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: high prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in western Sydney.

: high prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in western Sydney.
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Couldwell DL, Jalocon D, Power M, Jeoffreys NJ, Chen SC, Lewis DA,


Couldwell DL, Jalocon D, Power M, Jeoffreys NJ, Chen SC, Lewis DA, (click to view)

Couldwell DL, Jalocon D, Power M, Jeoffreys NJ, Chen SC, Lewis DA,

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Sexually transmitted infections 2018 03 22() pii 10.1136/sextrans-2017-053480

Abstract
OBJECTIVES
We aimed to estimate the prevalence ofinfection and of mutations linked to macrolide resistance using the ResistancePlus MG assay (SpeeDx, Sydney, New South Wales, Australia) in first-void urine (FVU), anorectal and oropharyngeal samples from men who have sex with men (MSM) attending Western Sydney Sexual Health Centre (WSSHC).

METHODS
Consecutive symptomatic and asymptomatic MSM attending for STI testing were prospectively enrolled.testing using the ResistancePlus MG assay was performed on FVU, anorectal and oropharyngeal samples routinely collected forandassays.

RESULTS
Overall, the prevalence ofinfection in the study group was 13.4% (68/508). Most (79.4%, 54/68)harboured macrolide resistance mutations (87.5% of urethral and 75.6% of anorectal infections). The anorectum was the most commonly infected site (45/505, 8.9%), followed by the urethra (24/508, 4.7%). No oropharyngealinfections were detected (0/508). Most of the anorectal (93.3%) and urethral (79.2%) infections were asymptomatic.MSM who were taking HIV pre-exposure prophylaxis (PrEP) were twice as likely to be infected withcompared with MSM who were not on PrEP (OR 2.1, 95% CI 1.3 to 3.6; P=0.0041). Always using condoms for anal sex in the last 3 months was protective of infection (OR 0.8, 95% CI 0.6 to 1.0; P=0.0186).

CONCLUSIONS
We demonstrated a high prevalence ofand very high levels of macrolide resistance among MSM attending WSSHC. Our findings support the routine use of an assay to detect macrolide resistance mutations ininfections. This will ensure, in regions or populations with high rates of macrolide resistance amongstrains, that first-line treatment with azithromycin will only be used if a macrolide-sensitive strain is identified.

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