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Original research
Mycoplasma genitalium coinfection in men with symptomatic gonococcal urethritis
  1. Daniel Richardson1,
  2. David A Lewis1,2,
  3. Neisha J Jeoffreys3,
  4. Deborah L Couldwell1,2
  1. 1Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia
  2. 2Marie Bashir Institute for Infectious Diseases and Biosecurity and Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
  3. 3Department of Microbiology, Institute of Clinical Pathology and Medical Research, Westmead, New South Wales, Australia
  1. Correspondence to Dr Daniel Richardson, Brighton & Sussex Medical School, Brighton, UK; daniel.richardson7{at}


Objectives International guidelines recommend Mycoplasma genitalium testing, preferably using an assay to detect macrolide resistance-associated mutations, for men presenting with non-gonococcal urethritis, but there is no specific guidance on such testing for men with gonococcal urethritis.

Methods This study aimed to estimate the proportion of men with gonococcal urethritis who have coinfection with M. genitalium through a retrospective analysis of cases of symptomatic urethral gonorrhoea at Western Sydney Sexual Health Centre in 2017 and 2018.

Results Fourteen of 184 (7.6%, 95% CI 3.7 to 11.5) men with gonococcal urethritis had M. genitalium detected in the urine at the time of presentation. No demographic or behavioural factors predicted M. genitalium coinfection. Coinfection with urethral Chlamydia trachomatis was detected in 29 of 184 (15.8%, 95% CI 10.5 to 21.1). All five men with macrolide-resistant M. genitalium detected returned for treatment with moxifloxacin at a median of 8 days (range 5–16 days) after presentation and treatment of gonorrhoea; three of five were documented to remain symptomatic at this visit.

Conclusion Although M. genitalium coinfection is less common than chlamydia among men with symptomatic gonococcal urethritis, M. genitalium testing, using an assay to detect macrolide resistance, will potentially reduce symptom duration particularly for men with macrolide-resistant infections, but may not be justifiable on cost-benefit analysis.

  • Mycoplasma
  • Neisseria gonorrhoeae
  • men
  • epidemiology (clinical)
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  • Handling editor Henry John Christiaan de Vries

  • Contributors DLC and DR designed the study. DLC collected and analysed the data. NJJ supervised the microbiology reporting. All authors contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from the Western Sydney Local Health District Human Research and Ethics Committee (ref: 2019/ETH13052).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data are not available.

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