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Birhanu, M., Abegaz, W. E., Schröder, D., Mihret, A., Abebe, T., Jacobsson, S., . . . Unemo, M. (2024). Antimicrobial susceptibility in Neisseria gonorrhoeae and epidemiological data of gonorrhoea patients in five cities across Ethiopia, 2021-22. JAC-antimicrobial resistance, 6(1), Article ID dlae002.
Open this publication in new window or tab >>Antimicrobial susceptibility in Neisseria gonorrhoeae and epidemiological data of gonorrhoea patients in five cities across Ethiopia, 2021-22
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2024 (English)In: JAC-antimicrobial resistance, E-ISSN 2632-1823, Vol. 6, no 1, article id dlae002Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern and enhanced global gonococcal AMR surveillance is imperative. As in many African countries, regular, representative and quality-assured gonococcal AMR is lacking in Ethiopia. We describe the AMR in gonococcal isolates from five cities across Ethiopia, 2021-22, and patient epidemiological data.

METHODS: Urethral discharge from males and cervical discharge from females were collected from October 2021 to September 2022. Epidemiological data were collected using a questionnaire. MIC determination (ETEST; eight antimicrobials) was performed on gonococcal isolates and EUCAST breakpoints (v13.1) were used.

RESULTS: From 1142 urogenital swab samples, 299 species-identified gonococcal isolates were identified; 78.3% were from males and 21.7% from females. The median age for males and females was 25 and 23 years, respectively. Most isolates (61.2%) were identified in Addis Ababa, followed by Gondar (11.4%), Adama (10.4%), Bahir Dar (10.0%) and Jimma (7.0%). The resistance level to ciprofloxacin, tetracycline and benzylpenicillin was 97.0%, 97.0% and 87.6%, respectively, and 87.6% of isolates were producing β-lactamase. All isolates were susceptible to ceftriaxone, cefixime, azithromycin and spectinomycin. Recommended therapy [ceftriaxone (250 mg) plus azithromycin (1 g)] was used for 84.2% of patients.

CONCLUSIONS: We present the first national quality-assured gonococcal AMR data from Ethiopia. Resistance levels to ciprofloxacin, tetracycline and benzylpenicillin were exceedingly high. However, all isolates were susceptible to ceftriaxone, cefixime, azithromycin and spectinomycin. In Ethiopia, it is essential to strengthen the gonococcal AMR surveillance by including further epidemiological data, more isolates from different cities, and WGS.

Place, publisher, year, edition, pages
Oxford University Press, 2024
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-111376 (URN)10.1093/jacamr/dlae002 (DOI)001155688400002 ()38304725 (PubMedID)2-s2.0-85184511888 (Scopus ID)
Funder
Region Örebro County
Note

The present study was supported by Addis Ababa University, College of Health Science (2019) and the Örebro Country Council Research Committee and the Foundation for Medical Research at Örebro University Hospital (2021), Örebro, Sweden.

Available from: 2024-02-05 Created: 2024-02-05 Last updated: 2024-02-20Bibliographically approved
Manjate, A., Andersson, S., Golparian, D., Kenga, D., Langa, J., Passanduca, A., . . . Unemo, M. (2024). Assessment of the performance of a multiplex real-time PCR, AmpliSens Florocenosis/Bacterial Vaginosis-FRT, versus Nugent's criteria in the diagnosis of BV in women in Mozambique. Paper presented at Annual Meeting of the Infectious-Diseases-Society-for-Obstetrics-and-Gynecology (IDSOG), Boston, MA, USA, August 4-6, 2022. Sexually Transmitted Diseases, 51(1S), S433-S434, Article ID P469.
Open this publication in new window or tab >>Assessment of the performance of a multiplex real-time PCR, AmpliSens Florocenosis/Bacterial Vaginosis-FRT, versus Nugent's criteria in the diagnosis of BV in women in Mozambique
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2024 (English)In: Sexually Transmitted Diseases, ISSN 0148-5717, E-ISSN 1537-4521, Vol. 51, no 1S, p. S433-S434, article id P469Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Bacterial vaginosis (BV) is a common vaginal disorder among women of reproductive age, and BV can be associated with adverse pregnancy outcomes and enhanced acquisition and transmission of STIs/HIV. The present study aimed to determine the prevalence of BV using the Nugent score and sociodemographic factors associated with BV among women in Maputo, Mozambique, and to evaluate the performance of the AmpliSens® Florocenosis/Bacterial vaginosis-FRT PCR kit versus Nugent score for diagnosis of BV.

Material and Methods: Vaginal swabs were collected from 886 non-pregnant symptomatic women during their visit to the Mavalane Health area in Maputo, Mozambique from February 2018 to January 2019. BV was diagnosed by Nugent score. The AmpliSens®Florocenosis/Bacterial vaginosis-FRT PCR kit (InterLabService, Moscow, Russia) was evaluated for BV diagnosis. HIV was detected using Determine HIV1/2 (Alere Medical Co. Ltd, Chiba, Japan) plus Uni-Gold HIV1/2 (Trinity Biotech, Ireland). The chisquare test was used to estimate associations between categorical variables.

Results: The prevalence of BV by PCR, Nugent score, and HIV was 47.2%, 39.1%, and 22.5%, respectively. Of those with BV, 52% were HIV-positive and 48% HIV-negative (p < 0.001). The highest proportion of women was under 24 years old (38.1%), single (49.5%), with secondary education (53.5%), and living in rural areas (55.4%). BV was associated with young age at first sexual intercourse (44.5%) (χ2 = 17.47, p=< 0.001), condom use (43.3%) (χ2 =3.7, p= 0.05), and no use of contraceptives (49%) (χ2= 13.6, p=0.02). In real-time PCR, a higher proportion of BV cases (47.2%) were detected. However, 12.5% of women had an unknown vaginal dysbiosis. The sensitivity and specificity of the PCR were 99.6% and 82.2%, respectively. Using the PCR as a reference test, the sensitivity and specificity of the Nugent score were 86.2% and 99.4%, respectively. The concordance of both tests was κ=0.825 (95% CI, 0.78 - 0.86), p<0.001.

Conclusions: A high prevalence of BV was associated with young age at first sexual intercourse, condom and contraceptive use among women in Maputo, Mozambique. The AmpliSens® Florocenosis/Bacterial vaginosis-FRT PCR assay detected more BV-positive cases than the Nugent score and needs further evaluation in other settings.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-111545 (URN)001145322900547 ()
Conference
Annual Meeting of the Infectious-Diseases-Society-for-Obstetrics-and-Gynecology (IDSOG), Boston, MA, USA, August 4-6, 2022
Available from: 2024-02-16 Created: 2024-02-16 Last updated: 2024-02-16Bibliographically approved
Sangprasert, P., Golparian, D., Paopang, P., Girdthep, N., Lawung, R., Gopinath, D., . . . Unemo, M. (2024). Complete reference genomes of two ceftriaxone-resistant Neisseria gonorrhoeae strains identified in routine surveillance in Bangkok, Thailand, using Nanopore Q20+ chemistry, VolTRAX V2b, and Illumina sequencing. Microbiology Resource Announcements, Article ID e0123123.
Open this publication in new window or tab >>Complete reference genomes of two ceftriaxone-resistant Neisseria gonorrhoeae strains identified in routine surveillance in Bangkok, Thailand, using Nanopore Q20+ chemistry, VolTRAX V2b, and Illumina sequencing
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2024 (English)In: Microbiology Resource Announcements, E-ISSN 2576-098X, article id e0123123Article in journal (Refereed) Epub ahead of print
Abstract [en]

Ceftriaxone-resistant Neisseria gonorrhoeae strains, mostly associated with Asia, threaten gonorrhea treatment. We report the reference genomes of two ceftriaxone-resistant isolates found in routine surveillance in Bangkok, Thailand. The genomes belonged to the more antimicrobial-susceptible genomic lineage B, illustrating that both ceftriaxone-resistant strains and the mosaic penA-60.001 ceftriaxone-resistance determinant are spreading.

Place, publisher, year, edition, pages
American Society for Microbiology, 2024
Keywords
Neisseria gonorrhoeae, Thailand, ceftriaxone resistance
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-111350 (URN)10.1128/mra.01231-23 (DOI)001155697800001 ()38299807 (PubMedID)
Funder
Region Örebro County
Note

The present work was funded by grants from the Bangrak STIs Center, Bangkok, Thailand; WHO Thailand; Örebro County Council Research Committee; and the Foundation for Medical Research at Örebro University Hospital, Sweden.

Available from: 2024-02-02 Created: 2024-02-02 Last updated: 2024-02-14Bibliographically approved
Sánchez-Busó, L., Sánchez-Serrano, A., Golparian, D. & Unemo, M. (2024). pyngoST: fast, simultaneous and accurate multiple sequence typing of Neisseria gonorrhoeae genome collections. Microbial Genomics, 10(1)
Open this publication in new window or tab >>pyngoST: fast, simultaneous and accurate multiple sequence typing of Neisseria gonorrhoeae genome collections
2024 (English)In: Microbial Genomics, E-ISSN 2057-5858, Vol. 10, no 1Article in journal (Refereed) Published
Abstract [en]

Extensive gonococcal surveillance has been performed using molecular typing at global, regional, national and local levels. The three main genotyping schemes for this pathogen, multi-locus sequence typing (MLST), Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST) and N. gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR), allow inter-laboratory and inter-study comparability and reproducibility and provide an approximation to the gonococcal population structure. With whole-genome sequencing (WGS), we obtain a substantially higher and more accurate discrimination between strains compared to previous molecular typing schemes. However, WGS remains unavailable or not affordable in many laboratories, and thus bioinformatic tools that allow the integration of data among laboratories with and without access to WGS are imperative for a joint effort to increase our understanding of global pathogen threats. Here, we present pyngoST, a command-line Python tool for fast, simultaneous and accurate sequence typing of N. gonorrhoeae from WGS assemblies. pyngoST integrates MLST, NG-MAST and NG-STAR, and can also designate NG-STAR clonal complexes, NG-MAST genogroups and penA mosaicism, facilitating multiple sequence typing from large WGS assembly collections. Exact and closest matches for existing alleles and sequence types are reported. The implementation of a fast multi-pattern searching algorithm allows pyngoST to be rapid and report results on 500 WGS assemblies in under 1 min. The mapping of typing results on a core genome tree of 2375 gonococcal genomes revealed that NG-STAR is the scheme that best represents the population structure of this pathogen, emphasizing the role of antimicrobial use and antimicrobial resistance as a driver of gonococcal evolution. This article contains data hosted by Microreact.

Place, publisher, year, edition, pages
Microbiology Society, 2024
Keywords
Genome assemblies, Neisseria gonorrhoeae, population structure, sequence typing
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-111227 (URN)10.1099/mgen.0.001189 (DOI)38288762 (PubMedID)
Note

This work was supported by the Spanish Ministry of Science and Innovation (PID2020-120113RA-I00/AEI/10.13039/501100011033) and Generalitat Valenciana (CDEI-06/20-B, Conselleria de Sanitat Universal i Salut Pública; and CISEJI/2022/66, Conselleria d’Innovació, Universitats, Ciència i Societat Digital), Valencia, Spain. A.S.S. was the recipient of a predoctoral fellowship from the Spanish Ministry of Science and Innovation (PRE2021-098199).

Available from: 2024-01-31 Created: 2024-01-31 Last updated: 2024-01-31Bibliographically approved
Kakooza, F., Kiggundu, R., Mboowa, G., Kateete, P. D., Nsangi, O. T., Kabahita, J. M., . . . Unemo, M. (2023). Antimicrobial susceptibility surveillance and antimicrobial resistance in Neisseria gonorrhoeae in Africa from 2001 to 2020: A mini-review. Frontiers in Microbiology, 14, Article ID 1148817.
Open this publication in new window or tab >>Antimicrobial susceptibility surveillance and antimicrobial resistance in Neisseria gonorrhoeae in Africa from 2001 to 2020: A mini-review
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2023 (English)In: Frontiers in Microbiology, E-ISSN 1664-302X, Vol. 14, article id 1148817Article, review/survey (Refereed) Published
Abstract [en]

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG), compromising gonorrhea treatment, is a global public health concern. Improved, quality-assured NG AMR monitoring at the global level is essential. This mini-review examined NG AMR susceptibility surveillance and AMR data from the African continent from 2001 to 2020. Eligible peer-reviewed publications (n = 30) containing NG AMR data for antimicrobials currently recommended for gonorrhea treatment were included. Overall, very limited NG surveillance and AMR data was available. Furthermore, the NG AMR surveillance studies varied greatly regarding surveillance protocols (e.g., populations and samples tested, sample size, antimicrobials examined), methodologies (e.g., antimicrobial susceptibility testing method [agar dilution, minimum inhibitory concentration (MIC) gradient strip test, disc diffusion test] and interpretative criteria), and quality assurance (internal quality controls, external quality assessments [EQA], and verification of AMR detected). Moreover, most studies examined a suboptimal number of NG isolates, i.e., less than the WHO Global Gonococcal Antimicrobial Surveillance Program (GASP) and WHO Enhanced GASP (EGASP) recommendations of ≥100 isolates per setting and year. The notable inter-study variability and frequently small sample sizes make appropriate inter-study and inter-country comparisons of AMR data difficult. In conclusion, it is imperative to establish an enhanced, standardized and quality-assured NG AMR surveillance, ideally including patient metadata and genome sequencing as in WHO EGASP, in Africa, the region with the highest gonorrhea incidence globally. This will enable the monitoring of AMR trends, detection of emerging AMR, and timely refinements of national and international gonorrhea treatment guidelines. To achieve this aim, national and international leadership, political and financial commitments are imperative.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
Africa, Neisseria gonorrhoeae, WHO Gonococcal Antimicrobial Surveillance Program (GASP), WHO enhanced GASP (EGASP), antimicrobial resistance, antimicrobial susceptibility surveillance, azithromycin, ceftriaxone
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-105686 (URN)10.3389/fmicb.2023.1148817 (DOI)000984400400001 ()37089569 (PubMedID)2-s2.0-85153495013 (Scopus ID)
Available from: 2023-04-25 Created: 2023-04-25 Last updated: 2024-01-17Bibliographically approved
Golparian, D., Jacobsson, S., Ohnishi, M. & Unemo, M. (2023). Complete Reference Genome Sequence of the Clinical Neisseria gonorrhoeae Strain H035, with Resistance to the Novel Antimicrobial Zoliflodacin, Identified in Japan in 2000. Microbiology Resource Announcements, 12(3), Article ID e0113022.
Open this publication in new window or tab >>Complete Reference Genome Sequence of the Clinical Neisseria gonorrhoeae Strain H035, with Resistance to the Novel Antimicrobial Zoliflodacin, Identified in Japan in 2000
2023 (English)In: Microbiology Resource Announcements, E-ISSN 2576-098X, Vol. 12, no 3, article id e0113022Article in journal (Refereed) Published
Abstract [en]

Zoliflodacin is a promising novel antimicrobial in clinical development for treatment of gonorrhea; currently, it is in a global phase 3 randomized controlled clinical trial. High activity against global Neisseria gonorrhoeae strains has been shown. We present the complete reference genome of the zoliflodacin-resistant strain H035, which was identified in Japan in 2000.

Place, publisher, year, edition, pages
American Society for Microbiology, 2023
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-104581 (URN)10.1128/mra.01130-22 (DOI)000940691300001 ()36853044 (PubMedID)2-s2.0-85150451848 (Scopus ID)
Note

Funding agencies:

Örebro County Council Research Committee

Foundation for Medical Research at Örebro University Hospital (Örebro, Sweden)

Available from: 2023-03-01 Created: 2023-03-01 Last updated: 2023-05-19Bibliographically approved
Kakooza, F., Golparian, D., Matoga, M., Maseko, V., Lamorde, M., Krysiak, R., . . . Unemo, M. (2023). Genomic surveillance and antimicrobial resistance determinants in Neisseria gonorrhoeae isolates from Uganda, Malawi and South Africa, 2015-20. Journal of Antimicrobial Chemotherapy, 78(8), 1982-1991
Open this publication in new window or tab >>Genomic surveillance and antimicrobial resistance determinants in Neisseria gonorrhoeae isolates from Uganda, Malawi and South Africa, 2015-20
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2023 (English)In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 78, no 8, p. 1982-1991Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Global antimicrobial resistance (AMR) surveillance in Neisseria gonorrhoeae is essential. In 2017-18, only five (10.6%) countries in the WHO African Region reported to the WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP). Genomics enhances our understanding of gonococcal populations nationally and internationally, including AMR strain transmission; however, genomic studies from Africa are extremely scarce. We describe the gonococcal genomic lineages/sublineages, including AMR determinants, and baseline genomic diversity among strains in Uganda, Malawi and South Africa, 2015-20, and compare with sequences from Kenya and Burkina Faso.

METHODS: Gonococcal isolates cultured in Uganda (n = 433), Malawi (n = 154) and South Africa (n = 99) in 2015-20 were genome-sequenced. MICs were determined using ETEST. Sequences of isolates from Kenya (n = 159), Burkina Faso (n = 52) and the 2016 WHO reference strains (n = 14) were included in the analysis.

RESULTS: Resistance to ciprofloxacin was high in all countries (57.1%-100%). All isolates were susceptible to ceftriaxone, cefixime and spectinomycin, and 99.9% were susceptible to azithromycin. AMR determinants for ciprofloxacin, benzylpenicillin and tetracycline were common, but rare for cephalosporins and azithromycin. Most isolates belonged to the more antimicrobial-susceptible lineage B (n = 780) compared with the AMR lineage A (n = 141), and limited geographical phylogenomic signal was observed.

CONCLUSIONS: We report the first multi-country gonococcal genomic comparison from Africa, which will support the WHO GASP and WHO enhanced GASP (EGASP). The high prevalence of resistance to ciprofloxacin (and empirical use continues), tetracycline and benzylpenicillin, and the emerging resistance determinants for azithromycin show it is imperative to strengthen the gonococcal AMR surveillance, ideally including genomics, in African countries.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-106582 (URN)10.1093/jac/dkad193 (DOI)001011899500001 ()37352017 (PubMedID)2-s2.0-85166442231 (Scopus ID)
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2023-08-10Bibliographically approved
Golparian, D., Jacobsson, S., Holley, C. L., Shafer, W. M. & Unemo, M. (2023). High-level in vitro resistance to gentamicin acquired in a stepwise manner in Neisseria gonorrhoeae. Journal of Antimicrobial Chemotherapy, 78(7), 1769-1778
Open this publication in new window or tab >>High-level in vitro resistance to gentamicin acquired in a stepwise manner in Neisseria gonorrhoeae
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2023 (English)In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 78, no 7, p. 1769-1778Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Gentamicin is used in several alternative treatments for gonorrhoea. Verified clinical Neisseria gonorrhoeae isolates with gentamicin resistance are mainly lacking and understanding the mechanisms for gonococcal gentamicin resistance is imperative. We selected gentamicin resistance in gonococci in vitro, identified the novel gentamicin-resistance mutations, and examined the biofitness of a high-level gentamicin-resistant mutant.

METHODS: Low- and high-level gentamicin resistance was selected in WHO X (gentamicin MIC = 4 mg/L) on gentamicin-gradient agar plates. Selected mutants were whole-genome sequenced. Potential gentamicin-resistance fusA mutations were transformed into WT strains to verify their impact on gentamicin MICs. The biofitness of high-level gentamicin-resistant mutants was examined using a competitive assay in a hollow-fibre infection model.

RESULTS: WHO X mutants with gentamicin MICs of up to 128 mg/L were selected. Primarily selected fusA mutations were further investigated, and fusAR635L and fusAM520I + R635L were particularly interesting. Different mutations in fusA and ubiM were found in low-level gentamicin-resistant mutants, while fusAM520I was associated with high-level gentamicin resistance. Protein structure predictions showed that fusAM520I is located in domain IV of the elongation factor-G (EF-G). The high-level gentamicin-resistant WHO X mutant was outcompeted by the gentamicin-susceptible WHO X parental strain, suggesting lower biofitness.

CONCLUSIONS: We describe the first high-level gentamicin-resistant gonococcal isolate (MIC = 128 mg/L), which was selected in vitro through experimental evolution. The most substantial increases of the gentamicin MICs were caused by mutations in fusA (G1560A and G1904T encoding EF-G M520I and R635L, respectively) and ubiM (D186N). The high-level gentamicin-resistant N. gonorrhoeae mutant showed impaired biofitness.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-106110 (URN)10.1093/jac/dkad168 (DOI)000997422800001 ()37253051 (PubMedID)2-s2.0-85164237930 (Scopus ID)
Funder
Region Örebro County
Note

Funding agencies:

Foundation for Medical Research at Örebro University Hospital, Örebro, Sweden

United States Department of Health & Human Services

National Institutes of Health (NIH) - USA AI47609

US Department of Veterans Affairs

Available from: 2023-05-31 Created: 2023-05-31 Last updated: 2023-12-08Bibliographically approved
Golparian, D., Vestberg, N., Södersten, W., Jacobsson, S., Ohnishik, M., Fang, H., . . . Unemo, M. (2023). Multidrug-resistant Neisseria gonorrhoeae isolate SE690: mosaic penA-60.001 gene causing ceftriaxone resistance internationally has spread to the more antimicrobial- susceptible genomic lineage, Sweden, September 2022. Eurosurveillance, 28(10), Article ID 2300125.
Open this publication in new window or tab >>Multidrug-resistant Neisseria gonorrhoeae isolate SE690: mosaic penA-60.001 gene causing ceftriaxone resistance internationally has spread to the more antimicrobial- susceptible genomic lineage, Sweden, September 2022
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2023 (English)In: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 28, no 10, article id 2300125Article in journal (Refereed) Published
Abstract [en]

We report a ceftriaxone-resistant, multidrug-resist-ant urogenital Neisseria gonorrhoeae in a female sex worker in Sweden, September 2022, who was treated with ceftriaxone i g, but did not return for test-of-cure. Whole genome sequencing of isolate SE690 identified MLST ST8i30, NG-STAR CCi885 (new NG-STAR ST4859) and mosaic penA-6o.oo1. The latter, causing ceftriax-one resistance in the internationally spreading FC428 clone, has now also spread to the more antimicrobial -susceptible genomic lineage B, showing that strains across the gonococcal phylogeny can develop ceftri-axone resistance.

Place, publisher, year, edition, pages
European Centre for Disease Prevention and Control, 2023
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-105633 (URN)10.2807/1560-7917.ES.2023.28.10.2300125 (DOI)000953542500002 ()36892469 (PubMedID)2-s2.0-85150001286 (Scopus ID)
Note

Funding agencies:

Örebro County Council Research Committee

Foundation for Medical Research at Örebro University Hospital, Örebro, Sweden

Available from: 2023-04-21 Created: 2023-04-21 Last updated: 2023-04-21Bibliographically approved
Shipitsyna, E., Kularatne, R., Golparian, D., Müller, E. E., Vargas, S. K., Hadad, R., . . . Unemo, M. (2023). Mycoplasma genitalium prevalence, antimicrobial resistance-associated mutations, and coinfections with non-viral sexually transmitted infections in high-risk populations in Guatemala, Malta, Morocco, Peru and South Africa, 2019-2021. Frontiers in Microbiology, 14, Article ID 1130762.
Open this publication in new window or tab >>Mycoplasma genitalium prevalence, antimicrobial resistance-associated mutations, and coinfections with non-viral sexually transmitted infections in high-risk populations in Guatemala, Malta, Morocco, Peru and South Africa, 2019-2021
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2023 (English)In: Frontiers in Microbiology, E-ISSN 1664-302X, Vol. 14, article id 1130762Article in journal (Refereed) Published
Abstract [en]

The prevalence of Mycoplasma genitalium (MG) and MG antimicrobial resistance (AMR) appear to be high internationally, however, prevalence data remain lacking globally. We evaluated the prevalence of MG and MG AMR-associated mutations in men who have sex with men (MSM) in Malta and Peru and women at-risk for sexually transmitted infections in Guatemala, South Africa, and Morocco; five countries in four WHO regions mostly lacking MG prevalence and AMR data, and estimated MG coinfections with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV). Male urine and anorectal samples, and vaginal samples were tested for MG, CT, NG, and TV (only vaginal samples) using Aptima assays (Hologic). AMR-associated mutations in the MG 23S rRNA gene and parC gene were identified using ResistancePlus MG kit (SpeeDx) or Sanger sequencing. In total, 1,425 MSM and 1,398 women at-risk were recruited. MG was detected in 14.7% of MSM (10.0% in Malta and 20.0% Peru) and in 19.1% of women at-risk (12.4% in Guatemala, 16.0% Morocco, 22.1% South Africa). The prevalence of 23S rRNA and parC mutations among MSM was 68.1 and 29.0% (Malta), and 65.9 and 5.6% (Peru), respectively. Among women at-risk, 23S rRNA and parC mutations were revealed in 4.8 and 0% (Guatemala), 11.6 and 6.7% (Morocco), and 2.4 and 3.7% (South Africa), respectively. CT was the most frequent single coinfection with MG (in 2.6% of MSM and 4.5% of women at-risk), compared to NG + MG found in 1.3 and 1.0%, respectively, and TV + MG detected in 2.8% of women at-risk. In conclusion, MG is prevalent worldwide and enhanced aetiological MG diagnosis, linked to clinical routine detection of 23S rRNA mutations, in symptomatic patients should be implemented, where feasible. Surveillance of MG AMR and treatment outcome would be exceedingly valuable, nationally and internationally. High levels of AMR in MSM support avoiding screening for and treatment of MG in asymptomatic MSM and general population. Ultimately, novel therapeutic antimicrobials and/or strategies, such as resistance-guided sequential therapy, and ideally an effective MG vaccine are essential.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
M. genitalium prevalence and antimicrobial resistance, Mycoplasma genitalium, antimicrobial resistance, azithromycin, men who have sex with men, moxifloxacin, prevalence, women at-risk
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-104906 (URN)10.3389/fmicb.2023.1130762 (DOI)000945517700001 ()36910203 (PubMedID)2-s2.0-85149799240 (Scopus ID)
Available from: 2023-03-14 Created: 2023-03-14 Last updated: 2024-01-17Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-0688-2521

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