To treat or not to treat Antimicrobial resistant Mycoplasma genitalium

Mycoplasma genitalium is a sexually transmitted bacterium that can cause urethritis in men and cervicitis, pelvic inflammatory disease, premature birth, spontaneous abortion and infertility in women. Infections are preferably treated with macrolides or alternatively with fluoroquinolones. Unfortunately antimicrobial resistance has been increasingly reported in recent years, limiting treatment options.
A single point mutation can already lead to resistance to the entire class of antibiotics. The mutations that cause antimicrobial resistance can be detected with polymerase chain reaction (PCR). In this thesis we described two newly designed PCRs that can detect macrolide resistance in M. genitalium.
We found M. genitalium with macrolide resistance frequently in clients who visited the general practitioner (21%), but much more often among clients of two sexually transmitted infections (STI) outpatient clinics (66%). Among clients who visited the STI outpatient clinics we found that 9% of the M. genitalium infections were resistant to fluoroquinolones. We also detected multidrug resistant (resistance against both macrolides and fluoroquinolones) M. genitalium infections in 7% of the clients. This is worrying, since alternative treatment options are limited.
M. genitalium was very frequently detected (23%) in men with urethritis and there the prevalence of macrolide resistance was extremely high (74%). We found that a majority of these men felt better after macrolide treatment, but those who were infected with macrolide-resistant M. genitalium often remained having symptoms. With the increasing prevalence of multidrug resistant M. genitalium, M. genitalium infections may become untreatable.