by the bioMérieux Connection Editors
One hard-to-diagnose pathogen linked to female infertility
Public health officials in the UK warned the public of exceptionally high incidence of sexually transmitted diseases, including drug resistant infections. On June 5th, Public Health England (PHE) issued a warning about “a considerable growth in new diagnosis of gonorrhea and syphilis in England.” And one week later, the British Association of Sexual Health and HIV (BASHH) issued a new guideline for the diagnosis and management of Mycoplasma genitalium to prevent the spread of the elusive infection that is becoming resistant to treatment and can lead to sterilization in women when left undiagnosed and treated.
According to PHE, the incidences of gonorrhea in the UK are at their highest level in decades. From 2016 to 2017, incidence of the infection increased 22%, or 44,676 new diagnoses. Over the same time period, PHE reports that the rate of syphilis infection increased 20%, or 7,137 new cases identified. And since 2008, the rate of syphilis infection has increased 148% in the UK.
In January of this year, a team from PHE published this paper: Neisseria gonorrheae in England and Wales between 2004 and 2015: analysis of annual cross-sectional surveillance surveys. According to the survey, “Between 2004 and 2015, the proportion of N. gonorrheae isolates fully susceptible to all antimicrobial classes fell from 80% to 46%, with the proportion resistant to multiple (two or more) classes increasing from 7.3% to 17.5%.”
In March, PHE reported the first case of a multi-drug-resistant isolate of Neisseria gonorrheae, which PHE defines as a strain resistant to dual first-line therapy of azithromycin and ceftriaxone. The isolate had a ceftriaxone minimum inhibitory concentration (MIC) of 0.5 mg/L and an azithromycin MIC of >256 mg/L, which is a high-level azithromycin-resistant strain (HLAziR). (In microbiology, MIC is a method to determine how susceptible a microbe is to a certain antibiotic or antimicrobial drug. MIC is the lowest concentration of an antibiotic or antimicrobial drug that visibly inhibits the growth during incubation of the microorganism being tested.)
This HLAziR N. gonorrheae strain was also resistant to ceftriaxone. According to PHE, this is the first multidrug resistant strain of N. gonorrheae documented in the UK. It is believed that the heterosexual male patient was exposed to this bug during a sexual encounter in Southeast Asia. As of April of this year, the patient was being treated with ertapenem, which appears to be effective in this case.
“These dramatic increases in syphilis and gonorrhoea are a huge concern and must provide a wake-up call to the Government about the importance of ensuring that high-quality, easily-accessible sexual health services are available for all those who need them,” said Olwen Williams, MD, President of BASHH. “Worryingly however, we are seeing an increase in the number of clinics that are being closed and patients are finding it increasingly difficult to access care. With the recent emergence of multi-drug resistant sexual infection, cuts in funding are coming at the worst possible time and are leaving services across the country at tipping point.”
As disturbing as these statistics are, many British public health officials see the relatively new sexually transmitted infection, Mycoplasma genitalium, (MGen) as a more menacing threat. The new MGen guideline from BASHH pulls no punches:
“Mycoplasma genitalium was first isolated in 1981, having been cultured from urethral specimens of two men presenting with non-gonococcal urethritis (NGU). M. genitalium belongs to the Mollicutes class, and with a genome of only 580 kilobases in size, is the smallest known self-replicating bacterium. It lacks a cell wall, and hence is not visible by Gram stain. The organism is fastidious and typically requires weeks or months to culture.
Although the diseases associated with M. genitalium infection are thought largely to be as a result of the host immune response rather than organism-specific features, it has been demonstrated in human fallopian tube organ culture that infection can be directly toxic to cells resulting in cilial damage.”
According to the new guideline, the majority of those with MGen infections of the genital tract are asymptomatic and do not develop disease. The best way to treat the infection isn’t clear, and the bacteria already show signs of resistance. According to BASHH, MGen is likely to blame for nearly 5,000 cases of female infertility in the UK each year.
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