Prevalence of Mycoplasma genitalium infection among HIV PrEP users: a systematic review and meta-analysis

Paulo Roberto Sokoll; Celina Borges Migliavaca; Uwe Siebert; Daniela Schmid; Marjan Arvandi

doi:10.1136/sextrans-2022-055687

Prevalence of Mycoplasma genitalium infection among HIV PrEP users: a systematic review and meta-analysis

Sex Transm Infect. 2023 Aug;99(5):351-359. doi: 10.1136/sextrans-2022-055687. Epub 2023 Feb 9.

Authors

Paulo Roberto Sokoll¹, Celina Borges Migliavaca², Uwe Siebert³, Daniela Schmid⁴, Marjan Arvandi³

Affiliations

¹ Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria paulo.sokoll88@outlook.de.
² Health Technology Assessment Institute (IATS), Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA). Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
³ Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
⁴ Division for Quantitative Methods in Public Health and Health Services Research, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.

PMID: 36759179
DOI: 10.1136/sextrans-2022-055687

Abstract

Objectives: To summarise the prevalence of Mycoplasma genitalium (MG) and antibiotic-resistant MG infection among HIV pre-exposure prophylaxis (PrEP) users.

Methods: We searched MEDLINE, Embase, Web of Science and Global Index Medicus up to 30 September 2022. We included studies reporting the prevalence of MG and/or antibiotic-resistant MG infection among PrEP users. Two reviewers independently searched for studies and extracted data. A systematic review with random-effects meta-analysis was performed to quantitatively summarise the results of included studies. The critical appraisal of included studies was conducted with the Joanna Briggs Institute checklist for prevalence studies and the quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: A total of 15 studies were included in the systematic review, with 2341 individuals taking PrEP. Studies were conducted in high-income level countries between 2014 and 2019. Median age of participants varied from 23.5 to 40 years. The majority were men (85%) and among them, 93% were men who have sex with men. To identify MG, urine samples were analysed in 14 studies, rectal or anal swabs in 12 studies, oral or pharyngeal swabs in 9 studies, and urethral or vaginal in 3 studies. The pooled point prevalence of MG among PrEP users was 16.7% (95% CI 13.6% to 20.3%; 95% prediction interval (95% PI) 8.2% to 31.1%). The pooled point prevalence of macrolide-resistant infections was 82.6% (95% CI 70.1% to 90.6%; 95% PI 4.7% to 99.8%) and the prevalence of fluoroquinolone-resistant infections was 14.3% (95% CI 1.8% to 42.8%). Individuals taking PrEP have a higher chance of being infected with MG compared with those not taking PrEP (OR 2.30; 95% CI 1.6 to 3.4). The quality of evidence was very low to moderate.

Conclusion: We observed a high prevalence of MG and its macrolide resistance among PrEP users, highlighting the need to reinforce prevention strategies against sexually transmitted infections in this population.

Prospero registration number: CRD42022310597.

Keywords: ANTIMICROBIAL RESISTANCE; Drug Resistance; Mycoplasma genitalium; PREP; Pre-Exposure Prophylaxis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Anti-Bacterial Agents
Drug Resistance, Bacterial*
HIV Infections* / prevention & control
Humans
Macrolides
Mycoplasma Infections* / epidemiology
Mycoplasma genitalium / drug effects
Pre-Exposure Prophylaxis*
Prevalence

Substances

Macrolides
Anti-Bacterial Agents