Original Research

Mycoplasma genitalium; pregnant women; azithromycin; macrolide resistance; 23S rRNA gene mutations; KwaZulu-Natal.

Meleshni Naicker, Ravesh Singh, Donald van der Westhuizen, Partson Tinarwo, Nathlee S. Abbai
Southern African Journal of Infectious Diseases | Vol 36, No 1 | a209 | DOI: https://doi.org/10.4102/sajid.v36i1.209 | © 2021 Meleshni Naicker, Ravesh Singh, Donald van der Westhuizen, Partson Tinarwo, Nathlee S. Abbai | This work is licensed under CC Attribution 4.0
Submitted: 20 April 2020 | Published: 15 January 2021

About the author(s)

Meleshni Naicker, School of Clinical Medicine Research Laboratory, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Ravesh Singh, Department of Medical Microbiology, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; and Department of Microbiology, National Health Laboratory Services, KwaZulu-Natal Academic Complex, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
Donald van der Westhuizen, Inqaba Biotechnical Industries (Pty) Ltd, Pretoria, South Africa
Partson Tinarwo, Department of Biostatistics, College of Health Sciences, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, Durban, South Africa
Nathlee S. Abbai, School of Clinical Medicine Research Laboratory, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa


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Abstract

Background: Azithromycin regimens have been considered first-line treatment for Mycoplasma genitalium (M. genitalium), a sexually transmitted infection (STI) associated with adverse pregnancy outcomes. However, recent years have seen rapid emergence of macrolide resistance in M. genitalium as a result of widespread administration of azithromycin. Currently, there are limited data on macrolide resistance in pregnant women from KwaZulu-Natal (KZN), South Africa. This study investigated the prevalence of M. genitalium and emerging patterns of macrolide resistance in pregnant women from KZN.

Methods: This was a sub-study of a larger study which involved laboratory-based detection of STIs in pregnant women. In the main study, pregnant women provided urine samples for detection of STIs. For this study, deoxyribose nucleic acid (DNA) extracted from stored urine was used to determine emerging macrolide resistance by amplification of the 23S ribosomal ribonucleic acid (rRNA) gene of M. genitalium by polymerase chain reaction (PCR) and sequencing of amplicons to identify mutations associated with resistance. The Allplex™ MG & AziR assay was used as a confirmatory assay.

Results: The prevalence of M. genitalium in pregnant women was 5.9% (13 out of 221). Sequencing of PCR amplicons did not reveal the presence of the A2059G and A2058G mutations associated with macrolide resistance. These findings were confirmed by the Allplex™ MG & AziR assay.

Conclusion: Despite the lack of resistance to macrolides in this study population, continued antimicrobial resistance surveillance for M. genitalium in pregnant women is important because azithromycin is now part of the South African national STI syndromic management guidelines for vaginal discharge syndrome.


Keywords

Mycoplasma genitalium; pregnant women; azithromycin; macrolide resistance; 23S rRNA gene mutations; KwaZulu-Natal

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