Investigation of Mycoplasma and Ureaplasma Species Using Molecular Method in Male Patients Suffering from Urethritis Symptoms

Investigation of Mycoplasma and Ureaplasma Species Using Molecular Method in Male Patients Suffering from Urethritis Symptoms | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigation of Mycoplasma and Ureaplasma Species Using Molecular Method in Male Patients Suffering from Urethritis Symptoms Tuncer Karpuz, Murat Şambel, Özlem Koyuncu Özyurt, Ahmet Ender Caylan, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5915186/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 May, 2025 Read the published version in BMC Urology → Version 1 posted 8 You are reading this latest preprint version Abstract Background: This study aimed to determine the frequency of Mycoplasma hominis , Mycoplasma genitalium , Ureaplasma urealyticum and Ureaplasma parvum in male patients suffering from urethritis symptoms. Methods: First-void urine and genital discharge samples were collected from 94 men. Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum and Ureaplasma parvum were investigated using a multiplex Polymerase Chain Reaction (PCR) method (BioGX Mycoplasma-Ureaplasma-OSR commercial multiplex PCR kit (BioGX, Netherlands)). Trichomonas vaginalis and Neisseria gonorrhoeae were investigated using microscopy and culture methods. In Mycoplasma genitalium positive samples, macrolide resistance was studied using the Macrolide-R/MG ELITe MGB Kit (ELITechGroup S.p.A., Italy) on the ELITe BeGenius® system Results: A total of 55 microorganisms were detected in 41.5% of the patients(n:39), [18 Ureaplasma urealyticum (33%), 14 Ureaplasma parvum (25%), 9 Neisseria gonorrhoeae (16%) , 8 Mycoplasma hominis (15%) and 6 Mycoplasma genitalium (11%) ] . Mycoplasma genitalium and Neisseria gonorrhoeae positivity was statistically higher in patients with more than three partners in the last 12 months, and patients with genital discharge had higher Ureaplasma urealyticum and Neisseria gonorrhoeae positivity (p<0.05). Additionally, a significant relationship was found between Neisseria gonorrhoeae positivity and genital itching and pain/discomfort during sexual intercourse symptoms (p<0.05). Macrolide resistance was detected in two of the six Mycoplasma genitalium positive samples (33.3%). Conclusions: The results of this study revealed that 41.5% of male patients suffering from urethritis symptoms had at least one from Ureaplasma urealyticum , Ureaplasma parvum , Neisseria gonorrhoeae , Mycoplasma hominis or Mycoplasma genitalium , respectively. The number of sexual partners is important in sexually transmitted diseases. Urethritis Mycoplasma genitalium Neisseria gonorrhoeae Ureaplasma urealyticum Polymerase Chain Reaction Introduction Sexually transmitted infections (STIs) spread predominantly through sexual contact, including vaginal, anal, and oral sex. The common symptoms of STIs include vaginal discharge, urethral discharge, dysuria, genital ulcers, and abdominal pain. The STIs can proceed asymptomatically. More than 30 different bacteria, viruses, and parasites are transmitted via sexual contact. Eight of these pathogens showed the highest incidence of sexually transmitted diseases. Four of these (syphilis, gonorrhea, chlamydia, and trichomoniasis) are treatable STIs [ 1 ]. Urethritis is inflammation of the urethra. Urethritis often develops due to infectious pathogens but rarely develops due to local irritation. The characteristic findings of urethritis include urethral discharge, dysuria, itching, and burning in the anterior urethra [ 2 ]. However, not every man with urethritis presents symptoms. Approximately 10% of cases of gonococcal urethritis and up to 42% of men with nongonococcal urethritis (NGU) are asymptomatic [ 3 ]. Infectious urethritis is typically caused by a sexually transmitted pathogen; therefore, most cases are in young, sexually active men [ 4 ]. The most commonly detected microorganisms in male patients with urethritis are Chlamydia trachomatis (C. trachomatis) , Neisseria gonorrhoeae (N. gonorrhoeae) , Mycoplasma spp. and Ureaplasma spp [ 5 ]. The most common cause of NGU is C. trachomatis , followed by Mycoplasma genitalium (M. genitalium) [ 4 ]. M. hominis , Ureaplasma urealyticum (U. urealyticum) and U. parvum are frequently found in the urogenital system of both healthy individuals and symptomatic patients [ 6 ]. It is debated whether Mycoplasma hominis ( M. hominis) and Ureaplasma parvum (U. parvum) are the causes of urethritis [ 2 ]. Furthermore, almost half of all NGU cases have no specific etiology [ 4 ]. Microscopy has no diagnostic value for Mycoplasma and Ureaplasma infections. Culture methods can be used for diagnosis. However, their culturing is difficult and requires weeks or months [ 7 , 8 ]. Molecular methods can be used to detect these agents [ 6 ]. Multiplex Polymerase Chain Reaction (PCR) is a highly sensitive and specific method capable of rapidly identifying a wide range of human pathogens. It also allows the use of noninvasive samples, such as first-void urine or self-collected swabs [ 5 ]. The British Association for Sexual Health and HIV (BASHH) recommends the use of nucleic acid amplification tests as the only useful diagnostic method for M. genitalium infection in clinical samples [ 9 ]. Empiric treatment of NGU usually involves doxycycline or azithromycin. It is recommended that M. genitalium be considered in all patients with persistent urethritis despite initial empirical therapy, and if possible, a test to detect resistance should be performed. The prevalence of macrolide resistance in M. genitalium limits the utility of azithromycin-based regimens [ 10 ]. The main aim of this study was to determine the frequency of M. hominis, M. genitalium, U. urealyticum and U. parvum using molecular methods in male patients suffering from urethritis symptoms, and to investigate macrolide resistance in M. genitalium positive samples. Other urethritis agents, such as N. gonorrhoeae and Trichomonas vaginalis (T. vaginalis) were also examined in the samples. Materials and methods The study included 94 male patients who visited the urology outpatient clinics of three different hospitals in the Antalya City Center with symptoms of urethritis, such as genital discharge, itching, burning sensation during urination, pain, and redness of the penis. After obtaining informed consent from patients, their demographic information, socioeconomic status, sexual activity status, number of sexual partners, and symptoms were assessed. First-void urine and urethral swab samples (Copan Diagnostics, ABD) were collected from patients. M. hominis, M. genitalium, U. urealyticum, U. parvum and macrolide resistance in M. genitalium were investigated in first-void urine samples using PCR, and T. vaginalis was investigated using direct microscopy and culture methods. N. gonorrhoeae was investigated using Gram-staining microscopy and culture methods from urethral swab samples. Swab samples were inoculated onto Modified Martin-Lewis agar (Becton Dickinson and Company, Franklin Lakes, NJ) for N. gonorrhoeae and then smeared for microscopic examination. The smear was Gram-stained and examined under a light microscope. Modified Martin-Lewis agar was incubated in an oven at 35–37 0 C in a 5–10% CO 2 environment for 48–72 hours. N. gonorrhoeae was identified from suspicious colonies grown in the medium using Gram-staining and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) (Bruker Daltonik GmbH, Bremen, Germany). The cultured microorganisms were transferred to a designated area on a MALDI-TOF MS metal plate. The plate was then placed into the MALDI-TOF MS device, and mass spectrometry data were obtained using the Flex Analysis software. The urine sample was centrifuged and the sediment was examined under a light microscope with x10 and x40 objectives to investigate T. vaginalis trophozoites. Culture was performed using Diamond TYM medium for T. vaginalis . Diamond TYM medium was prepared in the laboratory. For multiplex PCR, the urine samples were stored at -80 o C until further use. The presence of M. genitalium , M. hominis , U. urealyticum , U. parvum was investigated using the BioGX Mycoplasma-Ureaplasma-OSR commercial multiplex PCR kit (BioGX, Netherlands) running on a BD MAX system (BD Diagnostics, USA). The BioGX Mycoplasma-Ureaplasma-OSR commercial multiplex PCR kit is a multiplex real-time multiplex PCR assay used on the BD MAX™ platform for the qualitative detection of the presence of DNA from M. genitalium (MgPa operon gene), M. hominis (gap gene), U. urealyticum (UUR10_0680 gene), and U. parvum (UP063 gene). The samples were loaded into the device in accordance with the manufacturer's recommendations. At the end of the study, the results were evaluated in accordance with the manufacturer's recommendations. Macrolide resistance was studied using the Macrolide-R/MG ELITe MGB Kit (ELITechGroup S.p.A., Italy) on the ELITe BeGenius® system, in accordance with the manufacturer's recommendations. Macrolide resistance-associated mutations in the 23S rRNA gene were determined for all samples that tested positive for M. genitalium using the Macrolide-R/MG ELITe MGB Kit, which allows for the simultaneous detection and identification of M. genitalium and the seven mutations (A2058G, A2058C, A2058T, A2059G, A2059C, A2062G, and A2062T) responsible for macrolide resistance. Statistical analysis: Statistical analyses were performed using SSPS version 23.0. Patient characteristics and laboratory examination results were analyzed using descriptive statistics. Categorical data are presented as number (n) and percentage (%). Comparisons between groups were performed using the chi-square test or Fisher’s exact test for categorical data and Student’s t-test for numerical data. Statistical significance was set at P < 0.05. Results Of the patients included in the study, 71.0% were single and 53.8% reported having a new sexual partner in the last three months. 37.6% Of the patients reported having a history of previous illnesses such as gonorrhea, genital discharge, or warts, and 33.3% reported having had sex with a sex worker before. 53.8% of the patients reported genital discharge, 47.8% genital itching, 30.0% pain or discomfort during sexual intercourse, and 71.0% pain or discomfort during urination. The demographic data, sexual behavior characteristics, and symptoms of the patients are shown in Table 1 . Table 1 Demographic Data, Sexual Behavior Characteristics, and Symptoms of Patients Characteristics n % Characteristics n % Age Age at first sexual intercourse 18–25 28 30.8 <18 40 43.5 26–34 28 30.8 18–25 46 50.0 35–44 20 22.0 26–34 5 5.4 ≥44 15 16.4 35–44 1 1.1 Education Level Frequency of sexual intercourse Primary School 18 20.5 Daily 3 3.3 High School 28 31.8 3–4 times a week 23 25.6 University 42 47.7 Once a week 31 34.4 Less than once a week 33 36.7 Marital Status Sexual intercourse in the last 6 months 84 90.3 Married 27 29.0 New sexual partner in the last 3 months 50 53.8 Single 66 71.0 Number of sexual partners to date Monthly income level 1–3 28 31.8 Less than minimum wage 1 1.2 4–6 13 14.8 Minimum wage 34 41.5 7–9 3 3.4 Above minimum wage 47 57.3 ≥10 44 50.0 History of HIV or other STIs 12 12.9 Sexual intercourse with a sex worker (+) 31 33.3 Symptoms History of gonorrhea or genital discharge, warts 35 37.6 Genital discharge 50 53.8 Sexual intercourse with someone having similar symptoms 12 13.3 Genital itching 44 47.8 Use of condom during sexual intercourse (+) 38 42.7 Testicular pain 37 39.8 Number of sexual partners in the last 12 months Testicular swelling 12 13.0 0 2 2.2 Pain/discomfort during intercourse 27 30.0 1 31 34.4 Pain/discomfort during urination 66 71.0 2–3 30 33.3 Redness on penis or testicles 23 24.7 4–5 7 7.8 Pain/discomfort in the pelvic area 18 19.4 ≥6 20 22.2 Gram-stained microscopic examination revealed polymorphonuclear leukocytes and Gram-negative diplococci in two patients (2.1%). The growth of N. gonorrhoeae was observed on Modified Martin-Lewis agar in nine patients (9.6%). When the multiplex PCR results of all patients included in the study were evaluated, a total of 46 microorganisms were detected in 37 patients (39.4%). While monoinfection was detected in 28 patients (29.8%) by PCR, mixed infections were detected in nine patients (9.6%). When we examined the mixed infections detected by multiplex PCR, M. hominis + U. urealyticum was detected in three patients (3.2%), M. hominis + U. parvum in two patients (2.1%), and U. parvum and U. urealyticum in four patients (4.3%). The most common mixed infections detected using PCR were U. parvum and U. urealyticum (Table 2 ). Table 2 Methods Applied to Patient Samples and Their Results Methods Number of Patients (n: 94) Microscopy, (n, %) Direct Microscopic Examination (Urine) - Gram-Stained Microscopic Examination (Genital Swab) 2 (2.1%) Culture, (n, %) Trichomonas vaginalis - Neisseria gonorrhoeae 9 (9.6%) Polymerase Chain Reaction ( PCR), (n, %) Mycoplasma hominis 3 (3.2%) Mycoplasma genitalium 6 (6.4%) Ureaplasma urealyticum 11 (11.7%) Ureaplasma parvum 8 (8.5%) Mixed Infections, (n, %) Mycoplasma hominis + Ureaplasma urealyticum 3 (3.2%) Mycoplasma hominis + Ureaplasma parvum 2 (2.1%) Ureaplasma parvum + Ureaplasma urealyticum 4 (4.3%) When PCR and culture were evaluated together, a total of 55 microorganisms were detected in 39 (41.5%) patients. Seven of the nine patients in whom N. gonorrhoeae was detected had at least one accompanying Mycoplasma or Ureaplasma species ( U. urealyticum + U. parvum in two patients, U. urealyticum in three patients, M. genitalium in two patients). The mean age of the patients in whom any microorganism was detected was lower than that of patients without microorganism [30.66 (min-max: 17–72) versus 34.7 (min-max: 17–69) years]. The highest prevalence was the patients with 26–34 ages (41.8%). N. gonorrhoeae and M. hominis were between 18–25 ages, and M. genitalium , U. urealyticum and U. parvum were between 26–34 ages (Table 3 ). Table 3 Microorganisms Detected in Samples and Associated Clinical Factors Microorganism (-) (n, %) Any Microorganism (+) (n, %) M. genitalium (n:6) M. hominis (n:8) U. urealyticum (n:18) U. parvum (n:14) N. gonorrhoeae (n:9) Age 18–25 26–34 35–44 >44 15 (28.3) 12 (22.6) 15 (28.3) 11 (20.8) 2 (33.3) 4 (66.6) - - 3 (37.5) 2(25.0) 1 (12.5) 2 (25.0) 6 (33.3) 7 (38.9) 2 (11.1) 3 (16.7) 3 (21.4) 7 (50.0) 3 (21.4) 1 (7.1) 4 (44.4) 3 (33.3) 2(22.2) - Age at first sexual intercourse ≤25 Years >25 Years 51 (94,4) 3 (5,6) 6 (100) - 8 (100) - 17 (100) - 11 (78,6) 3 (21,4) 8 (100) Frequency of sexual intercourse Daily 3–4 times week Once a week Less than once a week 3 (5,6) 16 (29,6) 16 (29,6) 19 (35,2) - 2 (33,3) 3 (50) 1 (16,7) - 2 (28,6) 3 (42,8) 2 (28,6) - 3 (17,6) 6 (35,3) 8 (47,1) - - 7 (58,3) 5 (41,7) - 3 (37,5) 5 (62,5) - Number of partners in the last 12 months. ≤3 >3 42 (79,2) 11 (20,8) 2 (33,3) 4 (66,7)* 6 (75) 2 (25) 10 (58,8) 7 (41,2) 7 (53,9) 6 (46,1) 3 (37,5) 5 (62,5)* Sexual intercourse in the last 6 months 47 (87,1) 6 (100) 8 (100) 16 (88,9) 14 (100) 8 (88,9) A new sexual partner in the last 3 months 23 (42,6) 5 (83,3) 6 (75) 12 (66,7) 10 (71,4) 7 (77,9) History of previously diagnosed HIV or other STD 7 (13) 1 (16,7) - 3 (16,7) 1 (7,1) 1 (11,1) A history of previous illnesses such as gonorrhea or genital discharge or warts 21 (38,9) 1 (16,7) 2 (25) 7 (38,9) 6 (42,9) 5 (55,6) Sexual intercourse with someone who has the above complaints 7 (13,5) - 2 (28,6) 2 (11,1) 1 (7,1) 1 (11,1) Sexual intercourse with a sex worker 17 (31,5) 1 (16,7) 4 (50) 7 (38,9) 5 (35,7) 2 (22,2) Use of condoms during sexual intercourse 22 (41,5) 2 (33,3) 2 (28,6) 9 (56,3) 5 (38,5) 1 (12,5) Genital discharge 23 (42,6) 5 (83,3) 4 (50) 13 (72,2)* 7 (50) 9 (100)* Genital itching 23 (42,6) 3 (50) 5 (71,4) 9 (53) 8 (57,1) 8 (88,9)* Pain and discomfort during sexual intercourse 12 (23,1) 2 (33,3) 2 (25) 8 (47,1) 6 (42,9) 5 (62,5)* Pain and discomfort during urinating 36 (66,7) 3 (50) 6 (75) 14 (77,8) 13 (92,9) 8 (88,9) Pain and discomfort in your hip area 12 (22,2) 1 (16,7) 1 (12,5) 3 (16,7) 2 (14,2) 2 (22,2) Testicular pain 23 (42,6) 2 (33,3) 3 (37,5) 8 (44,4) 4 (28,5) 4 (44,4) Swelling in the testicles 6 (11,3) 2 (33,3) 1 (12,5) 2 (11,1) 1 (7,1) 2 (22,2) Redness on penis/testicles 13 (24,1) 1 (16,7) 2 (25) 7 (38,9) 4 (28,5) 4 (44,4) *p < 0.05 There was a statistically significant relationship between the number of partners greater than three in the last 12 months and M. genitalium and N. gonorrhoeae positivity (p < 0.05). Patients with genital discharge had higher U. urealyticum and N. gonorrhoeae positivity (p < 0.05). In addition, a significant relationship was found between N. gonorrhoeae positivity and genital itching and pain during sexual intercourse (P < 0.05) (Table 3 ). Macrolide resistance was detected in two of the six M. genitalium positive samples (33.3%). Discussion Molecular methods are better than culture in terms of sensitivity and specificity for the diagnosis of Mycoplasma and Ureaplasma . In particular, real-time PCR is the preferred PCR method for the detection of Mycoplasma and Ureaplasma [ 11 ]. The sensitivities of nucleic acid amplification tests for M. genitalium , M. hominis , U. urealyticum and U. parvum were reported to be 98–100% and specificities were reported to be 97–100% [ 5 ]. In one study, culture and PCR were compared for the detection of Ureaplasma spp., M. hominis and M. genitalium and it was concluded that PCR increased the test sensitivity by 24% compared to culture, which had a sensitivity of 70% [ 11 ]. In our study, the real-time PCR method, which is the method recommended in previous studies, was used to investigate Mycoplasma and Ureaplasma species. In studies conducted using the PCR method in men with urethritis, the frequency of M. genitalium was found to be 12% and 10.5% [ 2 , 12 ]. In another study, the frequency of M. genitalium infection in symptomatic men was found to be 12%, and symptomatic individuals were found to be more likely to have M. genitalium infection than asymptomatic individuals [ 13 ]. In a study conducted on 155 male patients with NGU, the second most common pathogen after C. trachomatis was determined to be M. genitalium (23%) [ 14 ]. The overall prevalence of M. genitalium was found to be 10.5% in a study conducted on men who have sex with men [ 15 ]. In a study conducted in Southern Ghana using two different kits, the total M. genitalium infection rates was determined as 3.1% and 3.4%, respectively [ 16 ]. In our study whose symptomatic men were included, the frequency of M. genitalium was found to be 6.4%. The different results among the studies may be due to various factors such as the patient group selected, the method used in the study, and the risky sexual behaviors of the patients. Routine testing of patients with or without urethritis symptoms for M. hominis , U. urealyticum , and U. parvum is not recommended. U. urealyticum might be associated with urethritis in men if a high load is present [ 6 ]. M. hominis displayed significant effects on sperm motility, morphology, and number of leukocytes [ 17 ]. It has been found that M. hominis can cause infertility in men even if asymptomatic, and infertility can be improved with antibiotic treatment [ 18 ]. In the literature, the frequency of U. urealyticum is given in a wide range from approximately 5–35% [ 12 , 18 , 20 ]. In studies conducted on men with urethritis using the PCR method, the frequency of U. urealyticum was determined as 4.8% in the study by Khatib et al. [ 12 ] and 14.2% in the study by Sarıer [ 20 ]. In our study, multiplex PCR method was used in male patients suffering from urethritis symptoms, and the frequency of U. urealyticum was found to be 19.1%, which is consistent with the literature. In a study where U. parvum was quantified, the bacterial load was similar in the NGU and control groups [ 21 ]. Conversely, studies have suggested that it may cause NGU, especially when found in large numbers [22, 23]. In our study, similar to the literature, the frequencies of M. hominis and U. parvum were determined as 8.5% and 14.9%, respectively. However, no quantitative evaluation was performed in this study. We are not sure whether these agents are causative agents, although all patients included in our study suffered from symptoms of urethritis. Considering the similar transmission patterns of STI agents, coinfection is a common and expected situation, and has been detected in many studies [ 24 , 25 ]. In a study conducted on NGU patients, a mixed infection rate of 10.2% was detected. U. urealyticum was detected in 79% of the cases, and the most common association was with M. genitalium (43% of the cases (n = 6/14)) [ 14 ]. In our study, mixed infections were detected in a total of 14 (14.9%) patients; the two most common bacteria were U. urealyticum and U. parvum , and three microorganisms ( U. urealyticum , U. parvum and N. gonorrhoeae ) were detected simultaneously in two (2.1%) patients. Genital discharge is one of the most common symptoms of urethritis and can occur with the use of many STI agents. Manhart et al. [ 13 ] reported in their study of symptomatic men that the most common symptom was urethral discharge (20.4%). In a study conducted by Rietmeijer et al. [ 26 ], a statistically significant relationship was found between the presence of purulent and thick discharges in male patients with genital discharge and the detection of N. gonorrhoeae . In our study, a statistically significant relationship was found between the presence of genital discharge and the detection of N. gonorrhoeae and U. urealyticum (p < 0.05). The main risk factors for STIs include age between 20 and 35 years, having multiple partners, and a history of STIs [27, 28 ]. de Souza et al. [ 28 ] found that STI agents were most common in the 20–29 age group, and Manhart et al. [ 13 ] found that M. genitalium was most common in the 15–24 age group. When the individuals in our study who were found to have any microorganism were evaluated, the age group with the highest prevalence was determined to be the 26–34 age group. We think that these differences in age groups may be due to various reasons, such as the time of initiation of sexual activity, sociocultural features, and sexual behavior characteristics of individuals in different populations. Risky sexual behaviors, especially increasing the number of sexual partners, are known to increase the risk of STIs. A study of young adults found a strong association between an increasing number of sexual partners and M. genitalium infection [ 29 ]. In studies investigating M. genitalium prevalence and risky behaviors, a relationship was observed between the total number of partners and the increase in the number of new sexual partners and M. genitalium positivity [ 21 , 30 ]. In a study conducted by Ona et al. [ 31 ], it was found that the probability of Mycoplasma detection was related to the increasing number of sexual partners, and that this risk increased significantly in those with two or more partners. In our study, a statistically significant relationship was found between having three or more partners in the previous year and M. genitalium and N. gonorrhoeae positivity (p < 0.05). Macrolides are used in the first-line treatment of M. genitalium infections and, if possible, it is recommended to detect mutations associated with macrolide resistance in M. genitalium positive samples [ 32 ]. In a study conducted on 170 patients with M. genitalium DNA positivity, macrolide resistance mutations were identified in 48.8% of the samples, and it is reported that the most common mutations were A2059C (18.2%) and A2059G (15.3%) [ 33 ]. The prevalence of mutations associated with macrolide resistance was found as 67.9% in a study from Sweden including male sex individuals [ 15 ]. In A study investigating the prevalence and macrolide resistance of Mycoplasma genitalium in Southern Vietnam showed that the frequency of M. genitalium in samples was 5.95% and macrolide resistance in their was 61.11% [ 34 ]. A study evaluating the performance of three commercial molecular diagnostic tests in detecting M. genitalium and macrolide resistance reported that the sensitivity of the Macrolide-R/MG ELITe MGB kit (ELITechGroup) was significantly higher than that of the others in detecting macrolide resistance [ 35 ]. In our study, macrolide resistance was investigated using the Macrolide-R/MG ELITe MGB kit and was detected in two of the six M. genitalium positive samples (33.3%). This rate may be misleading due to the small number of M. genitalium positive samples, and it would be appropriate to evaluate it with more samples. The most important limitation of our study is that C. trachomatis was not investigated. In some cases, where no microorganisms were detected, the cause of urethritis may be C. trachomatis . The other limitations of the study are that the agents N. gonorrhoeae and T. vaginalis were investigated by microscopy and culture methods, none of any molecular methods. Conclusion In summary, at least one from U. urealyticum, U. parvum, N. gonorrhoeae, M. hominis and M. genitalium was detected in 41.5% of male patients suffering from urethritis symptoms in this study. The frequency of causative pathogens of STIs and patient profiles can be changed for various reasons, such as the time of initiation of sexual activity, sociocultural features, and sexual behavior characteristics of individuals and populations. Abbreviations STIs Sexually transmitted infections NGU Nongonococcal urethritis C. trachomatis Chlamydia trachomatis N. gonorrhoeae Neisseria gonorrhoeae M. genitalium Mycoplasma genitalium U. urealyticum Ureaplasma urealyticum M. hominis Mycoplasma hominis U. parvum Ureaplasma parvum PCR Polymerase Chain Reaction BASHH The British Association for Sexual Health and HIV T. vaginalis Trichomonas vaginalis Declarations Acknowledgements None Author contributions All the authors contributed to the study. The first draft of the manuscript was written by T.K. and H.Y. All authors have read and approved the final manuscript. Funding This study was supported by the Scientific Research Projects Coordination Unit of Akdeniz University (project number TTU-2022-5973). Data availability Yes, the datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the Faculty of Medicine of Akdeniz on 10.11.2021, with (decision number KAEK-798). Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 Akdeniz University Medical Faculty, Department of Medical Microbiology, Antalya, Turkey 2 Healthy Sciences University, Medical Faculty, Department of Urology, Antalya, Turkey 3 Akdeniz University Medical Faculty, Department of Urology, Antalya, Turkey 4 Antalya City Hospital, Department of Urology, Antalya, Turkey References World Health Organization (WHO). Available from: https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis) Accessed 27 Feb 2024. Sarier M, Kukul E. Classification of non-gonococcal urethritis: a review. Int Urol Nephrol. 2019;51(6):901-907. 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Prevalence of Trichomonas vaginalis, Mycoplasma genitalium and Ureaplasma urealyticum in men with urethritis attending an urban sexual health clinic. Int J STD AIDS. 2015;26(6):388-92. Manhart LE, Gaydos CA, Taylor SN, Lillis RA, Hook EW 3rd, Klausner JD, et al. Characteristics of Mycoplasma genitalium Urogenital Infections in a Diverse Patient Sample from the United States: Results from the Aptima Mycoplasma genitalium Evaluation Study (AMES). J Clin Microbiol. 2020;58(7):e00165-20. Jordan SJ, Toh E, Williams JA, Fortenberry L, LaPradd ML, Katz BP, et al. Aetiology and prevalence of mixed-infections and mono-infections in non-gonococcal urethritis in men: a case-control study. Sex Transm Infect. 2020;96(4):306-311. Bjartling C, Kertes R, Kristiansen S, Johnsson A, Forslund O. Prevalence of Mycoplasma genitalium and macrolide resistance in rectal and urine samples among men who have sex with men in Sweden. Sex Transm Infect. 2024;100(7):430-434. Dela H, Behene E, Ocansey K, Yanney JN, Kwasi Addo K, Miranda HV, et al. Prevalence and macrolide resistance of Mycoplasma genitalium from patients seeking sexual health care in Southern Ghana. BMC Infect Dis. 2024;24(1):981. Dehghan A, Pourmand MR, Salimi V, Asbagh FA, Foroushani AR, Sadeghi K, et al. The effects of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum loads on semen quality: Detection and quantitative analysis. Microb Pathog. 2022;169:105676. doi: 10.1016/j.micpath.2022.105676 Ahmadi MH, Mirsalehian A, Sadighi Gilani MA, Bahador A, Talebi M. Asymptomatic Infection With Mycoplasma hominis Negatively Affects Semen Parameters and Leads to Male Infertility as Confirmed by Improved Semen Parameters After Antibiotic Treatment. Urology. 2017;100:97-102. doi: 10.1016/j.urology.2016.11.018 Sun Z, Meng J, Wang S, Yang F, Liu T, Zeng X, et al. A New Multiplex Genetic Detection Assay Method for the Rapid Semi-Quantitative Detection of Six Common Curable Sexually Transmitted Pathogens From the Genital Tract. Front Cell Infect Microbiol. 2021;11:704037. Sarıer M. Prevalence of Polymicrobial Infection in Urethritis. J Urol Surg. 2019;6(3):180-183. Frølund M, Lidbrink P, Wikström A, Cowan S, Ahrens P, Jensen JS. Urethritis-associated Pathogens in Urine from Men with Non-gonococcal Urethritis: A Case-control Study. Acta Derm Venereol. 2016;96(5):689-94. Cox C, McKenna JP, Watt AP, Coyle PV. Ureaplasma parvum and Mycoplasma genitalium are found to be significantly associated with microscopy-confirmed urethritis in a routine genitourinary medicine setting. Int J STD AIDS. 2016;27:861. Deguchi T, Shimada Y, Horie K, Mizutani K, Seike K, Tsuchiya T, et al. Bacterial loads of Ureaplasma parvum contribute to the development of inflammatory responses in the male urethra. Int J STD AIDS. 2015;26(14):1035-9. Lee TF, Lin KY, Chang SY, Huang YT, Hsueh PR. Performance of two commercial multiplex polymerase chain reaction assays for the etiological diagnosis of sexually transmitted infections among men who have sex with men. J Microbiol Immunol Infect. 2023;56(1):104-110. Hamill MM, Onzia A, Wang TH, Kiragga AN, Hsieh YH, Parkes-Ratanshi R, et al. High burden of untreated syphilis, drug resistant Neisseria gonorrhoeae, and other sexually transmitted infections in men with urethral discharge syndrome in Kampala, Uganda. BMC Infect Dis. 2022;22(1):440. Rietmeijer CA, Mungati M, Machiha A, Mugurungi O, Kupara V, Rodgers L, et al. The Etiology of Male Urethral Discharge in Zimbabwe: Results from the Zimbabwe STI Etiology Study. Sex Transm Dis. 2018;45(1):56-60. Tao X, Ghanem KG, Page KR, Gilliams E, Tuddenham S. Risk factors predictive of sexually transmitted infection diagnosis in young compared to older patients attending sexually transmitted diseases clinics. Int J STD AIDS. 2020;31(2):142-149. de Souza LS, Sardinha JC, Talhari S, Heibel M, Santos MND, Talhari C. Main etiological agents identified in 170 men with urethritis attended at the Fundação Alfredo da Matta, Manaus, Amazonas, Brazil. An Bras Dermatol. 2021;96(2):176-183. Horner PJ, Martin DH. Mycoplasma genitalium Infection in Men. J Infect Dis 2017;216 Suppl 2: S396-S405. Sonnenberg P, Ison CA, Clifton S, Field N, Tanton C, Soldan K, et al. Epidemiology of Mycoplasma genitalium in British men and women aged 16–44 years: evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Int J Epidemiol. 2015;44(6):1982-94. Ona S, Molina RL, Diouf K. Mycoplasma genitalium: An Overlooked Sexually Transmitted Pathogen in Women?. Infect Dis Obstet Gynecol. 2016;2016:4513089. Jensen JS, Cusini M, Gomberg M, Moi H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2016. 30:1650–1656. Azrad M, Saleh N, Zur IY, Becker D, Shiloah N, Habib S, et al. Mycoplasma genitalium's Antibiotic Resistance in Sexually Transmitted Infections Clinics in Israel. J Low Genit Tract Dis. 2024; doi: 10.1097/LGT.0000000000000828. Lam PPH, Nguyen NH, Nguyen TTT, Trinh NB, Luong BA. Mycoplasma genitalium prevalence, co-infection and macrolide resistance-associated mutations in Southern Vietnam. Infez Med. 2024;32(2):222-230. Le Roy C, Bébéar C, Pereyre S. Performance of Three Commercial Molecular Diagnostic Assays for the Simultaneous Detection of Mycoplasma genitalium and Macrolide Resistance. J Clin Microbiol. 2021;59(6):e00020-21. Additional Declarations No competing interests reported. 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University","correspondingAuthor":false,"prefix":"","firstName":"Murat","middleName":"","lastName":"Şambel","suffix":""},{"id":434986879,"identity":"d34098a1-373a-4ad8-9737-96dd26c540d3","order_by":2,"name":"Özlem Koyuncu Özyurt","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Özlem","middleName":"Koyuncu","lastName":"Özyurt","suffix":""},{"id":434986880,"identity":"29d5499d-be6a-499c-9770-8aa49abb441e","order_by":3,"name":"Ahmet Ender Caylan","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Ahmet","middleName":"Ender","lastName":"Caylan","suffix":""},{"id":434986881,"identity":"6c8fb746-b9a4-4c85-bb9f-f4676574c329","order_by":4,"name":"Ömer Kutlu","email":"","orcid":"","institution":"Akdeniz 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Yazısız","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIie3PsWoCQRCA4TlOxmY821k0+goXDkTw4F5lbba0sQ9WW0XyKqkk5cGh1WqtBAI2VglYiYEL5LaLgTWXzmL/YpjmY3cAfL5bLCc7GRDCHILZ/wjKH0T+SWwU1yPR63rF53KYRW1z4s+XtAfNYvkcnN+cRGwmSjwSjzWsF2JuVAKk1Bbk1EliQwMmZonBfMEtXYxnTIOKuH9miShjzjCkg/iqSzokOdBI2Kn1ijCUjLp5dQthMrrTKkF7i1RuEhm6372XD1n/qdjvPnTaazeL1faYuklVgy8WtOMqAAiPvxefz+fzXfQNvCtMBnZGyCwAAAAASUVORK5CYII=","orcid":"","institution":"Akdeniz University","correspondingAuthor":true,"prefix":"","firstName":"Hatice","middleName":"","lastName":"Yazısız","suffix":""}],"badges":[],"createdAt":"2025-01-27 22:23:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5915186/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5915186/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12894-025-01804-9","type":"published","date":"2025-05-19T15:57:04+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83460760,"identity":"f63623bd-2088-4bb2-809d-a565fa0b2922","added_by":"auto","created_at":"2025-05-26 16:13:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1297392,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5915186/v1/0b5b3012-91e8-46a6-b10f-26de0d5a2bc6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigation of Mycoplasma and Ureaplasma Species Using Molecular Method in Male Patients Suffering from Urethritis Symptoms","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSexually transmitted infections (STIs) spread predominantly through sexual contact, including vaginal, anal, and oral sex. The common symptoms of STIs include vaginal discharge, urethral discharge, dysuria, genital ulcers, and abdominal pain. The STIs can proceed asymptomatically. More than 30 different bacteria, viruses, and parasites are transmitted via sexual contact. Eight of these pathogens showed the highest incidence of sexually transmitted diseases. Four of these (syphilis, gonorrhea, chlamydia, and trichomoniasis) are treatable STIs [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUrethritis is inflammation of the urethra. Urethritis often develops due to infectious pathogens but rarely develops due to local irritation. The characteristic findings of urethritis include urethral discharge, dysuria, itching, and burning in the anterior urethra [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, not every man with urethritis presents symptoms. Approximately 10% of cases of gonococcal urethritis and up to 42% of men with nongonococcal urethritis (NGU) are asymptomatic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInfectious urethritis is typically caused by a sexually transmitted pathogen; therefore, most cases are in young, sexually active men [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The most commonly detected microorganisms in male patients with urethritis are \u003cem\u003eChlamydia trachomatis (C. trachomatis)\u003c/em\u003e, \u003cem\u003eNeisseria gonorrhoeae (N. gonorrhoeae)\u003c/em\u003e, \u003cem\u003eMycoplasma\u003c/em\u003e spp. and \u003cem\u003eUreaplasma\u003c/em\u003e spp [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The most common cause of NGU is \u003cem\u003eC. trachomatis\u003c/em\u003e, followed by \u003cem\u003eMycoplasma genitalium (M. genitalium)\u003c/em\u003e [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. \u003cem\u003eM. hominis\u003c/em\u003e, \u003cem\u003eUreaplasma urealyticum (U. urealyticum)\u003c/em\u003e and \u003cem\u003eU. parvum\u003c/em\u003e are frequently found in the urogenital system of both healthy individuals and symptomatic patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It is debated whether \u003cem\u003eMycoplasma hominis\u003c/em\u003e (\u003cem\u003eM. hominis)\u003c/em\u003e and \u003cem\u003eUreaplasma parvum (U. parvum)\u003c/em\u003e are the causes of urethritis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Furthermore, almost half of all NGU cases have no specific etiology [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMicroscopy has no diagnostic value for \u003cem\u003eMycoplasma\u003c/em\u003e and \u003cem\u003eUreaplasma\u003c/em\u003e infections. Culture methods can be used for diagnosis. However, their culturing is difficult and requires weeks or months [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Molecular methods can be used to detect these agents [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Multiplex Polymerase Chain Reaction (PCR) is a highly sensitive and specific method capable of rapidly identifying a wide range of human pathogens. It also allows the use of noninvasive samples, such as first-void urine or self-collected swabs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The British Association for Sexual Health and HIV (BASHH) recommends the use of nucleic acid amplification tests as the only useful diagnostic method for \u003cem\u003eM. genitalium\u003c/em\u003e infection in clinical samples [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEmpiric treatment of NGU usually involves doxycycline or azithromycin. It is recommended that \u003cem\u003eM. genitalium\u003c/em\u003e be considered in all patients with persistent urethritis despite initial empirical therapy, and if possible, a test to detect resistance should be performed. The prevalence of macrolide resistance in \u003cem\u003eM. genitalium\u003c/em\u003e limits the utility of azithromycin-based regimens [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe main aim of this study was to determine the frequency of \u003cem\u003eM. hominis, M. genitalium, U. urealyticum\u003c/em\u003e and \u003cem\u003eU. parvum\u003c/em\u003e using molecular methods in male patients suffering from urethritis symptoms, and to investigate macrolide resistance in \u003cem\u003eM. genitalium\u003c/em\u003e positive samples. Other urethritis agents, such as \u003cem\u003eN. gonorrhoeae\u003c/em\u003e and \u003cem\u003eTrichomonas vaginalis (T. vaginalis)\u003c/em\u003e were also examined in the samples.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThe study included 94 male patients who visited the urology outpatient clinics of three different hospitals in the Antalya City Center with symptoms of urethritis, such as genital discharge, itching, burning sensation during urination, pain, and redness of the penis. After obtaining informed consent from patients, their demographic information, socioeconomic status, sexual activity status, number of sexual partners, and symptoms were assessed. First-void urine and urethral swab samples (Copan Diagnostics, ABD) were collected from patients.\u003c/p\u003e \u003cp\u003e \u003cem\u003eM. hominis, M. genitalium, U. urealyticum, U. parvum\u003c/em\u003e and macrolide resistance in M. genitalium were investigated in first-void urine samples using PCR, and \u003cem\u003eT. vaginalis\u003c/em\u003e was investigated using direct microscopy and culture methods. \u003cem\u003eN. gonorrhoeae\u003c/em\u003e was investigated using Gram-staining microscopy and culture methods from urethral swab samples.\u003c/p\u003e \u003cp\u003eSwab samples were inoculated onto Modified Martin-Lewis agar (Becton Dickinson and Company, Franklin Lakes, NJ) for \u003cem\u003eN. gonorrhoeae\u003c/em\u003e and then smeared for microscopic examination. The smear was Gram-stained and examined under a light microscope. Modified Martin-Lewis agar was incubated in an oven at 35\u0026ndash;37 \u003csup\u003e0\u003c/sup\u003eC in a 5\u0026ndash;10% CO\u003csub\u003e2\u003c/sub\u003e environment for 48\u0026ndash;72 hours. \u003cem\u003eN. gonorrhoeae\u003c/em\u003e was identified from suspicious colonies grown in the medium using Gram-staining and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) (Bruker Daltonik GmbH, Bremen, Germany). The cultured microorganisms were transferred to a designated area on a MALDI-TOF MS metal plate. The plate was then placed into the MALDI-TOF MS device, and mass spectrometry data were obtained using the Flex Analysis software.\u003c/p\u003e \u003cp\u003eThe urine sample was centrifuged and the sediment was examined under a light microscope with x10 and x40 objectives to investigate \u003cem\u003eT. vaginalis\u003c/em\u003e trophozoites. Culture was performed using Diamond TYM medium for \u003cem\u003eT. vaginalis\u003c/em\u003e. Diamond TYM medium was prepared in the laboratory.\u003c/p\u003e \u003cp\u003eFor multiplex PCR, the urine samples were stored at -80\u003csup\u003eo\u003c/sup\u003eC until further use. The presence of \u003cem\u003eM. genitalium\u003c/em\u003e, \u003cem\u003eM. hominis\u003c/em\u003e, \u003cem\u003eU. urealyticum\u003c/em\u003e, \u003cem\u003eU. parvum\u003c/em\u003e was investigated using the BioGX Mycoplasma-Ureaplasma-OSR commercial multiplex PCR kit (BioGX, Netherlands) running on a BD MAX system (BD Diagnostics, USA). The BioGX Mycoplasma-Ureaplasma-OSR commercial multiplex PCR kit is a multiplex real-time multiplex PCR assay used on the BD MAX\u0026trade; platform for the qualitative detection of the presence of DNA from \u003cem\u003eM. genitalium\u003c/em\u003e (MgPa operon gene), \u003cem\u003eM. hominis\u003c/em\u003e (gap gene), \u003cem\u003eU. urealyticum\u003c/em\u003e (UUR10_0680 gene), and \u003cem\u003eU. parvum\u003c/em\u003e (UP063 gene). The samples were loaded into the device in accordance with the manufacturer's recommendations. At the end of the study, the results were evaluated in accordance with the manufacturer's recommendations. Macrolide resistance was studied using the Macrolide-R/MG ELITe MGB Kit (ELITechGroup S.p.A., Italy) on the ELITe BeGenius\u0026reg; system, in accordance with the manufacturer's recommendations. Macrolide resistance-associated mutations in the \u003cem\u003e23S rRNA\u003c/em\u003e gene were determined for all samples that tested positive for \u003cem\u003eM. genitalium\u003c/em\u003e using the Macrolide-R/MG ELITe MGB Kit, which allows for the simultaneous detection and identification of \u003cem\u003eM. genitalium\u003c/em\u003e and the seven mutations (A2058G, A2058C, A2058T, A2059G, A2059C, A2062G, and A2062T) responsible for macrolide resistance.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SSPS version 23.0. Patient characteristics and laboratory examination results were analyzed using descriptive statistics. Categorical data are presented as number (n) and percentage (%). Comparisons between groups were performed using the chi-square test or Fisher\u0026rsquo;s exact test for categorical data and Student\u0026rsquo;s t-test for numerical data. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf the patients included in the study, 71.0% were single and 53.8% reported having a new sexual partner in the last three months. 37.6% Of the patients reported having a history of previous illnesses such as gonorrhea, genital discharge, or warts, and 33.3% reported having had sex with a sex worker before. 53.8% of the patients reported genital discharge, 47.8% genital itching, 30.0% pain or discomfort during sexual intercourse, and 71.0% pain or discomfort during urination. The demographic data, sexual behavior characteristics, and symptoms of the patients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Data, Sexual Behavior Characteristics, and Symptoms of Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge at first sexual intercourse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eFrequency of sexual intercourse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026ndash;4 times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOnce a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLess than once a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e36.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eSexual intercourse in the last 6 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e90.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNew sexual partner in the last 3 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNumber of sexual partners to date\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly income level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than minimum wage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimum wage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove minimum wage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of HIV or other STIs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eSexual intercourse with a sex worker (+)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eHistory of gonorrhea or genital discharge, warts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e37.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGenital discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eSexual intercourse with someone having similar symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGenital itching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eUse of condom during sexual intercourse (+)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTesticular pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNumber of sexual partners in the last 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTesticular swelling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain/discomfort during intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain/discomfort during urination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRedness on penis or testicles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain/discomfort in the pelvic area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGram-stained microscopic examination revealed polymorphonuclear leukocytes and Gram-negative diplococci in two patients (2.1%). The growth of \u003cem\u003eN. gonorrhoeae\u003c/em\u003e was observed on Modified Martin-Lewis agar in nine patients (9.6%). When the multiplex PCR results of all patients included in the study were evaluated, a total of 46 microorganisms were detected in 37 patients (39.4%). While monoinfection was detected in 28 patients (29.8%) by PCR, mixed infections were detected in nine patients (9.6%). When we examined the mixed infections detected by multiplex PCR, \u003cem\u003eM. hominis\u003c/em\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eU. urealyticum\u003c/em\u003e was detected in three patients (3.2%), \u003cem\u003eM. hominis\u003c/em\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eU. parvum\u003c/em\u003e in two patients (2.1%), and \u003cem\u003eU. parvum\u003c/em\u003e and \u003cem\u003eU. urealyticum\u003c/em\u003e in four patients (4.3%). The most common mixed infections detected using PCR were \u003cem\u003eU. parvum\u003c/em\u003e and \u003cem\u003eU. urealyticum\u003c/em\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMethods Applied to Patient Samples and Their Results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethods\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Patients\u003c/p\u003e \u003cp\u003e(n: 94)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicroscopy, (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect Microscopic Examination (Urine)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGram-Stained Microscopic Examination (Genital Swab)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCulture, (n, %)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTrichomonas vaginalis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePolymerase Chain Reaction\u003c/b\u003e (\u003cb\u003ePCR), (n, %)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMycoplasma hominis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMycoplasma genitalium\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eUreaplasma urealyticum\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (11.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eUreaplasma parvum\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMixed Infections, (n, %)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMycoplasma hominis\u0026thinsp;+\u0026thinsp;Ureaplasma urealyticum\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMycoplasma hominis\u0026thinsp;+\u0026thinsp;Ureaplasma parvum\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eUreaplasma parvum\u0026thinsp;+\u0026thinsp;Ureaplasma urealyticum\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen PCR and culture were evaluated together, a total of 55 microorganisms were detected in 39 (41.5%) patients. Seven of the nine patients in whom \u003cem\u003eN. gonorrhoeae\u003c/em\u003e was detected had at least one accompanying \u003cem\u003eMycoplasma\u003c/em\u003e or \u003cem\u003eUreaplasma\u003c/em\u003e species (\u003cem\u003eU. urealyticum\u0026thinsp;+\u0026thinsp;U. parvum\u003c/em\u003e in two patients, \u003cem\u003eU. urealyticum\u003c/em\u003e in three patients, \u003cem\u003eM. genitalium\u003c/em\u003e in two patients).\u003c/p\u003e \u003cp\u003eThe mean age of the patients in whom any microorganism was detected was lower than that of patients without microorganism [30.66 (min-max: 17\u0026ndash;72) versus 34.7 (min-max: 17\u0026ndash;69) years]. The highest prevalence was the patients with 26\u0026ndash;34 ages (41.8%). \u003cem\u003eN. gonorrhoeae\u003c/em\u003e and \u003cem\u003eM. hominis\u003c/em\u003e were between 18\u0026ndash;25 ages, and \u003cem\u003eM. genitalium\u003c/em\u003e, \u003cem\u003eU. urealyticum\u003c/em\u003e and \u003cem\u003eU. parvum\u003c/em\u003e were between 26\u0026ndash;34 ages (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMicroorganisms Detected in Samples and Associated Clinical Factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMicroorganism (-)\u003c/p\u003e \u003cp\u003e(n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eAny Microorganism (+) (n, %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eM. genitalium\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(n:6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eM. hominis\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(n:8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eU. urealyticum\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(n:18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eU. parvum\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(n:14)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eN. gonorrhoeae\u003c/em\u003e (n:9)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge 18\u0026ndash;25\u003c/p\u003e \u003cp\u003e26\u0026ndash;34\u003c/p\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003cp\u003e\u0026gt;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (28.3)\u003c/p\u003e \u003cp\u003e12 (22.6)\u003c/p\u003e \u003cp\u003e15 (28.3)\u003c/p\u003e \u003cp\u003e11 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003cp\u003e4 (66.6)\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (37.5)\u003c/p\u003e \u003cp\u003e2(25.0)\u003c/p\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003cp\u003e2 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (33.3)\u003c/p\u003e \u003cp\u003e7 (38.9)\u003c/p\u003e \u003cp\u003e2 (11.1)\u003c/p\u003e \u003cp\u003e3 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (21.4)\u003c/p\u003e \u003cp\u003e7 (50.0)\u003c/p\u003e \u003cp\u003e3 (21.4)\u003c/p\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003cp\u003e2(22.2)\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at first sexual intercourse \u0026le;25 Years\u003c/p\u003e \u003cp\u003e\u0026gt;25 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (94,4)\u003c/p\u003e \u003cp\u003e3 (5,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (100)\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (100)\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (100)\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (78,6)\u003c/p\u003e \u003cp\u003e3 (21,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of sexual intercourse\u003c/p\u003e \u003cp\u003eDaily\u003c/p\u003e \u003cp\u003e3\u0026ndash;4 times week\u003c/p\u003e \u003cp\u003eOnce a week\u003c/p\u003e \u003cp\u003eLess than once a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5,6)\u003c/p\u003e \u003cp\u003e16 (29,6)\u003c/p\u003e \u003cp\u003e16 (29,6)\u003c/p\u003e \u003cp\u003e19 (35,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e2 (33,3)\u003c/p\u003e \u003cp\u003e3 (50)\u003c/p\u003e \u003cp\u003e1 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e2 (28,6)\u003c/p\u003e \u003cp\u003e3 (42,8)\u003c/p\u003e \u003cp\u003e2 (28,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e3 (17,6)\u003c/p\u003e \u003cp\u003e6 (35,3)\u003c/p\u003e \u003cp\u003e8 (47,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e7 (58,3)\u003c/p\u003e \u003cp\u003e5 (41,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e3 (37,5)\u003c/p\u003e \u003cp\u003e5 (62,5)\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of partners in the last 12 months. \u0026le;3\u003c/p\u003e \u003cp\u003e\u0026gt;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (79,2)\u003c/p\u003e \u003cp\u003e11 (20,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (33,3)\u003c/p\u003e \u003cp\u003e\u003cb\u003e4 (66,7)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (75)\u003c/p\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (58,8)\u003c/p\u003e \u003cp\u003e7 (41,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (53,9)\u003c/p\u003e \u003cp\u003e6 (46,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (37,5)\u003c/p\u003e \u003cp\u003e\u003cb\u003e5 (62,5)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual intercourse in the last 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (87,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (88,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (88,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA new sexual partner in the last 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (42,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (83,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (66,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (71,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (77,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of previously diagnosed HIV or other STD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (7,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (11,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA history of previous illnesses such as gonorrhea or genital discharge or warts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (38,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (38,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (42,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (55,6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual intercourse with someone who has the above complaints\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (13,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (28,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (11,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (7,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (11,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual intercourse with a sex worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (31,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (38,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (35,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (22,2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of condoms during sexual intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (41,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (33,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (28,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (56,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (38,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (12,5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGenital discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (42,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (83,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e13 (72,2)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e9 (100)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGenital itching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (42,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (71,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (57,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e8 (88,9)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain and discomfort during sexual intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (23,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (33,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (47,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (42,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e5 (62,5)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain and discomfort during urinating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (66,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (77,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (92,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (88,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain and discomfort in your hip area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (22,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (12,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (14,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (22,2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTesticular pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (42,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (33,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (37,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (44,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (28,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (44,4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwelling in the testicles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (11,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (33,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (12,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (11,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (7,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (22,2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRedness on penis/testicles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (24,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (38,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (28,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (44,4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere was a statistically significant relationship between the number of partners greater than three in the last 12 months and \u003cem\u003eM. genitalium\u003c/em\u003e and \u003cem\u003eN. gonorrhoeae\u003c/em\u003e positivity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Patients with genital discharge had higher \u003cem\u003eU. urealyticum\u003c/em\u003e and \u003cem\u003eN. gonorrhoeae\u003c/em\u003e positivity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In addition, a significant relationship was found between \u003cem\u003eN. gonorrhoeae\u003c/em\u003e positivity and genital itching and pain during sexual intercourse (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Macrolide resistance was detected in two of the six \u003cem\u003eM. genitalium\u003c/em\u003e positive samples (33.3%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMolecular methods are better than culture in terms of sensitivity and specificity for the diagnosis of \u003cem\u003eMycoplasma\u003c/em\u003e and \u003cem\u003eUreaplasma\u003c/em\u003e. In particular, real-time PCR is the preferred PCR method for the detection of \u003cem\u003eMycoplasma\u003c/em\u003e and \u003cem\u003eUreaplasma\u003c/em\u003e [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The sensitivities of nucleic acid amplification tests for \u003cem\u003eM. genitalium\u003c/em\u003e, \u003cem\u003eM. hominis\u003c/em\u003e, \u003cem\u003eU. urealyticum\u003c/em\u003e and \u003cem\u003eU. parvum\u003c/em\u003e were reported to be 98\u0026ndash;100% and specificities were reported to be 97\u0026ndash;100% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In one study, culture and PCR were compared for the detection of \u003cem\u003eUreaplasma\u003c/em\u003e spp., \u003cem\u003eM. hominis\u003c/em\u003e and \u003cem\u003eM. genitalium\u003c/em\u003e and it was concluded that PCR increased the test sensitivity by 24% compared to culture, which had a sensitivity of 70% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In our study, the real-time PCR method, which is the method recommended in previous studies, was used to investigate \u003cem\u003eMycoplasma\u003c/em\u003e and \u003cem\u003eUreaplasma\u003c/em\u003e species.\u003c/p\u003e \u003cp\u003eIn studies conducted using the PCR method in men with urethritis, the frequency of \u003cem\u003eM. genitalium\u003c/em\u003e was found to be 12% and 10.5% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In another study, the frequency of \u003cem\u003eM. genitalium\u003c/em\u003e infection in symptomatic men was found to be 12%, and symptomatic individuals were found to be more likely to have \u003cem\u003eM. genitalium\u003c/em\u003e infection than asymptomatic individuals [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In a study conducted on 155 male patients with NGU, the second most common pathogen after \u003cem\u003eC. trachomatis\u003c/em\u003e was determined to be \u003cem\u003eM. genitalium\u003c/em\u003e (23%) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The overall prevalence of \u003cem\u003eM. genitalium\u003c/em\u003e was found to be 10.5% in a study conducted on men who have sex with men [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In a study conducted in Southern Ghana using two different kits, the total \u003cem\u003eM. genitalium\u003c/em\u003e infection rates was determined as 3.1% and 3.4%, respectively [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our study whose symptomatic men were included, the frequency of \u003cem\u003eM. genitalium\u003c/em\u003e was found to be 6.4%. The different results among the studies may be due to various factors such as the patient group selected, the method used in the study, and the risky sexual behaviors of the patients.\u003c/p\u003e \u003cp\u003eRoutine testing of patients with or without urethritis symptoms for \u003cem\u003eM. hominis\u003c/em\u003e, \u003cem\u003eU. urealyticum\u003c/em\u003e, and \u003cem\u003eU. parvum\u003c/em\u003e is not recommended. \u003cem\u003eU. urealyticum\u003c/em\u003e might be associated with urethritis in men if a high load is present [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. \u003cem\u003eM. hominis\u003c/em\u003e displayed significant effects on sperm motility, morphology, and number of leukocytes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It has been found that \u003cem\u003eM. hominis\u003c/em\u003e can cause infertility in men even if asymptomatic, and infertility can be improved with antibiotic treatment [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In the literature, the frequency of \u003cem\u003eU. urealyticum\u003c/em\u003e is given in a wide range from approximately 5\u0026ndash;35% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In studies conducted on men with urethritis using the PCR method, the frequency of \u003cem\u003eU. urealyticum\u003c/em\u003e was determined as 4.8% in the study by Khatib et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and 14.2% in the study by Sarıer [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In our study, multiplex PCR method was used in male patients suffering from urethritis symptoms, and the frequency of \u003cem\u003eU. urealyticum\u003c/em\u003e was found to be 19.1%, which is consistent with the literature. In a study where \u003cem\u003eU. parvum\u003c/em\u003e was quantified, the bacterial load was similar in the NGU and control groups [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Conversely, studies have suggested that it may cause NGU, especially when found in large numbers [22, 23]. In our study, similar to the literature, the frequencies of \u003cem\u003eM. hominis\u003c/em\u003e and \u003cem\u003eU. parvum\u003c/em\u003e were determined as 8.5% and 14.9%, respectively. However, no quantitative evaluation was performed in this study. We are not sure whether these agents are causative agents, although all patients included in our study suffered from symptoms of urethritis.\u003c/p\u003e \u003cp\u003eConsidering the similar transmission patterns of STI agents, coinfection is a common and expected situation, and has been detected in many studies [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In a study conducted on NGU patients, a mixed infection rate of 10.2% was detected. \u003cem\u003eU. urealyticum\u003c/em\u003e was detected in 79% of the cases, and the most common association was with \u003cem\u003eM. genitalium\u003c/em\u003e (43% of the cases (n\u0026thinsp;=\u0026thinsp;6/14)) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In our study, mixed infections were detected in a total of 14 (14.9%) patients; the two most common bacteria were \u003cem\u003eU. urealyticum\u003c/em\u003e and \u003cem\u003eU. parvum\u003c/em\u003e, and three microorganisms (\u003cem\u003eU. urealyticum\u003c/em\u003e, \u003cem\u003eU. parvum\u003c/em\u003e and \u003cem\u003eN. gonorrhoeae\u003c/em\u003e) were detected simultaneously in two (2.1%) patients.\u003c/p\u003e \u003cp\u003eGenital discharge is one of the most common symptoms of urethritis and can occur with the use of many STI agents. Manhart et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] reported in their study of symptomatic men that the most common symptom was urethral discharge (20.4%). In a study conducted by Rietmeijer et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e], a statistically significant relationship was found between the presence of purulent and thick discharges in male patients with genital discharge and the detection of \u003cem\u003eN. gonorrhoeae\u003c/em\u003e. In our study, a statistically significant relationship was found between the presence of genital discharge and the detection of \u003cem\u003eN. gonorrhoeae\u003c/em\u003e and \u003cem\u003eU. urealyticum\u003c/em\u003e (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe main risk factors for STIs include age between 20 and 35 years, having multiple partners, and a history of STIs [27, 28 ]. de Souza et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e] found that STI agents were most common in the 20\u0026ndash;29 age group, and Manhart et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] found that \u003cem\u003eM. genitalium\u003c/em\u003e was most common in the 15\u0026ndash;24 age group. When the individuals in our study who were found to have any microorganism were evaluated, the age group with the highest prevalence was determined to be the 26\u0026ndash;34 age group. We think that these differences in age groups may be due to various reasons, such as the time of initiation of sexual activity, sociocultural features, and sexual behavior characteristics of individuals in different populations. Risky sexual behaviors, especially increasing the number of sexual partners, are known to increase the risk of STIs. A study of young adults found a strong association between an increasing number of sexual partners and \u003cem\u003eM. genitalium\u003c/em\u003e infection [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In studies investigating \u003cem\u003eM. genitalium\u003c/em\u003e prevalence and risky behaviors, a relationship was observed between the total number of partners and the increase in the number of new sexual partners and \u003cem\u003eM. genitalium\u003c/em\u003e positivity [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In a study conducted by Ona et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e], it was found that the probability of \u003cem\u003eMycoplasma\u003c/em\u003e detection was related to the increasing number of sexual partners, and that this risk increased significantly in those with two or more partners. In our study, a statistically significant relationship was found between having three or more partners in the previous year and \u003cem\u003eM. genitalium\u003c/em\u003e and \u003cem\u003eN. gonorrhoeae\u003c/em\u003e positivity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eMacrolides are used in the first-line treatment of \u003cem\u003eM. genitalium\u003c/em\u003e infections and, if possible, it is recommended to detect mutations associated with macrolide resistance in \u003cem\u003eM. genitalium\u003c/em\u003e positive samples [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In a study conducted on 170 patients with \u003cem\u003eM. genitalium\u003c/em\u003e DNA positivity, macrolide resistance mutations were identified in 48.8% of the samples, and it is reported that the most common mutations were A2059C (18.2%) and A2059G (15.3%) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The prevalence of mutations associated with macrolide resistance was found as 67.9% in a study from Sweden including male sex individuals [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In A study investigating the prevalence and macrolide resistance of \u003cem\u003eMycoplasma genitalium\u003c/em\u003e in Southern Vietnam showed that the frequency of \u003cem\u003eM. genitalium\u003c/em\u003e in samples was 5.95% and macrolide resistance in their was 61.11% [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. A study evaluating the performance of three commercial molecular diagnostic tests in detecting \u003cem\u003eM. genitalium\u003c/em\u003e and macrolide resistance reported that the sensitivity of the Macrolide-R/MG ELITe MGB kit (ELITechGroup) was significantly higher than that of the others in detecting macrolide resistance [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In our study, macrolide resistance was investigated using the Macrolide-R/MG ELITe MGB kit and was detected in two of the six \u003cem\u003eM. genitalium\u003c/em\u003e positive samples (33.3%). This rate may be misleading due to the small number of \u003cem\u003eM. genitalium\u003c/em\u003e positive samples, and it would be appropriate to evaluate it with more samples.\u003c/p\u003e \u003cp\u003eThe most important limitation of our study is that \u003cem\u003eC. trachomatis\u003c/em\u003e was not investigated. In some cases, where no microorganisms were detected, the cause of urethritis may be \u003cem\u003eC. trachomatis\u003c/em\u003e. The other limitations of the study are that the agents \u003cem\u003eN. gonorrhoeae\u003c/em\u003e and \u003cem\u003eT. vaginalis\u003c/em\u003e were investigated by microscopy and culture methods, none of any molecular methods.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, at least one from \u003cem\u003eU. urealyticum, U. parvum, N. gonorrhoeae, M. hominis\u003c/em\u003e and \u003cem\u003eM. genitalium\u003c/em\u003e was detected in 41.5% of male patients suffering from urethritis symptoms in this study. The frequency of causative pathogens of STIs and patient profiles can be changed for various reasons, such as the time of initiation of sexual activity, sociocultural features, and sexual behavior characteristics of individuals and populations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSTIs Sexually transmitted infections \u003c/p\u003e\n\u003cp\u003eNGU Nongonococcal urethritis \u003c/p\u003e\n\u003cp\u003e\u003cem\u003eC. trachomatis Chlamydia trachomatis \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN. gonorrhoeae Neisseria gonorrhoeae \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eM. genitalium Mycoplasma genitalium\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eU. urealyticum Ureaplasma urealyticum \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eM. hominis Mycoplasma hominis \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eU. parvum Ureaplasma parvum\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePCR Polymerase Chain Reaction \u003c/p\u003e\n\u003cp\u003eBASHH The British Association for Sexual Health and HIV \u003c/p\u003e\n\u003cp\u003e\u003cem\u003eT. vaginalis\u003cem\u003e Trichomonas\u003c/em\u003e vaginalis \u003c/em\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors contributed to the study. The first draft of the manuscript was written by T.K. and H.Y. \u0026nbsp; All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Scientific Research Projects Coordination Unit of Akdeniz University (project number TTU-2022-5973).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYes, the datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the Faculty of Medicine of Akdeniz on 10.11.2021, with (decision number KAEK-798). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eAkdeniz University Medical Faculty, Department of Medical Microbiology, Antalya, Turkey\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eHealthy Sciences University, Medical Faculty, Department of Urology, Antalya, Turkey\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eAkdeniz University Medical Faculty, Department of Urology, Antalya, Turkey\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003eAntalya City Hospital, Department of Urology, Antalya, Turkey\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization (WHO). 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Characteristics of Mycoplasma genitalium Urogenital Infections in a Diverse Patient Sample from the United States: Results from the Aptima Mycoplasma genitalium Evaluation Study (AMES). J Clin Microbiol. 2020;58(7):e00165-20.\u003c/li\u003e\n\u003cli\u003eJordan SJ, Toh E, Williams JA, Fortenberry L, LaPradd ML, Katz BP, et al. Aetiology and prevalence of mixed-infections and mono-infections in non-gonococcal urethritis in men: a case-control study. Sex Transm Infect. 2020;96(4):306-311. \u003c/li\u003e\n\u003cli\u003eBjartling C, Kertes R, Kristiansen S, Johnsson A, Forslund O. Prevalence of \u003cem\u003eMycoplasma genitalium\u003c/em\u003e and macrolide resistance in rectal and urine samples among men who have sex with men in Sweden. Sex Transm Infect. 2024;100(7):430-434. \u003c/li\u003e\n\u003cli\u003eDela H, Behene E, Ocansey K, Yanney JN, Kwasi Addo K, Miranda HV, et al. 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A New Multiplex Genetic Detection Assay Method for the Rapid Semi-Quantitative Detection of Six Common Curable Sexually Transmitted Pathogens From the Genital Tract. Front Cell Infect Microbiol. 2021;11:704037. \u003c/li\u003e\n\u003cli\u003eSarıer M. Prevalence of Polymicrobial Infection in Urethritis. J Urol Surg. 2019;6(3):180-183.\u003c/li\u003e\n\u003cli\u003eFr\u0026oslash;lund M, Lidbrink P, Wikstr\u0026ouml;m A, Cowan S, Ahrens P, Jensen JS. Urethritis-associated Pathogens in Urine from Men with Non-gonococcal Urethritis: A Case-control Study. Acta Derm Venereol. 2016;96(5):689-94.\u003c/li\u003e\n\u003cli\u003eCox C, McKenna JP, Watt AP, Coyle PV. Ureaplasma parvum and Mycoplasma genitalium are found to be significantly associated with microscopy-confirmed urethritis in a routine genitourinary medicine setting. Int J STD AIDS. 2016;27:861.\u003c/li\u003e\n\u003cli\u003eDeguchi T, Shimada Y, Horie K, Mizutani K, Seike K, Tsuchiya T, et al. Bacterial loads of Ureaplasma parvum contribute to the development of inflammatory responses in the male urethra. Int J STD AIDS. 2015;26(14):1035-9. \u003c/li\u003e\n\u003cli\u003eLee TF, Lin KY, Chang SY, Huang YT, Hsueh PR. Performance of two commercial multiplex polymerase chain reaction assays for the etiological diagnosis of sexually transmitted infections among men who have sex with men. J Microbiol Immunol Infect. 2023;56(1):104-110.\u003c/li\u003e\n\u003cli\u003eHamill MM, Onzia A, Wang TH, Kiragga AN, Hsieh YH, Parkes-Ratanshi R, et al. High burden of untreated syphilis, drug resistant Neisseria gonorrhoeae, and other sexually transmitted infections in men with urethral discharge syndrome in Kampala, Uganda. BMC Infect Dis. 2022;22(1):440. \u003c/li\u003e\n\u003cli\u003eRietmeijer CA, Mungati M, Machiha A, Mugurungi O, Kupara V, Rodgers L, et al. The Etiology of Male Urethral Discharge in Zimbabwe: Results from the Zimbabwe STI Etiology Study. Sex Transm Dis. 2018;45(1):56-60.\u003c/li\u003e\n\u003cli\u003eTao X, Ghanem KG, Page KR, Gilliams E, Tuddenham S. Risk factors predictive of sexually transmitted infection diagnosis in young compared to older patients attending sexually transmitted diseases clinics. Int J STD AIDS. 2020;31(2):142-149. \u003c/li\u003e\n\u003cli\u003ede Souza LS, Sardinha JC, Talhari S, Heibel M, Santos MND, Talhari C. Main etiological agents identified in 170 men with urethritis attended at the Funda\u0026ccedil;\u0026atilde;o Alfredo da Matta, Manaus, Amazonas, Brazil. An Bras Dermatol. 2021;96(2):176-183.\u003c/li\u003e\n\u003cli\u003eHorner PJ, Martin DH. Mycoplasma genitalium Infection in Men. J Infect Dis 2017;216 Suppl 2: S396-S405.\u003c/li\u003e\n\u003cli\u003eSonnenberg P, Ison CA, Clifton S, Field N, Tanton C, Soldan K, et al. Epidemiology of Mycoplasma genitalium in British men and women aged 16\u0026ndash;44 years: evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Int J Epidemiol. 2015;44(6):1982-94. \u003c/li\u003e\n\u003cli\u003eOna S, Molina RL, Diouf K. Mycoplasma genitalium: An Overlooked Sexually Transmitted Pathogen in Women?. Infect Dis Obstet Gynecol. 2016;2016:4513089.\u003c/li\u003e\n\u003cli\u003eJensen JS, Cusini M, Gomberg M, Moi H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2016. 30:1650\u0026ndash;1656. \u003c/li\u003e\n\u003cli\u003eAzrad M, Saleh N, Zur IY, Becker D, Shiloah N, Habib S, et al. Mycoplasma genitalium\u0026apos;s Antibiotic Resistance in Sexually Transmitted Infections Clinics in Israel. J Low Genit Tract Dis. 2024; doi: 10.1097/LGT.0000000000000828. \u003c/li\u003e\n\u003cli\u003eLam PPH, Nguyen NH, Nguyen TTT, Trinh NB, Luong BA. \u003cem\u003eMycoplasma genitalium\u003c/em\u003e prevalence, co-infection and macrolide resistance-associated mutations in Southern Vietnam. Infez Med. 2024;32(2):222-230. \u003c/li\u003e\n\u003cli\u003eLe Roy C, B\u0026eacute;b\u0026eacute;ar C, Pereyre S. Performance of Three Commercial Molecular Diagnostic Assays for the Simultaneous Detection of Mycoplasma genitalium and Macrolide Resistance. J Clin Microbiol. 2021;59(6):e00020-21. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Urethritis, Mycoplasma genitalium, Neisseria gonorrhoeae, Ureaplasma urealyticum, Polymerase Chain Reaction","lastPublishedDoi":"10.21203/rs.3.rs-5915186/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5915186/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThis study aimed to determine the frequency of \u003cem\u003eMycoplasma hominis\u003c/em\u003e, \u003cem\u003eMycoplasma genitalium\u003c/em\u003e, \u003cem\u003eUreaplasma urealyticum\u003c/em\u003e and \u003cem\u003eUreaplasma parvum\u003c/em\u003e in male patients suffering from urethritis symptoms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eFirst-void urine and genital discharge samples were collected from 94 men. \u003cem\u003eMycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum \u003c/em\u003eand \u003cem\u003eUreaplasma parvum \u003c/em\u003ewere investigated using a multiplex Polymerase Chain Reaction (PCR) method (BioGX Mycoplasma-Ureaplasma-OSR commercial multiplex PCR kit (BioGX, Netherlands)). \u003cem\u003eTrichomonas vaginalis\u003c/em\u003e and \u003cem\u003eNeisseria gonorrhoeae \u003c/em\u003ewere investigated using microscopy and culture methods. In \u003cem\u003eMycoplasma genitalium\u003c/em\u003e positive samples, macrolide resistance was studied using the Macrolide-R/MG ELITe MGB Kit (ELITechGroup S.p.A., Italy) on the ELITe BeGenius® system\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 55 microorganisms were detected in 41.5% of the patients(n:39), [18 \u003cem\u003eUreaplasma urealyticum\u003c/em\u003e(33%), 14 \u003cem\u003eUreaplasma parvum\u003c/em\u003e(25%), 9 \u003cem\u003eNeisseria gonorrhoeae \u003c/em\u003e(16%)\u003cem\u003e,\u003c/em\u003e 8 \u003cem\u003eMycoplasma hominis\u003c/em\u003e(15%) \u003cem\u003e\u0026nbsp;and \u003c/em\u003e6 \u003cem\u003eMycoplasma genitalium\u003c/em\u003e(11%)\u003cem\u003e]\u003c/em\u003e. \u003cem\u003eMycoplasma genitalium \u003c/em\u003eand \u003cem\u003eNeisseria gonorrhoeae \u003c/em\u003epositivity was statistically higher in patients with more than three partners in the last 12 months, and patients with genital discharge had higher \u003cem\u003eUreaplasma urealyticum \u003c/em\u003eand \u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e positivity (p\u0026lt;0.05). Additionally, a significant relationship was found between \u003cem\u003eNeisseria gonorrhoeae \u003c/em\u003epositivity and genital itching and pain/discomfort during sexual intercourse symptoms (p\u0026lt;0.05). Macrolide resistance was detected in two of the six \u003cem\u003eMycoplasma genitalium\u003c/em\u003e positive samples (33.3%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe results of this study revealed that 41.5% of male patients suffering from urethritis symptoms had at least one from \u003cem\u003eUreaplasma urealyticum\u003c/em\u003e, \u003cem\u003eUreaplasma parvum\u003c/em\u003e, \u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e, \u003cem\u003eMycoplasma hominis \u003c/em\u003eor \u003cem\u003eMycoplasma genitalium\u003c/em\u003e, respectively. The number of sexual partners is important in sexually transmitted diseases.\u003c/p\u003e","manuscriptTitle":"Investigation of Mycoplasma and Ureaplasma Species Using Molecular Method in Male Patients Suffering from Urethritis Symptoms","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-28 13:57:10","doi":"10.21203/rs.3.rs-5915186/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-04T17:01:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-04T08:55:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-31T17:31:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237374950137972869825360687882557521410","date":"2025-03-31T15:22:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247760005152217212265902321675497180694","date":"2025-03-28T15:08:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-27T13:22:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-27T05:54:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2025-03-26T23:28:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f62e2f10-0d0d-4560-9b66-e289015e3f5f","owner":[],"postedDate":"March 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-26T16:12:03+00:00","versionOfRecord":{"articleIdentity":"rs-5915186","link":"https://doi.org/10.1186/s12894-025-01804-9","journal":{"identity":"bmc-urology","isVorOnly":false,"title":"BMC Urology"},"publishedOn":"2025-05-19 15:57:04","publishedOnDateReadable":"May 19th, 2025"},"versionCreatedAt":"2025-03-28 13:57:10","video":"","vorDoi":"10.1186/s12894-025-01804-9","vorDoiUrl":"https://doi.org/10.1186/s12894-025-01804-9","workflowStages":[]},"version":"v1","identity":"rs-5915186","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5915186","identity":"rs-5915186","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}