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Background   Mycoplasma genitalium  is an emerging sexually transmitted infection, with increasing rates of resistance to fluroquinolones and macrolides, the recommended treatments. Despite this,  M. genitalium  is not part of routine screening for Sexually Transmitted Infections (STIs) in many countries and the prevalence of infection and patterns of disease remain to be determined in many populations. Such data is of particular importance in light of the reported rise in antibiotic resistance in  M. genitalium  isolates.    Methods  Urine and urethral swab samples were collected from the primary public sexual health clinic in Singapore and tested for  C. trachomatis (CT)  or  N. gonorrhoeae  (NG) infection and for the presence of  M. genitalium . Antibiotic resistance in  M. genitalium  strains detected was determined by screening for genomic mutations associated with macrolide and fluroquinolone resistance.    Results  We report the results of a study into  M. genitalium  prevalence at the national sexual health clinic in Singapore.  M. genitalium  was heavily associated with CT infection (8.1% of cases), but present in only of 2.4% in CT negative cases and not independently linked to NG infection. Furthermore, we found high rates of resistance mutations to both macrolides (25%) and fluoroquinolones (37.5%) with a majority of resistant strains being dual-resistant. Resistance mutations were only found in strains from patients with CT co-infection.    Conclusions  Our results support targeted screening of CT positive patients for  M. genitalium  as a cost-effective strategy to reduce the incidence of  M. genitalium  in the absence of comprehensive routine screening. The high rate of dual resistance also highlights the need to ensure the availability of alternative antibiotics for the treatment of multi-drug resistant  M. genitalium  isolates.

Mycoplasma genitalium in Singapore is associated with Chlamydia trachomatis infection and displays high macrolide and Fluoroquinolone resistance rates