Retrospective analysis of infection and antimicrobial resistance patterns of Mycoplasma genitalium among pregnant women in the southwestern USA

• Published in: BMJ open 2021-06, Vol.11 (6), p.e050475
• Main Authors: Stafford, Irene A, Hummel, Kelsey, Dunn, James J, Muldrew, Kenneth, Berra, Alexandra, Kravitz, Elizabeth Skye, Gogia, Soumya, Martin, Irene, Munson, Erik
• Format: Article
• Language: English
• Subjects: Abdomen; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; bacteriology; Chlamydia; Diabetes; Drug Resistance, Bacterial; Ethnicity; Female; Hepatitis; Herpes viruses; Hispanic people; Human papillomavirus; Humans; Hypertension; Infections; infectious diseases; Macrolides; maternal medicine; Mycoplasma genitalium - genetics; Mycoplasma Infections - drug therapy; Mycoplasma Infections - epidemiology; Obstetrics; Obstetrics and Gynaecology; Pacific Islander people; Pregnancy; Pregnant Women; Premature birth; Prevalence; reproductive medicine; Retrospective Studies; Vagina; Womens health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-050475

Background Mycoplasma genitalium is a sexually transmitted infection (STI) pathogen. There have been no published studies concerning symptomatology, prevalence data, antibiotic resistance profiling or reports of co-infection with other STI in pregnant women.ObjectiveTo describe these characteristics among pregnant women attending prenatal clinics in a large tertiary care centre.DesignRemnant genital samples collected from pregnant women between August 2018 and November 2019 were tested for M. genitalium and Trichomonas vaginalis by the transcription-mediated amplification technique. Specimens with detectable M. genitalium RNA were sequenced for 23S rRNA mutations associated with azithromycin resistance and parC and gyrA mutations associated with resistance to moxifloxacin. Demographic, obstetric and STI co-infection data were recorded.ResultsOf the 719 samples, 41 (5.7 %) were positive for M. genitalium. M. genitalium infection was associated with black race, Hispanic ethnicity and young age (p=0.003, p=0.008 and p=0.004, respectively). M. genitalium infection was also associated with T. vaginalis co-infection and Streptococcus agalactiae (group B Streptococcus) colonisation (p≤0.001 and p=0.002, respectively). Of the 41 positive samples, 26 (63.4%) underwent successful sequencing. Eight (30.8%) had 23S rRNA mutations related to azithromycin resistance. One of 26 (3.8%) positive samples with sequencing results had the gyrA gene mutation and 1 of 18 sequenced samples (5.6%) had the parC gene mutation associated with moxifloxacin resistance.ConclusionsPrevalence rates of M. genitalium in pregnant women was 5.7%. M. genitalium infection disproportionately affects young black women co-infected with T. vaginalis. Pregnant women remain at risk for persistent infection with M. genitalium due to decreased azithromycin susceptibility.