Abstract：
Background Increasing rates of macrolide and fluroquinolone resistance in Mycoplasma genitalium (MG) are being reported worldwide with resultant treatment failure. Aims and objectives We aimed to determine the level of antibiotic resistance of MG in men who have sex with men (MSM) attending a sexually transmitted infections (STIs) clinic in New Delhi, India. Methods Real-time polymerase chain reaction (PCR) assays targeting MgPa and pdhD genes were performed to detect MG rectal, urogenital or oropharyngeal infections in 180 MSM between January 2022 and June 2023. Macrolide resistance-associated mutations (MRM) and quinolone resistance-associated mutations (QRM) were detected by specific amplification of domain V of 23SrRNA gene and appropriate regions of parC and gyrA genes respectively followed by sequencing. PCR-based screening for Chlamydia trachomatis (CT) infection was also performed. Results A total of 13 (7.2%) MSM were positive for MG infection. The most common site of infection was anorectum (8/13; 61.5%) followed by the urethra (5/13; 38.5%). None of the patients had infection at both the sites, and no oropharyngeal MG infection was detected. CT infection was detected in 37 (20.6%) MSM. Of the 13 MG-infected MSM, 6 (46.2%) were co-infected with CT. MRM and QRM were found in five (46.2%) and two (15.4%) strains, respectively. Both Quinolone resistance mutation (QRM)-harbouring strains also harboured MRM. All the five MG isolates carried the MRM A2071G. Both the QRM isolates co-harboured the parC and gyrA single-nucleotide polymorphisms. There was no correlation between the presence of antibiotic resistance and co-infection with CT (P = 0.52). Limitation Because all patients in the study were MSM, the high rate of resistance to macrolides and fluoroquinolones could not be extrapolated for non-MSM patients. Conclusion This is a report of an initial survey of antibiotic resistance to MG in a country where its diagnosis and treatment are not routinely available. We found a high prevalence of MG-carrying MRM, QRM and dual-class resistance in MSM in the absence of antibiotic exposure. This study mandates the need for both screening and detection of antimicrobial resistance against MG.
摘要：
背景在全球范围内，据报道，生殖支原体（MG）中的大环内酯和氟喹诺酮耐药率正在上升，导致治疗失败。目的和目标我们旨在确定在新德里的性传播感染（STIs）诊所就诊的男男性行为者（MSM）中MG的抗生素耐药性水平，印度。方法采用针对MgPa和pdhD基因的实时聚合酶链反应（PCR）检测MG直肠，2022年1月至2023年6月，180名MSM的泌尿生殖系统或口咽部感染。通过分别对23SrRNA基因的结构域V以及parC和gyrA基因的适当区域进行特异性扩增，然后进行测序，检测大环内酯耐药相关突变（MRM）和喹诺酮耐药相关突变（QRM）。还进行了基于PCR的沙眼衣原体（CT）感染筛查。结果13例(7.2%)MSMMG感染阳性。最常见的感染部位是肛门直肠（8/13；61.5％），其次是尿道（5/13；38.5％）。没有病人在这两个部位都有感染,未检测到口咽部MG感染。37例(20.6%)MSM检出CT感染。在13名受MG感染的MSM中，6例(46.2%)合并CT感染。在5株(46.2%)和2株(15.4%)中发现了MRM和QRM,分别。两种具有喹诺酮抗性突变（QRM）的菌株也都具有MRM。所有五个MG分离物均携带MRMA2071G。QRM分离株都具有parC和gyrA单核苷酸多态性。抗生素耐药性与CT合并感染之间无相关性(P=0.52)。局限性因为研究中的所有患者都是MSM，非MSM患者对大环内酯类和氟喹诺酮类的高耐药率无法推断.结论这是在无法常规诊断和治疗的国家对MG的抗生素耐药性进行初步调查的报告。我们发现携带MG的MRM患病率很高，在没有抗生素暴露的情况下，MSM的QRM和双重耐药。这项研究要求筛选和检测针对MG的抗菌素耐药性。
