| Summary: | <i>Mycoplasma genitalium</i> causes sexually transmitted infecti.ons in men and women. Treatment failures to macrolides and fluoroquinolones have been reported worldwide. Although the <i>mgpB</i> typing method has often been used in <i>M. genitalium</i>-infected men who have sex with men (MSM), limited typing data are available for <i>M. genitalium</i>-infected women. In this study, we aimed to investigate the genetic relationship between <i>M. genitalium</i> strains and their antibiotic resistance profile in a cohort of MSM (86.2% on HIV preexposure prophylaxis [PrEP], 13.8% HIV positive) and a large cohort of women using <i>mgpB</i>/MG309 typing. The <i>mgpB</i> types were determined in 374 samples from 305 women and 65 MSM. Three MSM and one woman had two concurrent or subsequent samples. Macrolide and fluoroquinolone resistance-associated mutations were searched in the 23S rRNA as well as <i>parC</i> and <i>gyrA</i> genes. The <i>mgpB</i> phylogenetic construction revealed three large clusters that differed according to sexual practices and geographical origin of patients. The prevalence of macrolide and fluoroquinolone resistance was significantly higher in MSM compared with women (95.4% vs. 14.1% and 30.6% vs. 7.2%, <i>p</i> < 0.001, respectively). The macrolide resistance spread was polyclonal in both populations, but clonal diffusion of two dual-resistant types was observed in PrEP users in association with high antibiotic pressure and dense connectivity in this population.
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