Background Mycoplasma genitalium (MG) is a sexually transmitted organism associated with urethritis in men. We examined clinical improvement of symptoms in men treated syndromically for urethritis, and correlated the clinical outcome to MG positivity.

Methods At the STI clinic in Amsterdam, the Netherlands, urethritis is defined as the presence of ≥10 leucocytes per high power field in Gram stains of urethral discharge. The additional presence of intracellular gram-negative diplococci defines gonococcal urethritis. Point-of-care standard therapy for gonococcal urethritis is 1000 mg ceftriaxone and for non-gonococcal urethritis is azithromycin 1000 mg. From May 2018 onwards, urine samples of all men with urethritis were tested for presence of N. gonorrhoeae (NG), C. trachomatis (CT), and M. genitalium (MG) using TMA assays (Aptima, Hologic). These men were sent a text message two weeks after receiving standard therapy, with a questionnaire about improvement (including resolution) of their urethritis symptoms. We analyzed clinical improvement by MG status.

Results From May through December 2018, 1015 men presented with 1111 episodes of urethritis. Of 88 episodes, there were no results for MG. Of the remaining 1023 episodes, men responded to the text message in 379 cases (37%). Of 379 cases 87 (23%) were positive for NG, 119 (31%) for CT, and 81 (21%) for MG. Clinical improvement was reported in 312 episodes (82%); this was 89% in NG cases; 82% in CT cases, and 72% in MG cases. Clinical improvement was reported by 92%(55/60), 85%(83/98) and 70%(35/50) of those with single infection with NG, CT or MG respectively (P=0.009); and by 80%(110/134) of those with none of these infections. Those with MG/CT co-infection had worse outcomes than those without MG (P=0.015).

Conclusion Among men with urethritis 82% improved after standard syndromic treatment. Those with MG/CT co-infection and those with MG single infection had significantly worse treatment results.

Disclosure No significant relationships.