HPR volume 15 issue 14: news (27 August)
Updated 19 January 2022
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MARS second pilot report in summary
Public Health England (PHE) has published its second Mycoplasma genitalium antimicrobial resistance surveillance (MARS) pilot report which presents the latest data on antimicrobial resistance in M. genitalium from specimens collected from sentinel sexual health clinics in England.
The second pilot included data from all consecutive M. genitalium specimens collected from 15 clinics between January and March 2020. Clinics performed M. genitalium diagnostic testing for those presenting with non-gonococcal urethritis or pelvic inflammatory disease, and the current sex partners of those who tested positive for M. genitalium. Positive specimens sent to the PHE Antimicrobial Resistance in STIs (AMRSTI) national reference laboratory were tested for molecular markers predictive of macrolide and fluoroquinolone resistance in the M. genitalium 23S rRNA and parC gene, respectively.
Among 251 individuals included in the MARS pilot, 190 (76%) were symptomatic. The sample included 131 (52%) heterosexual men, 54 (22%) gay, bisexual or other men who have sex with men (MSM) and 61 (24%) women. One-hundred and twenty-four (49%) individuals were of White ethnicity, and 110 (44%) were aged 25 to 34 years old.
Of the corresponding 251 specimens submitted, 230 (92%) were successfully tested for macrolide resistance and, among these, 159 (69%) were predicted to be resistant. Most specimens from women (55%), heterosexual men (69%) and most notably, from MSM (88%) displayed macrolide resistance. Macrolide resistance mutations were more commonly detected among specimens from people of Black or Black British (80%) ethnicity compared to those who were White (62%), as well as among specimens from individuals who had a previous sexually transmitted infection (STI) in the past year (79%), compared to those who did not (68%). Of the 251 specimens, 233 (93%) were successfully tested for fluoroquinolone resistance and 26 (11%) were predicted to be resistant. Predicted resistance to both macrolides and fluoroquinolones was detected in 23 (10%) of 223 specimens.
As recommended in the national management guidelines, most individuals received either azithromycin or moxifloxacin (with or without doxycycline pre-treatment) for treating infection with M. genitalium. Azithromycin was prescribed either alone or in combination with another antibiotic for 105 individuals; of these, 16 (15%) failed initial treatment, as indicated by a positive test-of-cure, 14 of whom had specimens with mutations associated with macrolide resistance. Moxifloxacin was prescribed either alone or in combination with another antibiotic for 99 individuals, of which 1 failed initial treatment.
The results of the second pilot of MARS were consistent with those observed in the first, demonstrating evidence of widespread macrolide resistance and increasing dual-drug resistance.
Establishing MARS as a routine surveillance programme will mitigate the limitations of the first and second pilot studies by increasing the sample size, thereby improving statistical power for determining AMR risk factors and providing further treatment outcomes data to inform clinical management guidelines.
Sexual health services should continue to report cases of suspected M. genitalium treatment failure to second-line therapeutics to PHE.
Public health impact of mass gatherings
Public Health England has reported on a study of 37 public sports and cultural events held in England over a 4-month period earlier this year, concluding that it is possible for properly-organised, mass-participation events to be held safely and without generating significant increases in COVID-19 community infection rates.
The study was a continuation of the Events Research Programme – a joint project involving PHE and NHS Test and Trace, the earlier, first-phase findings of which were published in July.
The new study report, Public health impact of mass sporting and cultural events in a rising COVID-19 prevalence in England, presents data from more recent events (including attendance numbers, NHS Test and Trace data, estimations of the positive cases arising from attendance at the events and levels of community prevalence at the time).
Although the EURO 2020 football matches held at Wembley on 7 and 11 July, 2021, were exceptions (in that they were associated with subsequent spikes in cases across the country), cases observed in and around the other events were in line with, or below, community prevalence.
Infection report
Laboratory confirmed cases of measles, rubella and mumps, England: April to June 2021.