Individualised treatment of sexually transmitted infections by rapid molecular assays

Gerald L. Murray; Emma L. Sweeney; Catriona S. Bradshaw

doi:10.1071/MA24035

RESEARCH ARTICLE (Open Access)

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Individualised treatment of sexually transmitted infections by rapid molecular assays

Gerald L. Murray ^A ^B ^C ^* , Emma L. Sweeney ^D and Catriona S. Bradshaw ^E ^F ^G

+ Author Affiliations

- Author Affiliations

^A The Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic., Australia.

^B Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Parkville, Vic., Australia.

^C Molecular Microbiology Research Group, Murdoch Children’s Research Institute, Parkville, Vic., Australia.

^D Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia.

^E Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Vic., Australia.

^F School of Translational Medicine, Monash University, Melbourne, Vic., Australia.

^G School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia.

Gerald Murray is a senior research officer in the department of obstetrics, gynaecology and newborn health at The University of Melbourne, based at the Royal Women’s Hospital. His research interests include investigating mechanisms of antimicrobial resistance, studying the human microbiota in health and disease, and human papillomavirus (HPV).

Emma Sweeney is a senior research fellow at The University of Queensland Centre for Clinical Research. Her research interests include the development of novel molecular tools to detect and characterise pathogens of global health importance, with a particular focus on the sexually transmitted infection (STI) superbug Mycoplasma genitalium.

Catriona Bradshaw is a clinician researcher at Melbourne Sexual Health Centre, Monash University and Alfred Hospital. Her research interests include translational research to improve the treatment and control of drug resistant and refractory sexually transmitted infections.

^* Correspondence to: gerald.murray@unimelb.edu.au

Microbiology Australia https://doi.org/10.1071/MA24035

Submitted: 7 June 2024 Accepted: 11 July 2024 Published: 30 July 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the ASM. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY).

Abstract

Antimicrobial resistance (AMR) is a major problem in the field of sexually transmitted infections (STIs), where escalating levels have coincided with a surge in infections. The individualised treatment of STIs by rapid molecular ‘resistance’ assays is a new approach to patient management that has developed through understanding of the mechanisms of resistance, combined with nucleic acid amplification diagnostics. Mycoplasma genitalium provides an excellent example of this approach because of a restricted repertoire of effective antibiotics, and resistance mediated by single nucleotide polymorphisms. Detection of one of five M. genitalium 23S rRNA gene mutations is highly predictive of treatment failure with macrolides; employing this diagnostically yields >95% cure with azithromycin. Detection of fluoroquinolone resistance mutations in parC (especially affecting serine 83) and gyrA is predicted to have a similar diagnostic value and is currently being evaluated. This work is underpinned by high quality resistance data, emphasising the importance of ongoing surveillance. Despite some limitations, individualised treatment has demonstrated value in antimicrobial stewardship, extending the use of current therapies despite substantial levels of resistance, reducing prescription of ineffective treatments and sparing last-resort antibiotics.

Keywords: antibiotic resistance, diagnostic tests, Mycoplasma genitalium, PCR, sexually transmitted infections, STIs.

Biographies

Gerald Murray is a senior research officer in the department of obstetrics, gynaecology and newborn health at The University of Melbourne, based at the Royal Women’s Hospital. His research interests include investigating mechanisms of antimicrobial resistance, studying the human microbiota in health and disease, and human papillomavirus (HPV).

Emma Sweeney is a senior research fellow at The University of Queensland Centre for Clinical Research. Her research interests include the development of novel molecular tools to detect and characterise pathogens of global health importance, with a particular focus on the sexually transmitted infection (STI) superbug Mycoplasma genitalium.

Catriona Bradshaw is a clinician researcher at Melbourne Sexual Health Centre, Monash University and Alfred Hospital. Her research interests include translational research to improve the treatment and control of drug resistant and refractory sexually transmitted infections.

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