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Mycoplasma genitalium acquisition and macrolide resistance after initiation of HIV pre-exposure prophylaxis in men who have sex with men.
- Source :
-
Sexually transmitted infections [Sex Transm Infect] 2020 Sep; Vol. 96 (6), pp. 396-398. Date of Electronic Publication: 2020 Jan 02. - Publication Year :
- 2020
-
Abstract
- Objectives: Recent evidence shows that patients using HIV pre-exposure prophylaxis (PrEP) have an increased rate of bacterial STIs, including syphilis, chlamydia and gonorrhoea. Our study aimed to describe the acquisition and the susceptibility for macrolides of Mycoplasma genitalium in men who have sex with men (MSM) on PrEP.<br />Methods: We studied all MSM who started PrEP in the AZ Sint-Jan Hospital Bruges from 1 June 2017 to 31 March 2019 with at least one follow-up visit. Patients were screened for M. genitalium and other STIs with pooled rectal swabs, pharyngeal swabs and first-voided urine, and blood samples at baseline and quarterly intervals after initiating PrEP. TaqMan Array Card technology was used to detect M. genitalium and determine macrolide-resistance mediating mutations in region V of the 23S rRNA gene (A2058G, A2059G, A2058C and others). Patients with an STI were treated based on a national guideline.<br />Results: 131 MSM (median age 40 years, range 20-79) were included in the study. The median follow-up time was 12 months (IQR 6.1-17). Baseline prevalence of M. genitalium was 6.9% and incidence rate after PrEP initiation was 28.8 per 100 person-years (95% CI 21.7 to 37.2), without significant differences in proportions between the first four quarterly intervals. All but one acquisitions were asymptomatic. Younger age and positivity for M. genitalium at baseline were significantly associated with incident M. genitalium acquisition. The observed proportion of macrolide resistance increased not significantly from 44% at baseline to 57%-86% after PrEP initiation. None of the 27 macrolide-resistant M. genitalium acquisitions could be linked to azithromycin exposure in the three preceding months.<br />Conclusions: After initiation of PrEP, we found a stable incidence of almost exclusively asymptomatic M. genitalium . However, a non-significant trend of an increased percentage of macrolide-resistant strains was observed.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Adult
Age Factors
Aged
Asymptomatic Infections epidemiology
Belgium epidemiology
Bisexuality
Chancroid epidemiology
Chlamydia Infections epidemiology
Drug Resistance, Bacterial genetics
Gonorrhea epidemiology
Homosexuality, Male
Humans
Incidence
Logistic Models
Lymphogranuloma Venereum epidemiology
Macrolides
Male
Middle Aged
Mycoplasma Infections microbiology
Mycoplasma genitalium genetics
Prevalence
RNA, Ribosomal, 23S genetics
Syphilis epidemiology
Young Adult
Anti-HIV Agents therapeutic use
HIV Infections prevention & control
Mycoplasma Infections epidemiology
Pre-Exposure Prophylaxis
Sexual and Gender Minorities statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1472-3263
- Volume :
- 96
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Sexually transmitted infections
- Publication Type :
- Academic Journal
- Accession number :
- 31896737
- Full Text :
- https://doi.org/10.1136/sextrans-2019-054335