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Master Thesis

Mycoplasma genitalium chez les HSH à l'ère de la PrEP. Prévalence, incidence, évolution de la résistance aux antibiotiques et de la prise en charge thérapeutique

Abstract : Objective: few data are available about sexually transmitted infections (STIs) in PreExposure Prophylaxis (PrEP) users in France. We conducted a study to evaluate the prevalence and incidence of antimicrobial resistance to the main STIs (Chlamydia trachomatis (Ct), Neisseria Gonorrhea (Ng), syphilis, and Mycoplasma genitalium (Mg)) during a PrEP program. Methods: prospective study in Bordeaux University Hospital (France), from January 2016 to December 2017. Systematic detection of Ct, Ng and Mg by Transcription Mediated Amplification (TMA) was proposed for initial and follow-up consultations, in first-void urine, anorectal and oropharyngeal sites. For Mg-positive samples, detection of macrolide resistance was performed. Results:148 persons were enrolled. At baseline, 51 patients had an STI (34.5%; 95% confidence interval (CI) 26.9-42.7). Prevalence was 11.5% for Ct (CI 6.8-17.8), 10.8% for Ng (CI 6.3-17), 6.1% for syphilis (CI 2.8-11.2), 13.5% for Mg (CI 8.5-20.1). During follow-up, 104 STIs were diagnosed. The incidence was 89.8 for 100 person-years (PY) (CI 74.1-108.8): 25 Ct infections (21.6 for 100 PY, CI 14.6-32), 26 Ng infections (22.5 for 100 PY, CI 15.3-33), 14 cases of syphilis (12.1 for 100 PY, CI 7.2-20.4), 28 Mg infections (24.2 for 100 PY, CI 16.7-35). At baseline and during follow-up, the anus was the most frequently infected site for all STIs. Global Mg-macrolide resistance was 75%. Primary macrolide resistance of Mg was 71%. Four cases of acquired resistance after azithromycin first-line treatment were observed. Conclusions: STIs are increasing among men who have sex with men on PrEP. Preventive measures should be enhanced. Based on increasing rates of macrolide and fluoroquinolone resistance in Mg, even if asymptomatic infection may facilitate Human Immunodeficiency Virus transmission, systematic screening of Mg is not recommended in PrEP programs.
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https://dumas.ccsd.cnrs.fr/dumas-02419495
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Submitted on : Thursday, December 19, 2019 - 3:01:07 PM
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Maïlys Ducours. Mycoplasma genitalium chez les HSH à l'ère de la PrEP. Prévalence, incidence, évolution de la résistance aux antibiotiques et de la prise en charge thérapeutique. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02419495⟩

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