid, Luminex, Rheonix, and Roche Molecular. E.W.H. reports receiving honorarium or research support paid to his institution from Cepheid, Hologic, and Roche Molecular. W.M.G. has received consulting fees from Hologic, Inc. for development of educational materials on Mycoplasma genitalium.

Sources of Funding: This work was funded by a Development Research Project Award (L.X.) from the National Institute of Allergy and Infectious Diseases (NIAID) Sexually Transmitted Infection Cooperative Research Center (grant U19AI113212; E.H.).

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health.

Received for publication March 1, 2018, and accepted June 26, 2018.

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© Copyright 2019 American Sexually Transmitted Diseases Association