Abstract
ObjectivesWhileMycoplasma genitaliumis reported as a common rectal infection among men who have sex with men (MSM), published data refer predominantly to urethral infections. Currently, most guidelines recommendM. genitaliumtesting from urine in men with symptomatic, non-gonococcal urethritis. Macrolide resistance-associated mutations (MRMs) amongM. genitaliumhave increased during the last decade especially among MSM. We aim to demonstrate the prevalence and anatomical distribution ofM. genitaliuminfection and MRM in urine and rectal specimens among MSM in Sweden.MethodsIn this cross-sectional study in 2019, paired urine and rectal samples from symptomatic and asymptomatic MSM attending a sexually transmitted infection clinic in the south of Sweden were screened forM. genitalium, presence of MRM,Neisseria gonorrhoeae,Chlamydia trachomatis, HIV and syphilis.ResultsThe overall prevalence ofM. genitaliumwas 10.5% (64 of 609), rectal samples 7.6% (46 of 609) and urine samples 3.9% (24 of 609) (p=0.007). AmongM. genitalium-positive cases, single rectal and single urethral infection was detected in 62.5% (40 of 64) and 28.1% (18 of 64), respectively (p<0.0001). Infection at both sites was seen in 9.4% (6 of 64). The prevalence of MRM was 67.9% (19 of 28).M. genitaliumwas significantly associated with HIV (OR 2.60, 95% CI 1.14 to 5.88, p=0.02). Among the MSM, 7.4% (45 of 609) were infected withN. gonorrhoeae,6.7% (41 of 609) withC. trachomatis, 7.1% (43 of 609) with HIV and 0.7% (4 of 609) with syphilis.ConclusionsIn this study, among MSM, most infections withM. genitaliumwere detected as rectal mono infections. The prevalence ofM. genitaliumamong MSM was almost twofold higher in rectal samples (7.6%) compared with urine samples (3.9%). The prevalence of macrolide resistance was high with no difference between urine and rectal samples.