Review History

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  • The initial submission of this article was received on October 29th, 2019 and was peer-reviewed by 2 reviewers and the Academic Editor.
  • The Academic Editor made their initial decision on December 17th, 2019.
  • The first revision was submitted on February 10th, 2020 and was reviewed by 1 reviewer and the Academic Editor.
  • The article was Accepted by the Academic Editor on March 15th, 2020.

Version 0.2 (accepted)

· Mar 15, 2020 · Academic Editor


Authors should be congratulated on appropriate revisions.

[# PeerJ Staff Note - this decision was reviewed and approved by Keith Crandall, a PeerJ Section Editor covering this Section #]

Reviewer 1 ·

Basic reporting

Well written

Experimental design


Validity of the findings


Additional comments

After reviewing the updated version of the manuscript, I think this manuscript is ready for publication.

Version 0.1 (original submission)

· Dec 17, 2019 · Academic Editor

Major Revisions

Two independent reviewers plus the handling editor (myself) have assessed your manuscript. The validity of model is ok, and so, please pay attention to stylistic comments from the reviewer to polish your manuscript.

My own review comments are below. Please note that I suggested a small piece of sensitivity analysis as an additional effort.

Basic reporting

Well written paper. The scope and objectives are clearly written.

Experimental design

[important remark] The time of introduction $T$ is sought by the model, but the initial prevalence is fixed. The simulation is starting with the boundary of 2% prevalence, meaning that $R_0$ is fixed automatically. Don't we have to examine the impact of different transmissibility on the resulting proportion of de novo transmission?

[important remark 2] The treatment rate $\tau$ is statistically estimated by country. While it's interesting to see different values of $\tau$ by country, the model fit is not perfect, and it is strange to argue that azithromycin treatment rate has been kept constant over time. Wasn't there any change point of azithromycin use in those countries? For instance, when was it introduced to the treatment guideline? When was it covered by treatment formulae and covered by insurance? At least, based on these pieces of information, one can try to use a step function to replace the constant $\tau$, as part of sensitivity analysis.

Validity of the findings

Validity is ok. I can reproduce similar results.

Comments for the author

Page 1. Please discuss clinical signs and symptoms in Intro. Also, please describe the burden of disease (can be incidence/mortality and can be cost).

Page 2, Intro: Please explicitly describe that the large proportion being de novo emergence has a very important implication to AMS. Namely, tapering the use of azithromycin can expect the recovery of drug susceptibility.

Page 5, equation (6): Please indicate in what range $i$ was summed.

Reviewer 1 ·

Basic reporting

This paper is well written in clear English with appropriate referencing.

In the introduction, I suggest that you add a little bit more information about Mycoplasma genitalium infection, including epidemiology and natural history.

Line 157: remove "model"

Line 158 : (Figure 3, left panels), Fig 2?

Figure 3: Horizontal lines look like black color.

Experimental design

Your compartment model is simple and easy to understand, although this model is oversimplified.

I disagree with the equation 5. φA+T is not the growth rate of the resistant strain because the rate itself includes the prevalence of the resistant strain.

In the equation 6, what is the meaning of "find ki resistant samples in Ni tested individuals"?

Validity of the findings

Table 1: I suggest you to change the column name " number of specimens tested" . because it was a bit confusing. (e.g. number of mycoplasma genitalium positive)

Please explain a little bit more about fig 2 right panels


Basic reporting

1. Your first sentence in introduction(lines 32-34) needs more detail. For example, '~ a short history of macrolide usage as treatment of the organism'.
2. The latter part of same paragraph (lines 37-40) need more explanation. It seems NAATs are being used but also not being used at same time to detect M. geitalium.

Experimental design

1. Please clarify which criteria did you refer to while you include or exclude the data.(lines 71-76)

Validity of the findings

1. In the graph of France in the right part Figure 2, the line is barely within the shade. Please provide more data from France which support your results.

Additional comments

Your results are very impressive. Your model is simple and well explaining.
More comprehensive introduction and methods would make this article greater.

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