The Call-On-Doc Guide to Mycoplasma Genitalium

A member of the Mycoplasma genus, like Mycoplasma pneumoniae and Mycoplasma hominis, M. genitalium finds its way into the human body through sexual activity. (2) Transmitted through unprotected sex by both men and women, the infection can infect the penis, cervix, and rectum. It is not confirmed whether the disease can be passed orally or by hand, but the current recommendation is to practice caution in such cases. (1)

Currently, there is no indication that Mgen naturally occurs in the body, infecting the body through unprotected sex. However, the vast majority of cases are often asymptomatic or result in no symptoms. Additionally, the infection lasts inside the body for several months, with some retaining it for over a year and only being aware when symptoms suddenly arise or being prompted to get tested for it specifically. (3) 

It is possible for someone to have both Mgen and bacterial vaginosis at the same time, with bacterial vaginosis often contributing to the development of BV in women. (4) However, there is no evidence that the roles are reversed. As discussed in the CallonDoc Guide to Bacterial Vaginosis, BV naturally occurs in the female body due to an imbalance that causes the overgrowth of bacteria. At the time of writing, Mgen is only transmitted into the human body through sexual activity and is not naturally occurring. 

In the instance that it causes a noticeable infection, Mgen first gains entry into the body by attaching to the mucous membranes inside the rectum, vagina, penis, and urethra. Inherently lacking a cell wall, the STD more easily invades the cell lining of these membranes at a faster rate than other diseases like it. If symptoms are felt, they occur differently depending on the patient’s gender: 

Mycoplasma Genitalium in Women:

• Vaginal Discharge: Women with Mgen infection may notice a change in vaginal discharge. This discharge is often described as abnormal and can vary in color (white, greenish, or yellowish), consistency (thin or watery), and odor.
• Pelvic Pain: Some women with Mgen infection may experience lower abdominal or pelvic pain. This pain can range from mild discomfort to more severe and persistent discomfort in the pelvic area.
• Painful Urination: Dysuria, which is pain or discomfort during urination, can occur. This symptom is often associated with irritation of the urethra or the presence of inflammation in the genital tract.
• Bleeding After Sex: Mgen infection can sometimes lead to post-coital bleeding, which means experiencing bleeding or spotting after sexual intercourse.
• Bleeding Between Periods: Irregular vaginal bleeding, such as spotting or bleeding between menstrual periods, can be a symptom of Mgen infection. This can be concerning and should prompt medical evaluation.

Mycoplasma Genitalium in Men:

• Urethritis: Mgen infection in men often manifests as urethritis, which is inflammation of the urethra. Symptoms of urethritis may include pain or a burning sensation during urination, an increased need to urinate, and discomfort in the genital area.
• Penile Discharge: Some men with Mgen infection may have a clear or cloudy discharge from the penis. This discharge is often noticeable and can be a sign of infection.
• Irritation or Itching: Itching or discomfort in and around the genital area can occur in men with Mgen infection. This sensation is a result of inflammation and irritation caused by the bacterium.

In addition to symptoms occurring in the genitals, Mgen can play a role in developing infections in the anus. CDC research estimates that 3% of rectal infections in all female patients are due to Mycoplasma genitalium, while up to 26% of men in the LGBTQIA+ community suffer rectal infections caused by Mgen. (6)

The prevalence of M. genitalium cannot be understated, not just in the infections that can be felt but in those that go unnoticed. While most asymptomatic cases cause little to no damage to the body, they have been known to remain for months to years until arising in the form of an infection with symptoms or clearing itself out. (7)

Doctors and scientists have struggled with a number of problems surrounding Mycoplasma genitalium. Due to the recency of its discovery compared to other STDs, its capacity to remain asymptomatic for extended periods, and the lack of established tests to identify it in patients are just some of the many problems surrounding the infection. Fortunately, the United States Food and Drug Administration (FDA) has approved three tests to help detect Mgen alongside improved methods of detection that have improved our understanding of how prevalent the infection has become. (8) In the same year the first test was approved, the CDC added Mgen to the list of top three STDs that prove to be the most concerning to the national populace. (9) All of this is to say that thanks to the added national attention and improved resources, M. genitalium is becoming easier to detect in patients reporting correlating symptoms or are getting tested for conditions that are most known to be included in a co-infection.

When a mycoplasma genitalium test kit is deployed on a potential case, the condition is not necessarily difficult to diagnose. Each of the three uses the DNA gathered from either a swab or urine sample and amplifies the results to be viewed in a lab. In the instance that it is tested for, the results tend to be conclusive when the virus is present. With all of that said, the relatively low detection rate of Mgen is not necessarily due to the capability of tests used, but because the STD is still new to some medical providers. Call-On-Doc has been treating and testing for Mycoplasma since its foundation in 2017.

Simply due to how new the STD is and how unusually fast it infects any sexually active population, many doctors will still assume the presence of a more common sexually transmitted disease. In such instances, the more common conditions are tested for and then ruled out until a test for Mgen is considered necessary. That is especially the case when the patient is suffering from conditions like cervicitis or urethritis. (10)

Mycoplasma is an STD that can be transferred from person to person but does not necessarily cause additional STDs by itself. However,  it can lead to other conditions in the reproductive tract, such as:

• Cervicitis: Cervicitis is an inflammation of the cervix, the lower part of the uterus that connects to the vagina. Causing inflammation, vaginal discharge, pelvic pain, and discomfort, cervicitis is a natural result of getting infected by Mgen. (11)
• Pelvic Inflammatory Disease: Mycoplasma genitalium (Mgen) can lead to Pelvic Inflammatory Disease (PID) in women by infecting the cervix and ascending into the upper reproductive tract, including the uterus, fallopian tubes, and ovaries. As Mgen colonizes these structures, it induces inflammation and triggers an immune response. 
• Urethritis: Mycoplasma genitalium can cause urethritis, which is inflammation of the urethra, in both men and women. When Mgen infects the urogenital tract, it can adhere to and invade the mucous membrane lining of the urethra. This invasion triggers an immune response and inflammation, leading to the typical symptoms of urethritis, including pain or discomfort during urination, increased frequency of urination, and discharge from the urethra.

In terms of symptoms, several sexually transmitted infections (STIs) can share similarities with Mycoplasma genitalium (Mgen). Common STIs that can have similar symptoms to Mgen include:

Chlamydia: Chlamydia trachomatis is a bacterial STI that often presents with symptoms such as genital discharge, pain or discomfort during urination, and abdominal pain. Chlamydia can infect the genital and urogenital tract, leading to these symptoms, which can resemble those of Mgen infection. For more information about Chlamydia, read the CallonDoc Guide to Chlamydia. 

Gonorrhea: Neisseria gonorrhoeae is another bacterial STI that can infect the genital and urogenital tract. Symptoms of gonorrhea can include genital discharge, painful urination, and abdominal discomfort. These symptoms may overlap with those of Mgen infection. For more information on Gonorrhea, read the CallonDoc Guide to Gonorrhea. 

Trichomoniasis: Trichomonas vaginalis is a protozoan parasite that infects the genital tract. Symptoms of trichomoniasis in women can include vaginal discharge, itching, and discomfort, which can resemble some of the symptoms of Mgen infection. For more information on trichomoniasis, read the CallonDoc Guide to Trichomoniasis. 

M. genitalium is a complex challenge for healthcare providers due to its genetic makeup and its natural resistance to traditional means of treatment. In addition to most cases being asymptomatic, many are still assumed to be more common STDs like chlamydia, gonorrhea, or trichomoniasis. Some providers who are new to treating mycoplasma might introduce antibiotics that prove ineffective and cause antibiotic resistance. This is especially important to know and be considered when getting treated.

It is thereby important to stress the importance of STD testing when you believe you ultimately have one. At the time of writing, the most effective Mycoplasma genitalium treatment options are doxycycline or azithromycin. (12)

At the time of writing, the CDC favors doxycycline, azithromycin, and moxifloxacin in specific regimens when discussing mycoplasma genitalium treatment. More specifically, if the condition is sensitive to macrolide, doxycycline should be used first before it should be followed up by azithromycin. If the condition is resistant to macrolide, the doxycycline regimen should be followed up by moxifloxacin. In either case, the exact amount and for how long would be left up to your healthcare provider. (13) Call-On-Doc follows the guidance of the CDC and treats mycoplasma according to the government agency’s guidelines.

On top of Mgen lacking a cell wall and therefore being naturally immune to antibiotics that target cell walls, the condition has developed antibiotic resistance to many of the most commonly used STD antibiotics. In many cases, patients must get an additional round of Mycoplasma genitalium treatment due to many strains building immunity against azithromycin. In such instances where a patient develops an antibiotic resistant strain of Mgen, the CDC has developed a treatment failure registry for the healthcare and scientific community to keep track of for the purpose of creating a cure for such a problem. 

When undergoing Mycoplasma genitalium treatment, there are steps you can take to enhance the effectiveness of the treatment and minimize the risk of reinfection or complications:

1. Complete the Full Course of Antibiotics: It's crucial to take the prescribed antibiotics exactly as directed by your healthcare provider. Completing the full course of treatment is essential to ensure that the infection is completely eradicated.
2. Abstain from Sexual Activity: During the course of treatment, it's advisable to abstain from sexual activity or practice safe sex (using condoms) to prevent transmitting the infection to sexual partners and to avoid reinfection.
3. Notify Sexual Partners: Inform your sexual partners about the Mgen infection so that they can seek testing and treatment if necessary. This helps prevent the spread of the bacterium.
4. Follow-Up Testing: After completing treatment, your healthcare provider may recommend follow-up testing to ensure that the infection has been successfully cleared. Follow their guidance on when and how to get retested.
5. Avoid Sexual Contact If You or Your Partner Are Symptomatic: If you or your partner experience symptoms suggestive of an STI, it's best to avoid sexual contact until both individuals have been tested, diagnosed, and, if necessary, treated.
6. Regular STI Testing: If you are sexually active or at risk of STIs, consider regular STI testing as part of your routine healthcare. This can help detect infections early and allow for prompt treatment.
7. Communicate with Your Healthcare Provider: If you experience any new or persistent symptoms after completing treatment for Mgen or have concerns about your sexual health, consult your healthcare provider for further evaluation and guidance.

Knowing if Mycoplasma genitalium (Mgen) is cured typically involves a combination of factors. The primary method is through follow-up testing, also known as a “test of cure,” usually a few weeks after completing the prescribed antibiotic treatment. Healthcare providers may use nucleic acid amplification tests (NAATs) or other molecular techniques to detect the presence of Mgen DNA in genital samples. A negative test result suggests successful clearance of the bacterium. However, it's essential to follow your healthcare provider's recommendations regarding the timing of follow-up testing, as Mgen may require longer treatment durations in some cases. Additionally, the resolution of any symptoms or discomfort associated with the infection can be an indicator of successful treatment. Open communication with your healthcare provider is crucial to ensure proper follow-up and to address any concerns or persistent symptoms effectively.

When looking to get a mycoplasma genitalium test, treatment, or get retested after treatment, choose Call-On-Doc to get the best care possible for your and your partner’s infection. Call-On-Doc is known for its discreet, same-day treatment without appointments or expensive visits. Get started now and pick-up your treatment in just a few hours.

1. “STD Facts - Mgen.” CDC, 16 November 2022, https://www.cdc.gov/std/mgen/stdfact-Mgen.htm.
2. Sethi S, Singh G, Samanta P, Sharma M. Mycoplasma genitalium: an emerging sexually transmitted pathogen. Indian J Med Res. 2012 Dec, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612323/. 
3. Romano SS, Jensen JS, Lowens MS, Morgan JL, Chambers LC, Robinson TS, Totten PA, Soge OO, Golden MR, Manhart LE. Long Duration of Asymptomatic Mycoplasma genitalium Infection After Syndromic Treatment for Nongonococcal Urethritis. Clin Infect Dis. 2019 Jun 18, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6579957/. 
4. Nye MB, Harris AB, Pherson AJ, Cartwright CP. Prevalence of Mycoplasma genitalium infection in women with bacterial vaginosis. BMC Womens Health. 2020 Mar 26, https://pubmed.ncbi.nlm.nih.gov/32216785/.
5. Peel, Joanne et al. “Recent advances in understanding and combatting Mycoplasma genitalium.” Faculty reviews vol. 9 3. 30 Oct. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886083/. 
6. “Detailed STD Facts - Mgen.” CDC, https://www.cdc.gov/std/mgen/stdfact-Mgen-detailed.htm.
7. Romano, Sarah S et al. “Long Duration of Asymptomatic Mycoplasma genitalium Infection After Syndromic Treatment for Nongonococcal Urethritis.” Clinical infectious diseases: an official publication of the Infectious Diseases Society of America vol. 69,1 (2019), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6579957/. 
8. Yu, Jianwei et al. “Mycoplasma genitalium infection in the female reproductive system: Diseases and treatment.” Frontiers in microbiology vol. 14 1098276. 21 Feb. 2023, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9989269/. 
9. “2019 Antibiotic Resistance Threats Report.” CDC, https://www.cdc.gov/drugresistance/biggest-threats.html#myco.
10. Boskey, Elizabeth, and Kashif J. Piracha. “How Mycoplasma Genitalium Is Diagnosed.” Verywell, Verywell Health, 13 September 2023, https://www.verywellhealth.com/how-do-i-get-tested-for-mycoplasma-genitalium-3132760.
11. “Detailed STD Facts - Mgen.” CDC, https://www.cdc.gov/std/mgen/stdfact-Mgen-detailed.htm.
12. Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect Dis. 2009 Jun 15;48(12), https://pubmed.ncbi.nlm.nih.gov/19438399/. 
13. “Mycoplasma genitalium - STI Treatment Guidelines.” CDC, 22 July 2021, https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm.