LAUSR

Mycoplasma genitalium (MG) is the cause of an emerging sexually-acquired infection with high propensity for antimicrobial resistance development. In a prevalence study conducted at the public sexually transmitted infection (STI) service in Hong Kong, the first void urine (FVU) samples of 38 (8%) out of 493 male non-gonococcal urethritis (NGU) patients were tested positive by RT-PCR. Patients with MG were younger in age (31 vs 33, OR=0.96, 95% CI 0.93-0.996; P=0.03), more likely to present with urethral discharge (12% vs 6%, OR=2.16, 95% CI 1.10-4.23; P=0.02) and had longer symptom duration of over 2 weeks (14% vs 6%, OR=2.34, 95% CI 1.10-4.97; P=0.03). The prevalence of MG was lower in patients co-infected with Chlamydia trachomatis than as isolated infection (4% vs 10%, OR=0.38, 95% CI 0.17-0.84; P=0.02). Men who have sex with men (MSM) did not give a higher prevalence of MG. Antimicrobial resistance-conferring mutation was present in 24 (63%) patients with MG - 23S rRNA 18 (47%) and parC 19 (53%). Similar to neigbouring Asia Pacific countries, concurrent resistance mutation against both macrolide and fluoroquinolone was demonstrated in 14 (37%). Histories of azithromycin and moxifloxacin use were significantly associated with MG diagnosis. Characteristically, NGU in Hong Kong featured the co-existence of mono-resistance against macrolide or fluoroquinolone, and the presence of dual class resistance. The geographic variability of antimicrobial resistance against MG is attributed to not just the different transmission networks formed in separate population groups but the antimicrobial prescriptions in the treatment of urethritis in the community.