Background Associations between Mycoplasma genitalium (MG) and male urethritis and pelvic inflammatory disease are reported frequently. The recent prevalence of MG among clients of Dutch STI clinics is unknown. Treatment is hampered by resistance to azithromycin.

Methods Urogenital samples from 939 men who have sex with women (MSW), 1025 men who have sex with men (MSM) and 1273 women were included at the STI clinics of Amsterdam and the Hague. Also anal samples from all MSM and from 984 women were included. TMA assays (Aptima, Hologic) were used to detect MG, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Azithromycin resistance was tested using a new qPCR with LNA probes and confirmed by 23SrRNA gene sequencing.

Results The overall MG prevalence among STI clients was 19.9% in MSM, 8.4% in MSW and 12.5% in women. Prevalence for all risk groups was higher in STI clients in Amsterdam than in the Hague. MG-positivity was detected in 8.4% urines of MSW and 6.9% of MSM. In women, MG was found in 11.0% of vaginal samples. Of the anal samples of MSM 15.4% and of women10.0% were MG positive. Among MG-positive MSM 67.5% and among MG-positive women 16.1% were MG-positive in the anal sample only. MG and NG were associated in men (p<0.001), but not MG and CT. Detected azithromycin resistance was very high: 34/50 (68%) of urines, 48/81 (59%) of anal samples and 37/75 (49%) of vaginal samples.

Conclusion MG is highly prevalent in Dutch STI clinic clients and resistance frequency to azithromycin is very high. In MSM, isolated anal MG is common, but frequently missed if left untested. Anal MG in women is also common, but testing vaginal MG detects most cases. In men, NG and MG infections are associated. Information on clinical relevance of MG and azithromycin resistance is urgently needed.

Disclosure No significant relationships.