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What is Mycoplasma Genitalium?
Mycoplasma Genitalium (MG) is a sexually transmitted bacterial infection caused by the bacterium Mycoplasma Genitalium. First discovered in 1981, it is one of the smallest known bacteria capable of self-replication. MG primarily infects the urogenital tract, including the urethra in men and the cervix and reproductive tract in women.
Despite being relatively recently recognized as a sexually transmitted disease, MG has emerged as an important cause of urethritis in men and cervicitis in women. It is concerning to public health officials due to its increasing resistance to antibiotics and its association with serious reproductive health complications.
If you’re concerned about Mycoplasma Genitalium or other STDs, call (866) 566-8711 to learn about testing options.
How Common is Mycoplasma Genitalium?
- Approximately 1-3% of the general population in the United States is infected with MG
- Prevalence is higher (15-20%) among individuals attending STD clinics
- More common than gonorrhea but less common than chlamydia in many populations
- Often undiagnosed due to lack of routine testing
- Higher rates among men who have sex with men (prevalence of 5-10%)
- Rates are highest among young adults ages 18-35
- Infection rates have been increasing as awareness and testing improve
How Mycoplasma Genitalium Spreads
Mycoplasma Genitalium is primarily transmitted through sexual contact.
Mycoplasma Genitalium is transmitted through:
- Vaginal sex
- Anal sex
- Possibly genital-to-genital contact without penetration
Mycoplasma Genitalium is NOT typically transmitted through:
- Oral sex (though research is limited)
- Casual contact (handshakes, hugging)
- Sharing toilet seats
- Swimming pools or hot tubs
- Sharing towels or clothing
Important Transmission Facts:
- Can be transmitted when no symptoms are present
- May persist for months or years without treatment
- Can be transmitted through condoms in rare cases (though condoms significantly reduce risk)
- Often co-occurs with other STDs
- May increase susceptibility to other STDs, including HIV
Mycoplasma Genitalium Symptoms
Many people with Mycoplasma Genitalium have no symptoms. When symptoms do occur, they can be similar to those of chlamydia and gonorrhea.
- Abnormal vaginal discharge
- Pain during sex (dyspareunia)
- Bleeding after sex
- Spotting between periods
- Painful urination
- Lower abdominal pain
- Pelvic inflammatory disease symptoms in some cases
- Urethral discharge (clear or white)
- Burning or pain during urination
- Urethral itching or discomfort
- Pain or discomfort in the testicles (less common)
- Persistent urethritis despite treatment for other infections
- Up to 70% of infections may be asymptomatic
- Symptoms may appear 1-3 weeks after infection, if they appear at all
- Symptoms can be intermittent or persistent
- Without treatment, symptoms may resolve but the infection remains
- Men are more likely to experience symptoms than women
- Symptoms can be confused with other STDs or urinary tract infections
Diagnosing Mycoplasma Genitalium
Diagnosing MG requires specific laboratory testing that is not included in routine STD panels:
Testing Methods:
- Nucleic Acid Amplification Tests (NAATs):
- Most accurate method for detecting MG
- PCR-based tests that detect the genetic material of the bacteria
- Requires specific request as not included in standard STD testing
- Can be performed on urine samples, urethral swabs, or cervical/vaginal swabs
- Results typically available within 1-7 days depending on the laboratory
- Culture:
- Extremely difficult and time-consuming
- Not used for routine clinical diagnosis
- Primarily used for research purposes
- MG is extremely slow-growing in laboratory settings
Testing Challenges:
- Not part of routine STD screening
- Many healthcare providers are not familiar with MG
- Limited availability of FDA-approved tests until recently
- May require specialized laboratories
- Insurance coverage varies
- No point-of-care rapid tests currently available
When to Get Tested:
- If you have persistent urethritis or cervicitis despite treatment
- If your partner has been diagnosed with MG
- If you have unexplained genital symptoms
- If you have multiple sexual partners
- If you have other STDs, especially recurrent infections
- Before undergoing certain gynecological procedures
Complications of Mycoplasma Genitalium
If left untreated, MG can lead to several serious complications:
- Pelvic Inflammatory Disease (PID)
- Infection of the uterus, fallopian tubes, and ovaries
- Can cause scarring of the reproductive organs
- Associated with 2-4 times increased risk of PID
- Infertility
- Due to fallopian tube damage from PID
- Risk increases with repeated or untreated infections
- Increased risk of preterm birth and spontaneous abortion
- Research suggests association with adverse pregnancy outcomes
- Cervicitis
- Inflammation of the cervix
- Can be persistent despite treatment for other infections
- Urethritis
- Inflammation of the urethra
- May cause painful urination
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- Non-gonococcal urethritis (NGU)
- Leading cause of persistent or recurrent NGU
- May become chronic if not properly treated
- Epididymitis
- Inflammation of the epididymis
- Can cause pain and swelling in the testicles
- Reactive arthritis
- Joint inflammation triggered by infection
- Rare but documented complication
- Prostatitis
- Inflammation of the prostate
- Evidence suggests MG as a possible cause of chronic prostatitis
- Non-gonococcal urethritis (NGU)
- Increased HIV acquisition and transmission risk
- Antibiotic resistance
- MG rapidly develops resistance to antibiotics
- Makes treatment increasingly challenging
- May require multiple treatment attempts
- First identified in 1981 from men with non-gonococcal urethritis
- Genome sequenced in 1995 – was the second bacterial genome ever sequenced
- Contains only 482 genes compared to 4,288 in E. coli
- Requires 3-5 weeks to grow in laboratory culture
- Testing for MG not widely implemented until the 2010s
- CDC officially recognized MG as an STD in 2015
- Accounts for approximately 15-20% of non-gonococcal urethritis cases in men
- Estimated global prevalence of 1-3% in the general population
- Higher prevalence (up to 20%) in certain high-risk populations
- Resistance to azithromycin has increased from <10% to >50% in many regions over the past decade
The Biology of Mycoplasma Genitalium
Mycoplasma Genitalium has several unique biological characteristics:
- Smallest known self-replicating bacterium (about 580 kilobases)
- Lacks a cell wall, making it naturally resistant to many antibiotics
- Slow-growing, with doubling time of approximately 16 hours
- Parasitic lifestyle, requiring host cells to survive
- Intracellular pathogen that can enter host cells
- Contains attachment organelle that facilitates adhesion to host cells
- Produces adhesins (proteins) that attach to epithelial cells
- Limited metabolic capabilities, requiring nutrients from host
- Contains specific genes that trigger inflammation in host
- Highly adaptable and can rapidly develop antibiotic resistance
Infection Process:
- Attaches to epithelial cells using specialized adhesion proteins
- Triggers inflammatory response in host tissues
- Can enter host cells to evade immune system
- Causes cell damage through inflammatory processes
- Can persist for extended periods even with treatment
- Rapidly mutates to develop antibiotic resistance
Mycoplasma Genitalium Treatment
Treatment of MG has become increasingly challenging due to antibiotic resistance:
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Current Treatment Approaches
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Treatment Challenges
-
Important Treatment Considerations
- Recommended first-line treatment:
- Doxycycline (100 mg twice daily for 7 days) followed by
- Azithromycin (1 gram initially, then 500 mg daily for 3 days)
- Alternative treatments:
- Moxifloxacin (400 mg once daily for 7-14 days)
- Pristinamycin (1 gram four times daily for 10 days) – limited availability in the U.S.
- Macrolide resistance (azithromycin) now exceeds 50% in many regions
- Fluoroquinolone resistance (moxifloxacin) is increasing
- Limited treatment options for multiply-resistant strains
- No consensus on optimal regimen for resistant infections
- Test of cure recommended 3-4 weeks after treatment
- Multiple treatment courses may be necessary
- All sexual partners should be treated
- Abstain from sexual activity during treatment and for 7 days after
- Complete the full course of antibiotics even if symptoms resolve
- Follow-up testing is essential to confirm cure
- Drug allergies or intolerances may further limit treatment options
- Pregnancy may affect antibiotic choice
Antimicrobial Resistance in Mycoplasma Genitalium
Antibiotic resistance in MG is a major concern that complicates treatment:
- Macrolide resistance (e.g., azithromycin):
- Caused by mutations in the 23S rRNA gene
- Prevents antibiotics from binding to bacterial ribosomes
- Rates of 30-70% in many countries
- Often develops after single-dose azithromycin treatment
- Fluoroquinolone resistance (e.g., moxifloxacin):
- Caused by mutations in the parC or gyrA genes
- Prevents antibiotics from binding to DNA gyrase or topoisomerase IV
- Rates of 5-30% globally, but increasing
- Tetracycline resistance (e.g., doxycycline):
- Mechanism less well understood
- Doxycycline alone has low efficacy against MG (30-40%)
- Often used in combination with other antibiotics
- Molecular tests can detect genetic mutations associated with resistance
- Resistance-guided therapy is becoming the standard of care
- Not widely available in all clinical settings
- May guide choice of antibiotics
- Particularly important for recurrent infections
Preventing Mycoplasma Genitalium
Preventing MG relies on safe sex practices and appropriate testing:
Prevention Strategies:
- Consistent and correct condom use for vaginal and anal sex
- Regular STD testing if sexually active with multiple partners
- Limiting number of sexual partners
- Mutual monogamy with an uninfected partner
- Open communication with partners about STDs and testing
- Prompt treatment if infected
- Ensuring partners are treated
- Abstaining from sex until treatment is complete
Important Prevention Facts:
- Condoms reduce but don’t eliminate risk
- Standard STD tests don’t include MG
- Specific testing must be requested
- Many people are asymptomatic and unaware of infection
- Partner treatment is essential to prevent reinfection
Mycoplasma Genitalium Research and Emerging Issues
MG is an active area of scientific research with several important emerging issues:
- Improved diagnostic methods
- Development of point-of-care tests
- More accessible testing platforms
- New treatment approaches
- Novel antibiotics active against resistant strains
- Combination therapies to prevent resistance
- Resistance surveillance
- Global tracking of resistance patterns
- Identifying geographic hotspots
- Understanding pathogenesis
- How MG causes disease
- Factors determining symptom development
- Increasing recognition as an important STD
- Growing concern about untreatable infections
- Debate about routine screening recommendations
- Need for antimicrobial stewardship to prevent further resistance
- Potential inclusion in routine STD testing panels
- Economic burden of undiagnosed and untreated infections
MG is similar to chlamydia in terms of symptoms and complications but is more likely to develop antibiotic resistance. It’s not routinely tested for in standard STD panels, making it more likely to go undiagnosed and untreated for longer periods.
Some studies suggest that MG may clear spontaneously in a small percentage of people, but most infections persist without treatment. Even if symptoms resolve, the infection typically remains and can cause complications or be transmitted to partners.
It’s difficult to determine exactly when infection occurred because many people have no symptoms, and the infection can persist for months or years. If you test positive, all recent sexual partners should be notified and tested.
No, MG cannot survive outside the body for long periods. It is transmitted almost exclusively through sexual contact.
No, though the symptoms can be similar. MG is a sexually transmitted bacterial infection, while a urinary tract infection (UTI) typically involves different bacteria that have ascended from the external genitalia or perineum into the bladder. MG requires specific antibiotics different from those commonly used for UTIs.
Not necessarily. MG can persist in the body for months or years without symptoms, so it’s possible that either partner had the infection before the current relationship. Additionally, some people may not know they’re infected because routine STD testing doesn’t usually include MG.
Most standard STD panels do not include testing for MG. You need to specifically ask for MG testing, as it requires specialized nucleic acid amplification tests that aren’t part of routine screening.
Yes, you can be reinfected if you have sexual contact with an infected partner. Having MG once does not provide immunity against future infections.
Learn More About Mycoplasma Genitalium Testing
If you’re concerned about Mycoplasma Genitalium or want to get tested, call (866) 566-8711 to speak with a care advisor who can help you understand your testing options.
LocalSTDTesting is not a substitute for professional medical advice, diagnosis, or treatment.
Always seek the advice of your physician with any questions about medical conditions.
