(196) Sex-Specific Pathogen Signatures Revealed by Multiplex Genital Pcr: Classical Sti Dominance in Males Versus Microbiome Predominance in Females

Introduction Genital infections represent a major component of sexual health, with multiplex polymerase chain reaction (PCR) panels increasingly used for rapid and simultaneous detection of sexually transmitted and microbiome-associated pathogens. However, despite identical diagnostic techniques, sex-based differences in infection profiles remain insufficiently characterized. Understanding such sex-linked patterns may improve diagnostic interpretation, therapeutic decision-making, and partner management in clinical sexual medicine practice. Objective To compare pathogen distribution, prevalence rates, and co-infection profiles between male and female patients undergoing comprehensive genital multiplex PCR testing. Methods A retrospective analysis was conducted on 896 consecutive patients who underwent genital multiplex PCR testing over a 5-month period. Each sample was tested for seven pathogens: Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhoeae (NG), Ureaplasma urealyticum/parvum (UU), Gardnerella vaginalis (GV), Trichomonas vaginalis (TV), and herpes simplex virus types 1 and 2 (HSV-1/2). Demographic data including age and sex were recorded. Chi-square tests were used to compare positivity rates between sexes, with p<0.05 considered statistically significant. Results The cohort comprised 792 males and 104 females (mean age 35.3±9.3 years). Overall pathogen detection rate was 52.5%, with significant sex-based differences observed. Males demonstrated significantly higher prevalence of classical sexually transmitted infection (STI) pathogens: CT (16.3% vs 1.9%, p<0.001), MG (10.6% vs 1.9%, p<0.01), and NG (3.5% vs 1.0%, p>0.05). Conversely, females exhibited markedly elevated rates of microbiome-associated organisms: GV (76.2% vs 37.1%, p<0.001) and UU (64.3% vs 35.6%, p<0.001). Co-infections were identified in 22.8% of all patients, with significantly higher rates in females (47.1%) compared to males (19.6%). The most prevalent co-infection pair was GV+UU, accounting for 73.0% of all dual infections. Cluster analysis revealed two distinct infection profiles: an STI-predominant pattern in males (classical STI:commensal ratio 1.3:1) versus a microbiome-predominant pattern in females (ratio 1:13.1). Conclusions Multiplex PCR testing reveals profound sex-specific infection signatures in symptomatic patients. Males predominantly harbor classical bacterial STI pathogens, while females demonstrate overwhelming prevalence of polymicrobial, microbiome-associated organisms. These mirror-image infection patterns have important implications for diagnostic interpretation, as high detection rates of Ureaplasma and Gardnerella in females may represent colonization rather than pathogenic infection. Recognition of these sex-linked signatures may refine clinical decision-making, optimize antimicrobial stewardship, and improve partner-synchronized management strategies in sexual medicine practice. Disclosure No