Prevalence of Mycoplasma genitalium infection and macrolide and fluoroquinolone resistance mutations among U.S. Air Force service members living with HIV, 2016-2020

BackgroundMycoplasma genitalium (MG) infection is of public health concern due to antimicrobial resistance (AMR). Data are limited on repeat MG infection and AMR among United States Air Force (USAF) service members (SMs) living with human immunodeficiency virus (HIV). MethodsUSAF SMs seeking HIV care were screened for MG infection during the surveillance period (May 16, 2016-March 16, 2020). Baseline and repeat MG prevalence were estimated. An extended Cox proportional hazards regression model evaluated characteristics associated with repeat MG infection. MG-positive rectal samples were tested for macrolide or fluoroquinolone resistance. ResultsAmong 299 male patients of a total 308 patients followed during the surveillance period, baseline prevalence of MG infection was 19.7% (59/299) and repeat MG was 35% (36/101) among patients who screened positive for MG at any time during the surveillance period. Characteristics independently associated with increased risk of repeat infection were reported prior sexually-transmitted infection (STI) history vs none (adjusted hazards ratio (aHR) 2.21, 95% confidence interval (CI) 1.13-4.35), presence of STI coinfection vs not indicated (aHR 5.13, 95% CI 2.78-9.49), new HIV diagnosis (<1 year vs 1 year or more, aHR 2.63, 95% CI 1.62-4.27). AMR in MG-positive rectal specimens was 88% (43/49) indicating macrolide resistance, 18% (10/56) with quinolone resistance, and 18% (10/56) with both macrolides and fluoroquinolone resistance. ConclusionsMacrolide and fluoroquinolone resistance mutations were common. Testing for co-occurring MG infection and AMR mutations may be warranted in guiding treatment for STIs such as chlamydia or gonorrhea detected at HIV diagnosis.