Authors’ reply

Thank you for expressing interest in our article ‘Evidence of emerging sexually transmitted Mycoplasma genitalium infection among women detected using multiplex and uniplex PCR’.¹ We appreciate your efforts in re-emphasising the critical issue of Mycoplasma genitalium infection, an emerging sexually transmitted infection.² Your valuable insights into the pathogenic potential of Mycoplasma genitalium and its impact on both genital and extragenital infections in males and females is much appreciated.

We wish to highlight that in our initial study conducted among sexually active women with lower genital tract infections attending community clinics, the prevalence of Mycoplasma genitalium was found to be nil but the prevalence of other genital mycoplasma was high.³ Notably, all participants in that study reported having a single sexual partner. Building on this, we extended our research to investigate Mycoplasma genitalium prevalence in high-risk populations, focusing on female sex workers, among whom we reported a prevalence rate of 6.7%. As you rightly highlighted, the issue of antimicrobial resistance is a growing concern. With the evolving treatment guidelines for Mycoplasma genitalium that are recommending extended azithromycin regimens over a single-dose therapy, we are in the process of evaluating antimicrobial resistance patterns to azithromycin in the samples collected from female sex workers.^4,5

As rightly noted in your letter, men who have sex with men represent another high-risk group for Mycoplasma genitalium infection that warrants detailed exploration. We are currently planning to undertake research on the prevalence and associated risk factors of Mycoplasma genitalium among men who have sex with men and we will take your suggestions of screening extragenital sites for this high-risk group.⁶ This will further contribute to the growing body of evidence on Mycoplasma genitalium in diverse populations and assist in developing targeted interventions.

As highlighted in our study and reinforced by your valuable comments, co-infections are a significant aspect of sexually transmitted infections and must be carefully addressed in their management and treatment. Co-infections with other sexually transmitted pathogens, such as Chlamydia trachomatis, Neisseria gonorrhoeae and other genital mycoplasma are common among individuals with Mycoplasma genitalium, further complicating treatment and increasing the risk of adverse reproductive outcomes.^7,8 Therefore, a comprehensive approach to screening and treatment, addressing all potential co-infections, is essential for effective management.

As rightly noted, Mycoplasma genitalium infection presents a therapeutic challenge. Tandon et al. had also highlighted that there is a paucity of evidence regarding the pathogenic potential and treatment outcomes of sexually transmitted infections, especially Mycoplasma genitalium, in the Indian context. Hence there is a need to do research on various aspects of prevalence, co-infections and antimicrobial resistance in other high-risk groups as well.⁹ This research is crucial as it addresses a growing concern which has the potential to evolve into a significant public health challenge.

Thank you for your valuable contribution and for bringing attention to this important area of research.