Resistance to macrolides and quinolones among HIV-positive MSM infected with Mycoplasma genitalium

Background: The high prevalence of asymptomatic Mycoplasma genitalium (MG) infection, combined with limited treatment options due to emerging antimicrobial resistance, raises important questions about the necessity of routine screening and treatment, particularly among men who have sex with men (MSM). This study aimed to determine the prevalence of macrolide and quinolone resistance in MG among HIV-positive MSM and assess its clinical relevance. Methods: HIV-positive MSM were screened for sexually transmitted infections at the HIV clinic in Sheba Medical Center over a 43-month period, with demographic and clinical parameters recorded upon each visit. A subset of the patients underwent genetic resistance testing for macrolides and quinolones using real-time polymerase chain reaction assays. Results: A total of 317 patients were screened during the study period. MG was detected in 80 (25.2%) patients, covering 150 episodes, at least once during follow-up. In 15 of these episodes (10.0%), patients reported symptoms that might be explained by MG infection. Among the 35 patients who were tested for resistance, 28 (82.3%) harbored macrolide resistance–associated mutations, whereas 11 of 33 (33.3%) exhibited quinolone resistance–associated mutations. Conclusions: The findings highlight a high prevalence of macrolide-resistant MG infections among HIV-positive MSM, with a notable proportion also exhibiting macrolide quinolone resistance. Given the asymptomatic nature of many MG infections and the increasing challenge of antimicrobial resistance, routine screening for MG in this population may provide limited clinical benefits.