Prevalence and Distribution of Antimicrobial Resistance-Associated Mutations in Mycoplasma genitalium Identified Through Routine Molecular Diagnostics in Korea

Mycoplasma genitalium is a significant sexually transmitted pathogen, and its clinical management is increasingly complicated by the global distribution of mutations associated with macrolide and fluoroquinolone resistance. To characterize the molecular resistance landscape in a routine diagnostic setting, we retrospectively analyzed residual clinical specimens collected during routine sexually transmitted infection testing between January and December 2024. Among 374,021 specimens screened, we included 4019 M. genitalium-positive samples containing sufficient residual material. Using multiplex polymerase chain reaction assays, we detected mutations associated with macrolide and fluoroquinolone resistance in the 23S rRNA and parC genes, respectively. Frequent substitutions included A2059G and A2058G in the 23S rRNA gene (1253 samples) and substitutions at positions 248 and 259 in the parC gene (1306 samples). Mutations in the predefined 23S rRNA and/or parC targets were identified in approximately 44% of the analyzed samples, with distinct patterns of mutation distribution and co-occurrence. Although phenotypic susceptibility and clinical outcomes were not assessed, this large-scale, assay-based analysis provides a comprehensive overview of resistance-associated mutation patterns in M. genitalium derived from routine diagnostics, supporting molecular surveillance for monitoring antimicrobial resistance trends.