Distribution and resistance patterns of male urethritis pathogens from a private South African laboratory

Purpose: To assess the microbial aetiology and AMR patterns in MUS by analysing private laboratory urethral swab and urine specimens. The study also compared diagnostic performance between NAAT and culture and evaluated the relevance of syndromic management. This is the first large-scale South African private sector analysis of MUS pathogen profiles and AMR using NAAT and culture, providing critical evidence for diagnostic and management policy updates. Methods: A retrospective cross-sectional study was performed using laboratory data from 2012 to 2023, comprising over 61,000 samples. Organism prevalence and AMR rates were assessed. Diagnostic sensitivity and specificity of NAAT versus culture for Neisseria gonorrhoeae ( NG ) were calculated in matched samples. Results: NG and Chlamydia trachomatis were the most prevalent pathogens. NAAT demonstrated superior sensitivity, while culture yielded essential AMR data. NG showed elevated resistance patterns, but susceptibility to first-line antimicrobials remained high. Culture sensitivity and specificity relative to NAAT were 56% and 98.6%, respectively. Ureaplasma urealyticum showed elevated resistance versus global averages. The first cases of extensively drug-resistant (XDR) NG in South Africa were identified. Conclusion: NAAT improves MUS detection, while culture remains vital for AMR surveillance. Syndromic management remains effective, but rising resistance and XDR NG emergence warrant urgent attention.