The contribution of Mycoplasma genitalium to the aetiology of sexually acquired infectious proctitis in men who have sex with men

This study examined the contribution of Mycoplasma genitalium to sexually acquired infectious proctitis in men who have sex with men (MSM). MSM with symptomatic proctitis between May 2012 and August 2013 were tested for rectal sexually transmitted infections including chlamydia, gonorrhoea, herpes simplex virus (HSV) and M. genitalium. The load of rectal M. genitalium in men with symptomatic proctitis was compared with a separate group of men who had rectal M. genitalium but no symptoms of proctitis. Among 154 MSM with proctitis, rectal M. genitalium was detected in 18 men (12%, 95% CI 6.9–17.1) and was significantly more common among human immunodeficiency virus (HIV) -positive men (21%, 95% CI 9.5–32.6) than HIV-negative men (8%, 95% CI 2.9–13.1; prevalence ratio 3.2, 95% CI 1.2–8.8). Among HIV-positive men the detection of M. genitalium was comparable to that for chlamydia (21%, 95% CI 9.5–32.5), gonorrhoea (25%, 95% CI 16.2–41.8) and HSV (19%, 95% CI 7.9–30.1). Rectal M. genitalium load was significantly higher among the 18 men with symptomatic M. genitalium-associated proctitis than among a separate group of 18 men with asymptomatic rectal M. genitalium infection (60 000 copies of organism/swab versus 10 744 copies of organism/swab, p 0.023). Comprehensive testing for rectal pathogens in MSM with proctitis should include testing for M. genitalium.