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.

This analysis of notified syphilis cases in Victoria, Australia between 2015 and 2018 shows that the syphilis epidemic in Victoria has become more generalized, with increases among heterosexual men and women residing in outer Melbourne suburbs-areas that differ from those of gay men.I ncreases in syphilis among gay men were observed in the early 2000s in high-income countries, including the United States, the United Kingdom, Australia, and Europe. 1 More recently, syphilis cases have increased among heterosexuals in several countries, including North America, Japan, and Australia. [2][3][4][5][6][7] In Victoria, Australia, the number of cases in women has increased rapidly since 2015, 8 and congenital syphilis infections have reemerged for the first time since the last reported case in 2004. 9 What has driven the increase among women in Victoria is not fully understood. Australian surveillance data only report infectious syphilis cases by sex but not sexual orientation, making it difficult to track and understand the pattern of the epidemic between heterosexuals and gay men. In this study, we aimed to improve our understanding of the epidemiology of syphilis in Victoria by examining the demographic and clinical characteristics of notified syphilis cases by risk group and by mapping area of residence. Understanding the geographical distribution of syphilis by risk group would help inform the design and targeting of interventions aimed at improving control. METHODSSyphilis is a notifiable disease in Victoria, Australia. 10 Routinely collected syphilis notification data were obtained from the Victorian Government Department of Health: age, gender, country of birth, Aboriginal and Torres Strait Islander status, postcode of residence, gender of sex partners, presence or absence of symptoms, reasons for syphilis testing, and the source of notification. 10 The source of notification was categorized as follows: high caseload clinic (public sexual health clinics and general practices with a large clientele of gay men, sexually transmitted infections [STIs] and human immunodeficiency virus [HIV]); low caseload general practice (minimal STIs focus); hospitals; prisons; and laboratory.Deidentified and aggregated data on all infectious syphilis cases (primary, secondary, and early latent <2 years) 11 notified to the Victorian Department of Health between 2015 and 2018 were extracted. Late latent syphilis cases and those with unknown staging were excluded. Postcode of residence of the case was categorized by local government area based on Australian Standard Geography Classification. 12 Cases were categorized into four risk groups based on gender and sexual practices: "gay men"-men who have sex with men only, "heterosexual men"-men who have sex with women only, "bisexual men"-men who have sex with both men and women, and "women"-women who have sex with men and/or women. 13 Reinfection with syphilis was classified by the person notifying the case.Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version ...

Mycoplasma genitalium has emerged over the last 30 years as a sexually transmitted infection (STI). As data have accumulated, our understanding of this pathogen and its role in disease continues to evolve. This in turn creates new challenges and complexities. Questions remain regarding the natural history of M. genitalium , its contribution to disease and long-term sequelae. A decline in cure rates for first-line anti-microbials has been observed. This is likely in part due to high usage of single-dose azithromycin in the sexual health field but also due to the intrinsic ability of M. genitalium to rapidly acquire anti-microbial resistance. Consequently, the term ‘the new STI superbug’ is not infrequently used by the media to describe this pathogen. Currently available antibiotics have side effects that, though rare, are potentially serious. This leads to inherent questions regarding the benefit of testing for and treating M. genitalium , particularly in asymptomatic individuals or in genital syndromes where the benefit of treatment is not well established. In this review, we summarize the most recent evidence and literature regarding M. genitalium and explore areas of research where disparities exist. We discuss the contribution of M. genitalium to genital syndromes, particularly those where data are conflicting, in order to inform indications for testing and treatment. Avoidance of increasing anti-microbial resistance with astute anti-microbial stewardship is paramount if we are to successfully manage M. genitalium infection. We examine the state of play regarding anti-microbial resistance and how to combat this, including currently available anti-microbials, resistance-guided therapy and novel therapeutic approaches. We aim to provide an overview of the current understanding of M. genitalium and the implications for current clinical practise and suggestions for future research.