Impact of mass drug administration of azithromycin for trachoma elimination on prevalence and azithromycin resistance of genital Mycoplasma genitalium infection

Mark Andrew Harrison, Emma Harding-Esch, Michael Marks, Marcus James Pond, Robert Butcher, Anthony W. Solomon, Liqing Zhou, Ngeekeong Tan, Achyuta V. Nori, Henry Kako, Oliver Sokana, David C.W. Mabey, Syed Tariq Sadiq*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background Mass drug administration (MDA) of 20 mg/kg (maximum 1 g in adults) azithromycin for ocular Chlamydia trachomatis (CT) infection is a key component of the WHO trachoma elimination strategy. However, this dose may be suboptimal in Mycoplasma genitalium infection and may encourage emergence of antimicrobial resistance (AMR) to azithromycin. Objectives To determine the effect of MDA for trachoma elimination on M. genitalium prevalence, strain type and azithromycin resistance. Methods A secondary analysis of CT-negative vulvovaginal swabs from three outpatient antenatal clinics (Honiara, Solomon Islands) from patients recruited either pre-MDA, or 10 months post-MDA in two cross-sectional surveys was carried out. Swabs were tested for M. genitalium infection using Fast Track Diagnostics Urethritis Plus nucleic acid amplification assay. M. genitalium-positive samples were subsequently tested for azithromycin resistance by sequencing domain V of the 23S rRNA DNA region of M. genitalium and underwent phylogenetic analysis by dual locus sequence typing. Results M. genitalium prevalence was 11.9%(28/236) in women pre-MDA and 10.9%(28/256) 10 months post-MDA (p=0.7467). Self-reported receipt of azithromycin as part of MDA was 49.2%in women recruited post-MDA and 17.9%(5/28) in those who tested M. genitalium positive. Of samples sequenced (21/28 pre-MDA, 22/28 post-MDA), all showed a macrolide susceptible genotype. Strain typing showed that sequence types diverged into two lineages, with a suggestion of strain replacement post-MDA. Conclusion A single round of azithromycin MDA in an island population with high baseline M. genitalium prevalence did not appear to impact on either prevalence or azithromycin resistance, in contrast to reported decreased genital CT prevalence in the same population. This may be due to limitations such as sample size, including CT-negative samples only, and low MDA coverage. Further investigation of the impact of multiple rounds of MDA on M. genitalium azithromycin AMR in antibiotic experienced and naïve populations is warranted.

Original languageEnglish
Pages (from-to)522-528
Number of pages7
JournalSexually Transmitted Infections
Issue number7
Publication statusPublished - 1 Nov 2019

Bibliographical note

Funding Information:
Funding this work was supported by the national institute for Health research (niHr) i4i Programme ( boards-andpanels/programme-boards-and-panels/invention-for-innovation/) (grant number ii-lB-0214-20005), the UK clinical research collaboration (Medical research council) ( translation infection research initiative consortium (grant number g0901608), a grant from the royal Society of tropical Medicine and Hygiene to MM (grant number 522), a grant from the chadwick trust, UK, a Wellcome trust clinical research Fellowship (Wt 102807) and a Wellcome trust intermediate clinical Fellowship (Wt 098521).

Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.


  • antimicrobial resistance
  • azithromycin
  • drug resistance
  • infection
  • mass drug administration
  • mycoplasma
  • Mycoplasma genitalium
  • trachoma


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