There are fears that one of the most common sexually transmitted infections among gay men in Australia could become more resistant to antibiotics, with a new research recommending that GPs not test patients for the infection unless they present symptoms.

Mycoplasma genitalium is a common sexually transmitted infection – it is the second most common bacterial STI after Chlamydia trachomatis in many countries. While there are no authoritative studies about its prevalence in Australia, health experts estimate the numbers to be around 2% of the population. 

Among gay men and men who have sex with men who visit the Melbourne Sexual Health Centre clinic, the prevalence is around 10%. 

Common, But Stubborn STI

“Prevalence has not increased over the years but what is concerning is that the resistant form of MG is increasing dramatically  from around 15% in 2005-2007 to around 80% in 2020,” sexual health physician and Associate Professor Jason Ong told Star Observer.

The fear is that testing all patients may reduce the overall prevalence of MG, but it may lead to an increase in the numbers of those who become resistant to antibiotics. 

“Resistance to antibiotics is growing rapidly. This means that MG could become untreatable in the near future as we are running out of options to treat it.”

 The study by the Melbourne Sexual Health Centre, with Monash University and international experts in MG research found that if the screening is expanded from the current recommendation to test MG among gay men with symptoms to those who are symptomatic, could result in building resistance to antibiotics. 

“(The recommendation is) don’t test for MG among asymptomatic men who have sex with men, as having a positive test obligates its treatment which can increase the proportion of resistant MG,” said Ong, pointing out to the estimate that around 5-10% of patients with MG will become resistant on exposure to antibiotics. 

Antibiotics Resistance Increasing

“Only test for MG in men who are symptomatic (urethritis), or in women with cervicitis or pelvic inflammatory disease. If testing, it is best to use resistance guided therapy i.e. the test will also give information about the resistance profile of MG, and thus help direct the clinician to treat with the most effective antibiotics,” advised Ong. 

Mycoplasma genitalium, is a small and pathogenic bacterium that lives on the skin cells of the urinary and genital tracts in humans and is transmitted through sexual contact. Symptoms include a burning or stinging sensation when urinating in men and women have symptoms like pain during sex or bleeding after sex. 

“The treatment efficacy of antibiotics like azithromycin has continued to decrease over time and we’re also seeing the emergence of resistance to the second-line antibiotics. This poses the question of whether MG could become untreatable in the near future. That’s why it’s so important that patients have access to the best available treatment and why screening of asymptomatic men who have sex with men is strongly advised against,” said associate Professor Ong. 

The researchers say there may not be danger to gay man from not testing for MG if they do not have any symptoms. “There may be little danger (for gay men) as the main concern relates to the effects of MG on infertility in women. So the potential concern may be if gay and bisexual men are also having sex with females (so there is a bridging to that population). Currently there is no study to evaluate the value of screening for MG among asymptomatic heterosexual populations – this is something we are planning to conduct in the future,” added Professor Ong

 

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