Molecular epidemiological analysis of Mycoplasma genitalium shows low prevalence of azithromycin resistance and a well-established epidemic in South Africa

dc.contributor.authorLaumen, Jolein G.E.
dc.contributor.authorVan Alphen, Lieke B.
dc.contributor.authorMaduna, Liteboho Daniel
dc.contributor.authorHoffman, Charlotte M.
dc.contributor.authorKlausner, Jeffrey D
dc.contributor.authorMedina‑Marino, Andrew
dc.contributor.authorKock, Marleen M.
dc.contributor.authorPeters, Remco P.H.
dc.date.accessioned2022-11-09T10:00:29Z
dc.date.available2022-11-09T10:00:29Z
dc.date.issued2021-03
dc.description.abstractOBJECTIVES: Macrolide resistance in Mycoplasma genitalium is emerging globally. There is paucity of data from sub-Saharan Africa where syndromic management is used to treat sexually transmitted infections (STIs). We conducted a molecular epidemiological study to determine the prevalence of azithromycin resistance and epidemic diversity of M. genitalium infections in South Africa. METHODS : We analysed 90 M. genitalium-positive specimens that had been collected consecutively from men and women (50% symptomatic) from geographically diverse communities across the northern part of South Africa between 2015 and 2019. Melting curve analysis followed by targeted sequencing of the 23S rRNA gene was performed to detect azithromycin resistance. Molecular typing was done through single nucleotide polymorphism (SNP) analysis of the MG191 gene and short tandem repeats (STR) assessment of the MG309 gene. An overview of all published M. genitalium sequence types was generated and novel sequence types identified in this study were allocated numbers accordingly. RESULTS : Azithromycin resistance was detected in 1/90 M. genitalium-positive specimens (1.1%; 95% CI 0% to 3.3%) as conferred by A2071G mutation; this strain also harboured a C234T mutation in the parC gene with wild type gyrA gene. SNP typing and STR assessment was successful in 38/90 specimens (42%) and showed a genetically diverse epidemic, without geographic clustering, with eight novel sequence types identified. CONCLUSION : This is the first study that determines resistance in M. genitalium infection since introduction of azithromycin in the syndromic management regimen for STIs in South Africa in 2015. Despite a well-established epidemic, azithromycin-resistant M. genitalium infection is still uncommon in the public healthcare sector. However, it has the potential to undermine the effectiveness of syndromic management. Introduction of molecular diagnostics and continuous surveillance are warranted for early detection emergence of resistance.en_US
dc.description.departmentMedical Microbiologyen_US
dc.description.librarianhj2022en_US
dc.description.sponsorshipThe Netherlands Enterprise Agency (Rijksdienst voor Ondernemend Nederland) and by the Eunice Kennedy Shriver National Institute of Child Health & Human Development, U.S. National Institute of Health.en_US
dc.description.urihttp://sti.bmj.comen_US
dc.identifier.citationLaumen, J.G.E., Van Alphen, L.B., Maduna, L.D. et al. 2021, 'Molecular epidemiological analysis of Mycoplasma genitalium shows low prevalence of azithromycin resistance and a well-established epidemic in South Africa', Sexually Transmitted Infections, vol. 97, no. 2, pp. 152-156. doi: 10.1136/sextrans-2019-054371.en_US
dc.identifier.issn1368-4973 (print)
dc.identifier.issn1472-3263 (online)
dc.identifier.other10.1136/sextrans-2019-054371
dc.identifier.urihttps://repository.up.ac.za/handle/2263/88215
dc.language.isoenen_US
dc.publisherBMJ Publishing Groupen_US
dc.rights© Author(s) (or their employer(s)) 2021.en_US
dc.subjectAfricaen_US
dc.subjectAzithromycin (AZM)en_US
dc.subjectMolecular epidemiologyen_US
dc.subjectMolecular typingen_US
dc.subjectMycoplasma genitalium infectionen_US
dc.subjectSouth Africa (SA)en_US
dc.subjectSexually transmitted infection (STI)en_US
dc.subjectSingle nucleotide polymorphism (SNP)en_US
dc.subjectShort tandem repeats (STR)en_US
dc.titleMolecular epidemiological analysis of Mycoplasma genitalium shows low prevalence of azithromycin resistance and a well-established epidemic in South Africaen_US
dc.typePostprint Articleen_US

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