Prevalence of Neisseria gonorrhoeae , Ureaplasma urealyticum , and Chlamydia trachomatis infections in 37,680 patients in Guangzhou, China

ABSTRACT To refine the epidemiological profile of sexually transmitted infections (STIs) in Guangzhou, this study analyzed Neisseria gonorrhoeae (NG), Ureaplasma urealyticum (UU), and Chlamydia trachomatis (CT) infections among 37,680 patients treated at the Affiliated Guangdong Second Provincial General Hospital of Jinan University from 2020 to 2024. Overall prevalence was 15.48% for NG, 30.91% for UU, and 4.78% for CT. NG and CT prevalences were both significantly higher in males than in females (NG: 25.07% vs 2.86%; CT: 5.33% vs 4.28%), whereas UU prevalence was higher in females (41.67% vs 24.96%). Age-specific patterns revealed distinct trends. NG prevalence in males peaked in the ≤20 age group (48.34%) and declined with age. UU prevalence was highest in females ≤20 years (60.00%). CT prevalence peaked in youth ≤20 years (25% and 30.34% for males and females, respectively), with lower rates observed in subsequent age groups. Regarding co-infections, UU+CT was the most frequent (5.00%). NG+UU and NG+CT co-infections were male-predominant, whereas UU+CT was significantly higher in females ≤20 years (36.00% vs 13.95%). O / E and OR analyses suggested a synergistic interaction for UU+CT in both sexes aged ≤30 years. Triple infection (NG+UU+CT) remained below 1% and showed no significant sex difference. Stratified by clinical presentation, NG and CT infections in males were highly concentrated in the urogenital inflammation group, demonstrating a symptom-driven pattern. In females, CT infection was prevalent in the urogenital inflammation (7.37%), others (7.11%), and screening and asymptomatic examination (5.86%) groups, and NG was detected in both the inflammation (3.46%) and screening (3.61%) groups, indicating a coexistence of symptomatic and occult infections. UU showed consistently high prevalence across all female clinical groups (32.50%–46.07%). Our study provided evidence for tailored STI control strategies. IMPORTANCE This study systematically characterized the epidemiological profile of Neisseria gonorrhoeae (NG), Ureaplasma urealyticum (UU), and Chlamydia trachomatis (CT) infections in Guangzhou, revealing distinct sex- and age-specific patterns, identifying UU+CT as the predominant co-infection with a synergistic interaction in individuals aged ≤30 years, and demonstrating a symptom-driven pattern for NG and CT in males versus a dual burden of symptomatic and occult infections in females. These findings fill a gap in the epidemiological data in South China and support gender-specific screening strategies that distinguish symptomatic management in males from proactive case-finding in females.