Background Data on Mycoplasma genitalium (MG) in female sex workers (FSW) is scarce. FSW without regular contact to public health services may be at high risk for STI. Amongst other STI, we measured prevalence of MG among FSW at their workplace to identify most vulnerable subgroups and to plan effective interventions.

Methods Outreach-workers screened FSW in Berlin, Hamburg, and North Rhine-Westphalia for MG using self-collected vaginal swabs. Swabs were analysed by TMA (APTIMA® Mycoplasma genitalium assay, RUO). We collected data on sociodemographics, duration of sex work and access to medical care through cultural mediators. We fitted multivariate logistic regression models to calculate adjusted odds ratio (aOR) and 95% confidence intervals (95 CI) for diagnosis of MG.

Results Overall, 1,445 FSW working at 292 places were enrolled. 88% of FSW were born abroad, 28% in Romania, 21% in Bulgaria. 41% of non-Germans had no German skills. German and non-German FSW differed regarding existing health insurance (89% vs. 21%, p < 0.01) and ever attending low threshold STI clinics (70% vs. 43%, p < 0.01). FSW worked in brothels (26%), clubs/bars (20%), rented rooms inside brothels (18%), apartments (14%), saunaclubs (9%) and on the street (7%).

Prevalence of MG was 18%. Of MG-positive FSW, 18% were coinfected with chlamydia or trichomonas respectively, 9% with gonorrhoea. Diagnosis of MG was associated with younger age (aOR = 0.97; 95 CI = 0.95–0.99, per year increasing), being born in Bulgaria (aOR = 2.9; 95 CI = 1.2–7.2) or Romania (aOR = 3.4; 95 CI = 1.4–8.3; reference Germany), having no German skills (aOR = 3.1; 95 CI = 1.2–8.0), having no health insurance (aOR = 1.8; 95 CI = 1.0–3.2), and an interaction term of German skills and health insurance status.

Conclusion Prevalences of MG and STI-coinfections were high in the tested population, especially in younger, migrated FSW, without German skills and health insurance. Tests for MG, and if tested positive, for chlamydia, trichomonas and gonorrhoea, should be offered for FSW, combined with cultural mediation.

Disclosure of interest statement The testkits and reagents used in the scope of the study were distributed free of cost by Hologic.