Prevalence of Antimicrobial Resistant Mycoplasma genitalium among Men Who Have Sex with Men: a Systematic Review and Meta-analysis

Background: Mycoplasma genitalium (MG) is an emerging sexually transmitted pathogen with increasing antimicrobial resistance, and is now a common cause of non-gonococcal urethritis (NGU). Men who have sex with men (MSM) are at increased risk of sexually transmitted infections, including MG. This systematic review aims to summarize the evidence on the prevalence of antimicrobial-resistant MG among MSM. Methods: We searched PubMed, Embase, and Scopus from database inception to January 31, 2026 for studies that reported the prevalence of macrolide, fluoroquinolone, or tetracycline-resistant MG among MSM, included studies according to pre-determined eligibility criteria, and conducted a random effects meta-analysis to summarize findings and assess for trends over time and differences across geographic regions. Study quality was assessed using a 10-item critical appraisal tool developed by the Joanna Briggs Institute specifically for prevalence studies. Results: Fifty-one studies (N = 5,247) were included that conducted MG resistance testing, with sample sizes ranging from 7 to 1557 (median 56). The pooled prevalence of macrolide resistance was 75.7% (95% CI 69.5%-81.5%) and that of fluoroquinolone resistance was 23.5% (95% CI 17.8%-29.7%). Studies were highly heterogeneous ( I 2 = 94.5% for macrolide resistance and 89.1% for fluoroquinolone resistance). Most studies were of low to moderate quality per the assessment tool. Conclusions: This systematic review revealed a high prevalence of macrolide resistant MG among MSM, and a lower, but significant prevalence of fluoroquinolone resistance. Larger, more rigorous studies that focus exclusively on MSM are needed to better estimate the global burden of antimicrobial resistant MG among MSM.