Retrospective analysis of infection and antimicrobial resistance patterns of <i>Mycoplasma genitalium</i> among pregnant women in the southwestern USA.

Abstract

<i>Mycoplasma genitalium</i> is a sexually transmitted infection (STI) pathogen. There have been no published studies concerning symptomatology, prevalence data, antibiotic resistance profiling or reports of co-infection with other STI in pregnant women. To describe these characteristics among pregnant women attending prenatal clinics in a large tertiary care centre. Remnant genital samples collected from pregnant women between August 2018 and November 2019 were tested for <i>M. genitalium</i> and <i>Trichomonas vaginalis</i> by the transcription-mediated amplification technique. Specimens with detectable <i>M. genitalium</i> RNA were sequenced for 23S rRNA mutations associated with azithromycin resistance and <i>parC</i> and <i>gyrA</i> mutations associated with resistance to moxifloxacin. Demographic, obstetric and STI co-infection data were recorded. Of the 719 samples, 41 (5.7 %) were positive for <i>M. genitalium. M. genitalium</i> infection was associated with black race, Hispanic ethnicity and young age (p=0.003, p=0.008 and p=0.004, respectively). <i>M. genitalium</i> infection was also associated with <i>T. vaginalis</i> co-infection and <i>Streptococcus agalactiae</i> (group B <i>Streptococcus</i>) colonisation (p≤0.001 and p=0.002, respectively). Of the 41 positive samples, 26 (63.4%) underwent successful sequencing. Eight (30.8%) had 23S rRNA mutations related to azithromycin resistance. One of 26 (3.8%) positive samples with sequencing results had the gyrA gene mutation and 1 of 18 sequenced samples (5.6%) had the parC gene mutation associated with moxifloxacin resistance. Prevalence rates of <i>M. genitalium</i> in pregnant women was 5.7%. <i>M. genitalium</i> infection disproportionately affects young black women co-infected with <i>T. vaginalis</i>. Pregnant women remain at risk for persistent infection with <i>M. genitalium</i> due to decreased azithromycin susceptibility.