O11.5 Heterogeneity of Mycoplasma genitalium resistance to macrolides and fluoroquinolones among men who have sex with men initiating PrEP in West-Africa

I De Baetselier,B Dembélé,B Vuylsteke,A Dagnra,C Anoma,S Diandé,E Dah,C Laurent,I Yaya,E Mensah,H Fayé-Ketté,S Hilde,A Koné,T Crucitti,C Vicky

doi:10.1136/sextrans-2021-sti.114

Abstract

<h3>Background</h3> An alarming high prevalence of antimicrobial resistance in Mycoplasma genitalium (MG) has been reported among men who have sex with men (MSM) in many parts of the world. However, data on West-Africa are lacking. Our aim was to assess the prevalence of macrolide and fluoroquinolone resistance-associated mutations (RAMs) of MG among MSM initiating PrEP in Burkina Faso, Côte d’Ivoire, Mali, and Togo. <h3>Methods</h3> At the baseline visit 594 MSM were screened for MG in the urethra, anorectum, and pharynx using the S-DiagMGTV multiplex assay. Positive MG samples were genotyped via Sanger sequencing of the 23S rRNA. Moreover, RAMs in the quinolone resistance determining region (QRDR) of the parC and gyrA gene were detected by Sanger sequencing. <h3>Results</h3> MG was detected in 115/594 participants (19.4% ). Country-specific prevalence of MG was, in descending order: Togo (25.7%, 26/101), Burkina Faso (23.9%, 27/113), Mali (18.3%, 48/263) and Côte d’Ivoire (12.0%, 14/117). Of 107 samples with available resistance data, none had RAMs to macrolides and 27 (25.2%) had RAMS to fluoroquinolones. QRDR mutations were more frequent in Mali ( 38.6%, 17/44) than in Togo (25.0%, 6/24) and Côte d’Ivoire (21.4%, 3/14). All except one sample collected in Burkina Faso were of wild type (96.0%, 24/25 ). RAMs at position 83 or 87 of ParC, which are highly associated with clinical resistance to fluoroquinolones, were detected in ten participants (9.7%) including four in Togo (16.7% of 24), five in Mali (11.9% of 42), and one in Côte d’Ivoire (7.7% of 13). <h3>Conclusion</h3> While no macrolide RAM in MG was detected, the high prevalence of fluoroquinolone RAMs calls for public health attention. Between-country heterogeneity of fluoroquinolone RAMs prevalence figures may be explained by different treatment guidelines or over-the-counter use of fluoroquinolones.

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