Multi-anatomical site prevalence of Mycoplasma genitalium infection, resistance and association with coinfections: a prospective study in MSM with HIV

Ngai Sze Wong; Bonnie Chun Kwan Wong; Denise Pui-Chung Chan; Danny King Fai Cheung; Heather Ki Wai To; Sze Long Chung; Margaret Ip; Shui Shan Lee

doi:10.1093/jacamr/dlaf158

Multi-anatomical site prevalence of Mycoplasma genitalium infection, resistance and association with coinfections: a prospective study in MSM with HIV

JAC Antimicrob Resist. 2025 Sep 8;7(5):dlaf158. doi: 10.1093/jacamr/dlaf158. eCollection 2025 Oct.

Authors

Ngai Sze Wong^{1

2

3}, Bonnie Chun Kwan Wong⁴, Denise Pui-Chung Chan^{2

3}, Danny King Fai Cheung⁴, Heather Ki Wai To⁴, Sze Long Chung^{2

3}, Margaret Ip^{3

5}, Shui Shan Lee^{2

3}

Affiliations

¹ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
² Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
³ S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
⁴ Special Preventive Programme, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, China.
⁵ Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.

Abstract

Background: Mycoplasma genitalium is a cause of sexually transmitted infections (STIs). This study assessed its prevalence, resistance and coinfection with Chlamydia trachomatis/Neisseria gonorrhoeae infections in MSM with HIV.

Methods: MSM in HIV care in Hong Kong were recruited during 2023-24 for completion of an online survey, and self-collection of urine specimens, rectal and pharyngeal swabs, which were tested for C. trachomatis, N. gonorrhoeae, M. genitalium and M. genitalium resistance-associated mutations (RAMs). The main outcome variables included M. genitalium infection and RAMs at individual and anatomic-site levels.

Findings: Among 562 MSM with HIV aged 20-71 years, all-site prevalence was 20% for M. genitalium, 19% for C. trachomatis and 10% for N. gonorrhoeae. Among C. trachomatis/N. gonorrhoeae infections, 28% were coinfected with M. genitalium. The prevalence was highest at the rectal site for M. genitalium (14%), C. trachomatis (17%) and N. gonorrhoeae (8%). M. genitalium infection was associated with N. gonorrhoeae (OR = 3.29 at the individual level, OR = 4.76 at pharyngeal sites and OR = 4.00 at rectal sites) but not C. trachomatis infection. Among 102 typeable M. genitalium-positive samples, 88 (86%) had RAMs-macrolides (78%), fluoroquinolones (49%) and both (41%). Recent sexualized drug use was a significant predictor for urethral M. genitalium RAMs [adjusted OR (aOR) = 3.21], while prolonged symptoms (aOR = 4.82), N. gonorrhoeae coinfection (aOR = 3.19) and HIV diagnosis in 2015-19 (aOR = 6.20) were predictors for rectal RAMs. The cure rate for non-susceptible M. genitalium infection was satisfactory with moxifloxacin or minocycline but not with azithromycin.

Conclusions: M. genitalium RAM prevalence is high in MSM with HIV, in whom rectal infection and C. trachomatis/N. gonorrhoeae coinfections are common.