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Background Mycoplasma genitalium (MG) is a cause of nongonococcal, nonchlamydial urethritis and may cause subclinical infection of the anorectum, thereby potentiating HIV transmission among men who have sex with men (MSM). We describe the prevalence and incidence of MG among Nigerian MSM. Methods Adult MSM were recruited in Lagos, Nigeria, and screened for HIV and bacterial sexually transmitted infections (STIs) every 3 months for up to 18 months. HIV infection was diagnosed using a parallel algorithm of rapid tests. PCR testing for Neisseria gonorrhoeae and Chlamydia trachomatis was performed on voided urine and rectal swab specimens. Nucleic acid amplification testing for qualitative detection of MG ribosomal RNA was performed on first and last available specimens. Wald and exact 95% confidence intervals (95% CIs) were calculated for prevalence and incidence, respectively, by anatomic site. Chi-squared test was used to compare proportions across groups of interest. Results From May 13, 2014–July 25, 2016, 413 MSM were tested for MG with median age 23 (interquartile range 20–26) years and HIV prevalence 67.5% (278/413). Anorectal MG prevalence was 36.8% (150/408, 95% CI 32.1–41.4%) and urogenital prevalence was 12.4% (51/410, 95% CI 9.2–16.0%), including 6.0% (25/413) of participants who were infected at both sites. Among prevalent anorectal MG cases, co-infection with gonorrhea was observed in 25.3% (38/150) and chlamydia in 19.3% (29/150). Among prevalent urogenital MG cases, gonorrhea was observed in 0% and chlamydia was observed in 15.7% (8/51). There was a trend toward more MG among participants with anorectal gonorrhea (46.8% vs. 35.0%, P = 0.07). Thirty-one new anorectal infections were observed over 272 person-years (11.4/100 person-years, 95% CI 7.7–16.2/100 person-years) and 10 incident urogenital infections over 282 person-years (3.5/100 person-years, 95% CI 1.7–6.5/100 person-years). Prevalent or incident MG at any site was more common among HIV-infected participants compared with HIV-uninfected (55.4% vs. 38.8%, P = 0.0016). Conclusion MG was highly prevalent among MSM in this study, including over half of HIV-infected participants. MG should be considered among cases of urethritis that fail to respond to conventional therapies, particularly in populations with a high burden of HIV, STIs, and frequent drug exposures that promote emergence of drug-resistant MG. Disclosures J. Malia, Hologic: Research Contractor, Research support. S. Peel, Hologic: Research Contractor, Research support. C. Gaydos, BioFire: consultant, consulting fee; Cepheid: Speaker’s Bureau, speaker honorarium; Becton Dickinson: Speaker’s Bureau, Speaker honorarium.

1496. Anorectal Mycoplasma genitalium Is Common Among Nigerian MSM and Associated with HIV