Understanding STI burden and antibiotic resistance

Dr Dorothy Machalek
21 March 2023 |

Untreated sexually transmitted infections can cause pelvic inflammatory disease leading to serious complications such as infertility and premature birth.

Research conducted at the Women’s to inform clinical practice examined the prevalence of the two most common STIs - Chlamydia trachomatis and Mycoplasma genitalium (MG) - among women attending the hospital for termination of pregnancy and contraceptive services.

Lead Researcher Dr Dorothy Machalek said clinical data was collected from 17,573 women aged 15-45 years, who sought pregnancy termination or contraception services (including insertion of intrauterine contraceptive devices) between 2009 and 2019.

Antibiotic resistance was also examined from 2016, when resistance testing was introduced into routine practice.

The prevalence of women testing positive with Chlamydia was 3.7 per cent, and with MG 3.4 per cent. One in 10 women who tested positive to Chlamydia was also infected with MG.

Risk of pelvic inflammatory disease is increased after gynecological procedures, including termination of pregnancy and insertion of intrauterine contraceptive devices. To reduce this risk, screening for Chlamydia prior to these procedures is recommended. Unlike Chlamydia, MG is highly prone to antimicrobial resistance.

“What is most concerning is that one third of MG infections tested were resistant to the first-line antibiotic treatment with azithromycin,” Dr Machalek said.

“Single-dose azithromycin is the most common treatment for Chlamydia, but its use in the management of Chlamydia is leading to a rise in antibiotic resistance in MG.”

Previous work by the team has shown that Australia has one of the highest rates of antibiotic resistance in MG in the world, and the findings of this study provide further evidence.

Dr Machalek said action was needed to reduce the spread of antibioticresistant MG in women.

“There is an urgent need for comprehensive MG and antibiotic resistance surveillance to inform treatment strategies,” she said. “We also need a concerted effort to promote antimicrobial stewardship at a national, jurisdictional, and service level.”

This research was published in Sexually Transmitted Infections.