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J Clin Microbiol. 2019 Feb 27;57(3). pii: e01555-18. doi: 10.1128/JCM.01555-18. Print 2019 Mar.

Levels of Mycoplasma genitalium Antimicrobial Resistance Differ by Both Region and Gender in the State of Queensland, Australia: Implications for Treatment Guidelines.

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The University of Queensland Centre for Clinical Research (UQ-CCR), The University of Queensland, Brisbane, Queensland, Australia
The University of Queensland Centre for Clinical Research (UQ-CCR), The University of Queensland, Brisbane, Queensland, Australia.
Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia.
Melbourne Sexual Health Centre, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Townsville Sexual Health Service, Townsville, Queensland, Australia.
Pathology Queensland Townsville Laboratory, Townsville, Queensland, Australia.
Metro North Sexual Health Service, Brisbane, Queensland, Australia.


Mycoplasma genitalium is frequently associated with urogenital and rectal infections, with the number of cases of macrolide-resistant and quinolone-resistant M. genitalium infection continuing to increase. In this study, we examined the levels of resistance to these two common antibiotic treatments in geographically distinct locations in Queensland, Australia. Samples were screened for macrolide resistance-associated mutations using a commercially available kit (ResistancePlus MG; SpeeDx), and quinolone resistance-associated mutations were identified by PCR and DNA sequencing. Comparisons between antibiotic resistance mutations and location/gender were performed. The levels of M. genitalium macrolide resistance were high across both locations (62%). Quinolone resistance mutations were found in ∼10% of all samples, with a number of samples harboring mutations conferring resistance to both macrolides and quinolones. Quinolone resistance was higher in southeast Queensland than in north Queensland, and this was consistent in both males and females (P = 0.007). The M. genitalium isolates in rectal swab samples from males harbored high levels of macrolide (75.9%) and quinolone (19%) resistance, with 15.5% harboring resistance to both classes of antibiotics. Overall, the lowest observed level of resistance was to quinolones in females from north Queensland (1.6%). These data highlight the high levels of antibiotic resistance in M. genitalium isolates within Queensland and the challenges faced by sexually transmitted infection clinicians in managing these infections. The data do, however, show that the levels of antibiotic resistance may differ between populations within the same state, which has implications for clinical management and treatment guidelines. These findings also support the need for ongoing antibiotic resistance surveillance and tailored treatment.


Australia; Mycoplasma genitalium ; Queensland; antimicrobial resistance; azithromycin; macrolide; moxifloxacin; quinolone; sexually transmitted infection

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