Background Mycoplasma genitalium (MG) caus+es urethritis in males and cervicitis and PID in females. MG prevalence in the UK is not well understood and frequent use of single dose macrolide antibiotics is driving antimicrobial resistance.

Methods From November 2011 to May 2015 selected men with persistent urethritis or proctitis and women with persistent PID were tested for MG using the Fast-track Diagnostics™ urethritis PCR.

Results 461 patients were tested for MG. 30/461 (6.5%) were positive. Median age was 30 years(range 16–53) and more MG-positive males (26/30) than females (4/30) were identified. 1/4 females provided a cervical sample and 3/4 vaginal swabs. Of males, 1/26 provided a penile swab, 3/26 rectal swabs, and 22/26 (84.6%) gave urine samples. All females self-identified as heterosexual. 10/26 (38%) men self-identified as men who have sex with men (MSM); 6/30 (20%) patients were known to be HIV-positive, all of whom were male and 5/6 (83%) were MSM. 9/30 (30%) patients were treated with 1g single dose azithromycin and 5/30 (16.7%) received a regimen of azithromycin 500mg stat followed by 250mg od for 4 days. Tests of cure were done in 13/30 (43.3%). 4/13 (30.7%) remained positive and all received moxifloxacin, which was curative.

Conclusion We found MG in symptomatic patients attending our service. Many patients were treated with single dose azithromycin which may be insufficient to clear infection and lead to acquired resistance. Local protocols for persistent urethritis and PID should include routine testing for MG, and newer and better access to diagnostics are urgently needed to support this.