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[# PeerJ Staff Note - this decision was reviewed and approved by Keith Crandall, a PeerJ Section Editor covering this Section #]
After reviewing the updated version of the manuscript, I think this manuscript is ready for publication.
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.
Well written paper. The scope and objectives are clearly written.
[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.
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.
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"?
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
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.
1. Please clarify which criteria did you refer to while you include or exclude the data.(lines 71-76)
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.
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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