Pediatric Emergency Medicine Fellow Children's Mercy Hospital and Clinics Children's Mercy Hospitals and Clinics Kansas City, Missouri, United States
Background: Mycoplasma genitalium is an established sexually transmitted cause of nongonococcal urethritis in males and macrolide resistance is increasing. The pathogenic role is less well-defined in adolescent females and guidelines recommend M. genitalium testing only be considered in cases of persistent or recurrent cervicitis and pelvic inflammatory disease (PID). We lack understanding of the prevalence and macrolide resistance of M. genitalium in adolescent females.
Objective: To determine the prevalence of M. genitalium and rate of detected macrolide resistance among adolescent females seeking care at a pediatric children’s hospital.
Design/Methods: We collected 200 salvaged urogenital samples (56 urine and 144 vaginal) from adolescent females aged 12-17 years seeking care between November 1, 2019 and April 31, 2020. We used Aptima Mycoplama genitalium assay (Hologic) to detect M. genitalium, Lightmix Modular Mycoplasma Macrolide kit (TIB MOLBIOL) to determine macrolide resistance, and confirmed findings by using Sanger Sequencing. We reviewed electronic medical records to determine presenting symptoms, concurrent urinary tract or sexually transmitted infections, demographics, and sexual risk behaviors. To look for associations with presence of M. genitalium, we used t-tests and chi-square or Fisher’s Exact tests.
Results: The prevalence of M. genitalium was 9.5% (95% CI, 5.4, 13.6). Of the 19 positive specimens, 5 were urine and 14 were vaginal samples. Macrolide resistance was detected in 89.5% positives (95% CI, 75.7, 100). Both susceptible positives were from vaginal specimens. Among these positives, 89.5% had history of positive/negative sexual experience documented and 53% reported history of vaginal intercourse. Compared to those without co-infection, females with any co-infection were more likely to have M. genitalium (6.6% vs. 18.4%, p=0.023). The most common co-infection among positives was Chlamydia trachomatis (26.3%) and nearly all (80%) of these patients received azithromycin. The mean age for females with M. genitalium was somewhat higher than those without (17.1 + 0.7 vs 16.4 + 1.7, p=0.057). Compared to white females, black females were more likely to have M. genitalium (3.3% vs 17.4%, p=0.015%). Conclusion(s): M. genitalium can often be detected among genitourinary samples from adolescent females and is nearly always resistant to macrolide antibiotics. Further work is needed to clarify the potential pathogenic role of M. genitalium in adolescent female reproductive health.
Authors/Institutions: Kayla Barnes, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States; Bishnu Adhikari, Children's Mercy Hospitals and Clinics, Kansas City , Missouri, United States; Rangaraj Selvarangan, Childrens Mercy, Kansas City, Missouri, United States; Christopher J. Harrison, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States; Melissa K. Miller, Children's Mercy Hospital, Kansas City, Missouri, United States