Health professionals in Eswatini are raising urgent concerns about the rapid spread of Mycoplasma genitalium (MG), a sexually transmitted infection (STI) that is increasingly being detected in the country.
Médecins Sans Frontières (MSF), also known as Doctors Without Borders, has highlighted the potential for MG to develop resistance to commonly used antibiotics, urging both the public and healthcare providers to exercise heightened caution.
Mycoplasma genitalium is a bacterium that can infect the genital and urinary tracts. It often presents with symptoms similar to other STIs, such as Chlamydia trachomatis and Neisseria gonorrhoeae, including urethritis in men and cervicitis or pelvic inflammatory disease in women.
In some cases, it can lead to complications like infertility if left untreated.
According to MSF Communi-cations Officer Futhie Mathonsi, the infection is primarily transmitted through sexual contact, including vaginal, anal, and oral sex.
However, it is not spread through casual contact such as hugging, kissing, or sharing baths and towels.
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A recent study conducted in Eswatini from July, 2022 to April, 2023 across six out-patient care sites in Shiselweni, found that among 735 participants, the median age was 27 (uinterquartile range 23-34) years, 65.5 per cent were women and 9.5 per cent were HIV positive.
MG infection was detected in 10.5 per cent of patients attending outpatient clinics tested positive for MG. Among these, 45.5 per cent had co-infections with other STIs like chlamydia, gonorrhoea or trichomoniasis.
Alarmingly, 66.2 per cent of MG-positive individuals did not receive appropriate antibiotic treatment, despite reporting STI symptoms .
The study also revealed that the syndromic approach to STI management where treatment is based on symptoms rather than laboratory tests, often leads to misdiagnosis and ineffective treatment.
This approach may contribute to the development of antibiotic resistance, as inappropriate use of antibiotics can promote the survival of resistant strains .
While the study reported a low rate of macrolide resistance (0.1 per cent) in Eswatini, the widespread use of azithromycin during the COVID-19 pandemic raises concerns about the emergence of drug-resistant MG strains.
MSF warns that continued misuse of antibiotics could lead to higher resistance rates, making treatment more challenging and less effective.
In response to the growing threat of MG, MSF has opened a comprehensive sexual health clinic in Matsapha. The clinic, named ‘Sitsandziwe’ (meaning ‘You Are Loved’), offers a range of services, including STI testing and treatment, HIV prevention, and family planning.
MSF emphasises the importance of laboratory-based diagnosis and treatment of STIs to ensure accurate identification and effective management .
MSF also advocates for the expansion of molecular-based testing for MG, particularly among individuals who test negative for other STIs but exhibit symptoms.
This targeted approach could help identify and treat MG infections more effectively, reducing the risk of complications and the spread of resistant strains .
The rise of MG in Eswatini underscores the need for improved STI surveillance, better diagnostic capabilities, and more effective treatment strategies.
Public health campaigns should focus on raising awareness about MG, its symptoms, and the importance of seeking medical attention for STI-related concerns.
Individuals are encouraged to practice safer sex by using condoms consistently and correctly, limiting the number of sexual partners, and getting regularly tested for STIs.
Early detection and appropriate treatment are crucial in preventing the spread of MG and other STIs.
The increasing prevalence of Mycoplasma genitalium in Eswatini, coupled with the potential for antibiotic resistance, presents a significant public health challenge.
Collaborative efforts between healthcare providers, organisations like MSF, and the community are essential to combat this emerging threat.
By enhancing diagnostic capabilities, promoting safe sexual practices, and ensuring appropriate treatment, Eswatini can work towards controlling the spread of MG and safeguarding public health.
