Background With the current debate over testing and screening for Mycoplasma genitalium (MG) in various populations, more information on the prevalence of MG is needed particularly in populations at high risk of sexually transmitted infections, such as men who have sex with men (MSM). We assessed the available data on the prevalence of MG in MSM across three anatomical sites: the urethra, pharynx and rectum.

Methods Ovid Medline, PubMed, Embase were searched for all peer-reviewed studies published until 1st June 2018 (in addition to conference proceedings from 2015), that reported prevalence of MG (using nucleic acid amplification testing) in the urethra, rectum and/or pharynx in at least 50 MSM. Data were extracted by anatomical site, symptom and HIV status. Pooled estimates (95% confidence intervals [CIs]) were calculated using random effects meta-analysis. Subgroup analyses were performed to assess heterogeneity between studies.

Results Forty-six studies met inclusion criteria. The overall prevalence of MG at any site was 5.8% (4.5–7.3%, I2=95.0%). MG prevalence was 4.6% (3.0–6.4%, I2=94.4%) in the urethra, 6.1% (4.5–7.9%, I2=89.0%) in the rectum, and 1.0% (0.0–5.1%, I2=96.0%) in the pharynx. Pooled estimates of MG prevalence were higher among HIV-positive compared with HIV-negative men (9.0% [5.2–13.4%, I2=90.7%] versus 5.7% [3.5–8.2%, I2=93.1%], p=0.019), and among symptomatic men compared to asymptomatic men (9.2% [6.2–12.7%, I2=87.3%] versus 4.0% [2.3–6.2%, I2=90.7], p=0.003).

Conclusion MG is commonly detected in MSM, particularly in the urethra and rectum. Prevalence was highest in HIV positive and symptomatic men. While a prevalence of 9% would prompt discussion of screening, more needs to be known about the natural history of MG in MSM, given the high levels of antimicrobial resistance and risk associated with quinolones. MG was uncommon in the pharynx of MSM (1%), suggesting this site is not a significant source of transmission and testing is not indicated.

Disclosure No significant relationships.