Detection of Mycoplasma genitalium from male primary urine specimens: an epidemiologic dichotomy with Trichomonas vaginalis

•A transcription-mediated amplification (TMA)–based assay for detection of Mycoplasma genitalium yielded a detection rate from male urine that was equivalent to that of Chlamydia trachomatis.•Over one-half of males with detectable M. genitalium (without codetection of other sexually transmitted infection [STI] agents) exhibited symptoms of STI.•Utilization of TMA-based assays for M. genitalium and Trichomonas vaginalis in a high STI prevalence community revealed a dichotomy in which M. genitalium predominated within an STI clinic patient population and T. vaginalis had increased prevalence in an outpatient clinic patient population. This paradigm warrants additional investigation.•Commercialization of the M. genitalium TMA for routine use in clinical laboratories will result in detection of additional cases of nongonococcal and nonchlamydial urethritis, providing benefit for both clinicians and public health practitioners.

A total of 2750 male urines subjected to a transcription-mediated amplification (TMA)–based Mycoplasma genitalium assay yielded 188 positive results (6.84%). This rate was similar to Chlamydia trachomatis (6.87%; P = 0.96) and greater than Neisseria gonorrhoeae (4.0%) and Trichomonas vaginalis (2.3%; P < 0.0002). Mean age of M. genitalium–infected males (30.8) was similar to N. gonorrhoeae (P = 0.78) but less than T. vaginalis (mean, 41.6; P < 0.0001). A total of 266 STI clinic encounters had at least 1 sexually transmitted infection (STI); 36.5% of these encounters had sole detection of M. genitalium (P ≤ 0.009 versus sole detection of other STI agents). In 209 community encounters with at least 1 STI, 22.0% exhibited sole detection of M. genitalium (P = 0.0007 versus sole M. genitalium detection in STI clinic males), while 18.7% had sole detection of T. vaginalis (P < 0.0002 versus detection in STI clinic males). TMA-based M. genitalium screening identifies additional cases of nongonococcal urethritis.