Sexual contacts of patients with M. genitalium at high risk
Among sexual contacts of patients with Mycoplasma genitalium, nearly half of women at a large Australian STD clinic were also infected, according to researchers.
Rates were also high among men who have sex with men (MSM) and other groups in that cohort, researchers wrote in the CDC journal Emerging Infectious Diseases. The results can help guide clinicians in testing and treating sexual contacts of those with M. genitalium infection, they said, perhaps even before confirmatory test results are received.
“These findings will inform guidelines for the management of sexual contacts of M. genitalium-infected patients and provide an evidence base for informed discussion between clinicians and their patients regarding the appropriateness of presumptive treatment for contacts of infected patients or recommending testing and return for treatment,” researcher Josephine B. Slifirski, a postgraduate medical student at Deakin University in Australia, and colleagues wrote.
In their retrospective study, the researchers included the records of 377 patients who presented at the Melbourne Sexual Health Center between August 2008 and July 2016 and reported sexual contact with someone infected with M. genitalium. Only those reporting anal or vaginal sex were included in the analysis.
The cohort included 139 women, 126 heterosexual men and 112 MSM. M. genitalium was detected in 48.2% of women and 31% of heterosexual men. Women were more than twice as likely to be infected as heterosexual men (adjusted OR = 2.18).
Among MSM, test samples were not taken from all the same anatomical sites, so results varied. Of the 48 MSM tested only at the urethra, three tested positive for M. genitalium, and of the 16 tested only at the rectum, 7 (43.8%) tested positive. However, among the 48 MSM tested at both sites, 20 (41.7%) tested positive.
The researchers found that MSM tested at the rectum had more than an eightfold increased risk for M. genitalium positivity compared with those tested at the urethra (aOR = 8.39).
Slifirski and colleagues acknowledged that their data may not be generalizable to larger populations because they were gathered specifically from an STD clinic.
“As such, the data reflect the prevalence of infection only among those persons who seek care reporting exposure to M. genitalium rather than among all of those exposed,” they wrote.
Furthermore, although the prevalence of infection was high in their cohort, the researchers warned that presumptive treatment of sexual contacts is not necessarily appropriate.
“An important consideration before presumptively treating contacts for M. genitalium infection is the increasing prevalence of macrolide resistance, which is more than 40% in Europe, Japan and the United States and more than 75% among MSM in Australia,” they wrote, citing previous studies.
Other factors also must be considered, the researchers added.
“Overall, a prudent approach entails managing sexual contacts according to the informed preferences of the person and, if known, the resistance status of the notifying partner,” they wrote. “The results of our study provide an evidence base for informed discussions between clinicians and patients at risk for infection and can inform international treatment and partner-notification guidelines.” – by Joe Green
Disclosures: Slifirski reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.