Background This study evaluated the distribution of macrolide-resistant Mycoplasma genitalium in multiple urogenital specimens collected from women enrolled in a prospective multi-center US clinical study. Methods Four female urogenital specimens (vaginal swab, urine, endocervical swab, ectocervical brush/spatula) collected from each subject were tested using a transcription-mediated amplification (TMA) assay for M. genitalium. TMA-positive specimens were evaluated by reverse transcription-PCR and bi-directional Sanger sequencing of M. genitalium 23S rRNA to identify the presence of macrolide resistance-mediating mutations (MRM) at base positions 2058/2059. Results Of 140 women with one or more TMA-positive specimens, 128 (91.4%) yielded M. genitalium 23S rRNA sequence. MRM were found in 52% of vaginal specimens, 46.3% of urine specimens, 37.8% of endocervical specimens, and 46% of ectocervical specimens. There were 44 unique specimen type/sequence phenotype combinations of M. genitalium infection. The majority (81, 63.3%) of women had single specimen-sequence phenotype (macrolide-susceptible, MRM, or both) infections, while 24 (18.8%) women had multiple specimen-sequence phenotype concordant infections, and 23 (17.9%) women had multiple specimen-sequence phenotype discordant infections. The sensitivity for any single specimen type to detect overall urogenital tract macrolide-resistant M. genitalium infection status was 96.3% for vaginal swab samples, 82.6% for urine samples, 70.8% for endocervical swab samples, and 82.1% for ectocervical brush/spatula liquid Pap samples. Conclusions The distribution of M. genitalium infections in female urogenital tract specimens is highly complex, with multiple phenotypic combinations of the organism infecting a significant proportion of women at different anatomic specimen collection sites. Vaginal swab sampling yielded the highest sensitivity for identifying women with macrolide resistant M. genitalium urogenital tract infections.

中文翻译：

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美国临床研究队列女性泌尿生殖道标本中大环内酯类抗性生殖支原体的分布


背景本研究评估了从参加一项前瞻性多中心美国临床研究的女性收集的多个泌尿生殖样本中的大环内酯类耐药性生殖支原体的分布。方法 使用转录介导扩增 (TMA) 测定法对从每位受试者收集的四份女性泌尿生殖样本（阴道拭子、尿液、宫颈拭子、宫颈外刷/刮刀）进行生殖支原体检测。通过逆转录 PCR 和生殖支原体 23S rRNA 的双向桑格测序对 TMA 阳性样本进行评估，以确定碱基位置 2058/2059 处是否存在大环内酯耐药性介导的突变 (MRM)。结果 在 140 名拥有一份或多份 TMA 阳性样本的女性中，有 128 名 (91.4%) 产生了生殖支原体 23S rRNA 序列。 52%的阴道标本、46.3%的尿液标本、37.8%的宫颈内膜标本和46%的宫颈外膜标本中发现了MRM。生殖支原体感染有 44 种独特的样本类型/序列表型组合。大多数（81 名，63.3%）女性患有单一样本序列表型（大环内酯敏感、MRM 或两者兼而有之）感染，而 24 名（18.8%）女性患有多种样本序列表型一致感染，23 名（17.9%）女性患有多种样本序列表型一致感染。女性有多个样本序列表型不一致的感染。任何单一样本类型检测整体泌尿生殖道耐大环内酯类生殖支原体感染状态的灵敏度为，阴道拭子样本为 96.3%，尿液样本为 82.6%，宫颈内拭子样本为 70.8%，宫颈外刷/抹刀液体为 82.1%巴氏样本。结论 M 的分布。 女性泌尿生殖道标本中的生殖器感染非常复杂，该微生物的多种表型组合感染了不同解剖标本采集地点的很大一部分女性。阴道拭子取样对于识别患有大环内酯耐药性生殖支原体泌尿生殖道感染的女性具有最高的敏感性。