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Ljubin-Sternak S, Meštrović T, Marijan T, Anušić M, Šuto S, Vraneš J. Detection of Macrolide and/or Fluoroquinolone Resistance Genes in Mycoplasma genitalium Strains Isolated from Men in the Northwest Region of Croatia in 2018-2023. Genes (Basel) 2024; 15:470. [PMID: 38674404 PMCID: PMC11049799 DOI: 10.3390/genes15040470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Mycoplasma genitalium (M. genitalium) poses a significant public health challenge due to its association with non-gonococcal urethritis (particularly in men) and antimicrobial resistance. However, despite the prevalence of M. genitalium infections and the rise in resistance rates, routine testing and surveillance remain limited. This is the first study from Croatia that aimed to assess the prevalence and trends of resistance in M. genitalium strains isolated from male individuals by detecting macrolide and fluoroquinolone resistance genes. The study also aimed to explore the factors associated with resistance and changes in resistance patterns over time. Urine samples collected from male individuals in the Zagreb County and northwest region of Croatia between 2018 and 2023 were tested for M. genitalium with the use of molecular methods. Positive samples were subjected to DNA extraction and multiplex tandem polymerase chain reaction (MT-PCR) targeting genetic mutations associated with macrolide (23S rRNA gene) and fluoroquinolone (parC gene) resistance. Of the 8073 urine samples tested from 6480 male individuals (and following the exclusion of repeated specimens), we found that the prevalence of M. genitalium infection was 2.2%. Macrolide resistance was observed in 60.4% of strains, while fluoroquinolone resistance was found in 19.2%. Co-resistance to both antibiotics was present in 18.2% of cases. A statistically significant increase in fluoroquinolone resistance was noted over the study period (p = 0.010), but this was not evident for azithromycin resistance (p = 0.165). There were no statistically significant differences in resistance patterns between age groups, whereas re-testing of patients revealed dynamic changes in resistance profiles over time. The high burden of macrolide resistance and increasing fluoroquinolone resistance underscore the urgent need for comprehensive resistance testing and surveillance programs. The implementation of resistance-guided treatment strategies, along with enhanced access to molecular diagnostics, is pivotal for effectively managing M. genitalium infections.
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Affiliation(s)
- Sunčanica Ljubin-Sternak
- Clinical Microbiology Department, Teaching Institute of Public Health “Dr Andrija Štampar”, 10000 Zagreb, Croatia; (T.M.); (M.A.); (S.Š.); (J.V.)
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Meštrović
- University Centre Varaždin, University North, 42000 Varaždin, Croatia;
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Tatjana Marijan
- Clinical Microbiology Department, Teaching Institute of Public Health “Dr Andrija Štampar”, 10000 Zagreb, Croatia; (T.M.); (M.A.); (S.Š.); (J.V.)
| | - Maja Anušić
- Clinical Microbiology Department, Teaching Institute of Public Health “Dr Andrija Štampar”, 10000 Zagreb, Croatia; (T.M.); (M.A.); (S.Š.); (J.V.)
| | - Sandra Šuto
- Clinical Microbiology Department, Teaching Institute of Public Health “Dr Andrija Štampar”, 10000 Zagreb, Croatia; (T.M.); (M.A.); (S.Š.); (J.V.)
| | - Jasmina Vraneš
- Clinical Microbiology Department, Teaching Institute of Public Health “Dr Andrija Štampar”, 10000 Zagreb, Croatia; (T.M.); (M.A.); (S.Š.); (J.V.)
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Bébéar C, Pereyre S, Berçot B, Cazanave C. Managing bacterial sexually transmitted infections (STIs) and preventing HIV/STIs in Europe. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100760. [PMID: 37927429 PMCID: PMC10625011 DOI: 10.1016/j.lanepe.2023.100760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Cécile Bébéar
- CHU Bordeaux, Bacteriology Department, National Reference Centre for Bacterial Sexually Transmitted Infections, Bordeaux, France
- University Bordeaux, CNRS, UMR 5234, Fundamental Microbiology and Pathogenicity, Bordeaux, France
| | - Sabine Pereyre
- CHU Bordeaux, Bacteriology Department, National Reference Centre for Bacterial Sexually Transmitted Infections, Bordeaux, France
- University Bordeaux, CNRS, UMR 5234, Fundamental Microbiology and Pathogenicity, Bordeaux, France
| | - Béatrice Berçot
- Paris Cité University, INSERM, IAME, Paris, France
- APHP, Saint Louis-Lariboisière Hospitals, Infectious Agents Department, French National Reference Center for Bacterial Sexually Transmitted Infections, Associated Laboratory for Gonococci, Paris, France
| | - Charles Cazanave
- University Bordeaux, CNRS, UMR 5234, Fundamental Microbiology and Pathogenicity, Bordeaux, France
- CHU Bordeaux, Infectious and Tropical Diseases Department, Bordeaux, France
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Mitjà O, Padovese V, Folch C, Rossoni I, Marks M, Rodríguez i Arias MA, Telenti A, Ciuffi A, Blondeel K, Mårdh O, Casabona J. Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100742. [PMID: 37927427 PMCID: PMC10625005 DOI: 10.1016/j.lanepe.2023.100742] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023]
Abstract
In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.
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Affiliation(s)
- Oriol Mitjà
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trías i Pujol, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Valeska Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Cinta Folch
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Isotta Rossoni
- Van Vollenhoven Institute for Law, Governance and Society, Leiden University, Netherland
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, United Kingdom
- Division of Infection and Immunology, University College London, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
| | - Miquel Angel Rodríguez i Arias
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trías i Pujol, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
| | | | - Angela Ciuffi
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Karel Blondeel
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Otilia Mårdh
- STI, Blood Borne Viruses and TB Section, Disease Programmes Unit, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
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Gökengin D, Noori T, Alemany A, Bienkowski C, Liegon G, İnkaya AÇ, Carrillo J, Stary G, Knapp K, Mitja O, Molina JM. Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100738. [PMID: 37927439 PMCID: PMC10625023 DOI: 10.1016/j.lanepe.2023.100738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.
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Affiliation(s)
- Deniz Gökengin
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ege University, Izmir, Turkiye
- Ege University HIV/AIDS Practice and Research Center, Izmir, Turkiye
| | - Teymur Noori
- European Centre for Disease Prevention and Control STI, Blood-Borne Viruses and TB DPR, Stockholm, Sweden
| | - Andrea Alemany
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carlo Bienkowski
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Poland and Hospital for Infectious Diseases in Warsaw, Poland
| | - Geoffroy Liegon
- Section of Infectious Diseases and Global Health University of Chicago Medicine Chicago, Illinois, United States
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine Department of Infectious Diseases Ankara, Turkey
| | - Jorge Carrillo
- IrsiCaixa AIDS Research Institute, Campus Can Ruti, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBERINFEC, Instituto de Salud Carlos IIII, Madrid, Spain
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Katja Knapp
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Oriol Mitja
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jean-Michel Molina
- University of Paris Cité and Department of Infectious Diseases Saint-Louis and Lariboisiére Hospitals, APHP, Paris, France
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