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Background   Mycoplasma genitalium  is a sexually transmitted infection (STI), and a common cause of non-gonococcal urethritis (NGU). There is concern regarding the rise in prevalence of  M .  genitalium  and rates of resistance to macrolide antibiotics. International backpackers represent a unique population that may be at an increased risk of STIs. The purpose of this study was to determine the prevalence of  M .  genitalium  and antibiotic resistance in international backpackers.    Methods  First void urine samples were obtained utilising opportunistic sampling from 294 non-treatment-seeking international backpackers at a variety of hostels in Cairns, Queensland Australia. Participants also answered a fixed-answer survey regarding sociodemographic characteristics and sexual risk behaviours. Samples were tested for  M .  genitalium ,  Chlamydia trachomatis  and  Neisseria gonorrhoeae  using polymerase chain reaction (PCR). Samples positive for  M .  genitalium  were investigated for macrolide resistance-associated mutations in the 23S rRNA genome at positions A2058G, A2058C, A2058T, A2059G and A2059C ( Escherichia coli  numbering).    Results  Of the 294 samples, 23 failed the internal control. The prevalence of  M .  genitalium  was 1.8% (5/271, 95% confidence interval [CI] ± 1.58),  C .  trachomatis  was 4.1% (11/271, 95% CI ± 2.36) and  N .  gonorrhoeae  was not detected. Macrolide resistance-associated mutations were identified in 40% (2/5) of  M .  genitalium -positive samples.  M .  genitalium  infection was associated with reporting symptoms (odds ratio [OR] 14.36, 95% CI 2.17–94.94, p < 0.05).    Conclusions   M .  genitalium  and  C .  trachomatis  are relatively common amongst non-treatment seeking international backpackers, but may not differ from Australian population prevalence. This article provides evidence to further support the increased utilisation of  M .  genitalium  PCR in the diagnosis of NGU, and for macrolide resistance testing for all identified  M .  genitalium  infections.

Mycoplasma genitalium in the Far North Queensland backpacker population: An observational study of prevalence and azithromycin resistance