Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Mycoplasma genitalium infection in men and women

Victoria Mobley, MD, MPH
Arlene C Seña, MD, MPH
Section Editor
Noreen A Hynes, MD, MPH, DTM&H
Deputy Editor
Allyson Bloom, MD


Mycoplasma genitalium is a bacterium that is a common cause of nongonococcal urethritis (NGU) in men [1-4] and an increasingly recognized cause of cervicitis [5-9] and pelvic inflammatory disease (PID) in women [10-15].

M. genitalium infection is discussed here. Other causes of urethritis, cervicitis, and pelvic inflammatory disease are discussed elsewhere. (See "Approach to infectious causes of dysuria in the adult man" and "Acute cervicitis" and "Pelvic inflammatory disease: Clinical manifestations and diagnosis" and "Epidemiology and pathogenesis of Neisseria gonorrhoeae infection" and "Clinical manifestations and diagnosis of Chlamydia trachomatis infections".)

Infections caused by other Mycoplasma species are also discussed in detail elsewhere. (See "Mycoplasma pneumoniae infection in adults" and "Mycoplasma pneumoniae infection in children" and "Mycoplasma hominis and Ureaplasma urealyticum infections".)


M. genitalium was first described in 1981 after being isolated from the urethral specimens of two men diagnosed with nongonococcal urethritis (NGU) [16]. It is a member of the Mycoplasmataceae family and Mollicutes class of bacteria [17]. It lacks a cell wall and is thus not visible following Gram staining. With a genome of only 580 kilobases in size, M. genitalium is the smallest known free-living bacterium. Its genomic structure is similar to the larger and more well-known pathogen Mycoplasma pneumoniae, a cause of atypical bacterial pneumonia [18]. (See "Mycoplasma pneumoniae infection in adults".)

Culture of M. genitalium is difficult, as the organism is fastidious and may require one to two months to grow. Growth is optimal at 37° Celsius in an anaerobic atmosphere of nitrogen with 5 percent CO2 [19]. On culture, M. genitalium does not produce hemolysis, and its colonies look like a "fried egg," having a dense center and paler outer zone. On electron microscopy, the organism has a flask or bottle-like shape.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: May 17, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Falk L, Fredlund H, Jensen JS. Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis. Sex Transm Infect 2004; 80:289.
  2. Totten PA, Schwartz MA, Sjöström KE, et al. Association of Mycoplasma genitalium with nongonococcal urethritis in heterosexual men. J Infect Dis 2001; 183:269.
  3. Taylor-Robinson D. The Harrison Lecture. The history and role of Mycoplasma genitalium in sexually transmitted diseases. Genitourin Med 1995; 71:1.
  4. Jensen JS, Orsum R, Dohn B, et al. Mycoplasma genitalium: a cause of male urethritis? Genitourin Med 1993; 69:265.
  5. Taylor-Robinson D. Mycoplasma genitalium -- an up-date. Int J STD AIDS 2002; 13:145.
  6. Gaydos C, Maldeis NE, Hardick A, et al. Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics. Sex Transm Dis 2009; 36:598.
  7. Anagrius C, Loré B, Jensen JS. Mycoplasma genitalium: prevalence, clinical significance, and transmission. Sex Transm Infect 2005; 81:458.
  8. Falk L, Fredlund H, Jensen JS. Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection. Sex Transm Infect 2005; 81:73.
  9. Manhart LE, Critchlow CW, Holmes KK, et al. Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis 2003; 187:650.
  10. Møller BR, Taylor-Robinson D, Furr PM. Serological evidence implicating Mycoplasma genitalium in pelvic inflammatory disease. Lancet 1984; 1:1102.
  11. Simms I, Eastick K, Mallinson H, et al. Associations between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease. Sex Transm Infect 2003; 79:154.
  12. Haggerty CL, Totten PA, Astete SG, Ness RB. Mycoplasma genitalium among women with nongonococcal, nonchlamydial pelvic inflammatory disease. Infect Dis Obstet Gynecol 2006; 2006:30184.
  13. Cohen CR, Manhart LE, Bukusi EA, et al. Association between Mycoplasma genitalium and acute endometritis. Lancet 2002; 359:765.
  14. Cohen CR, Mugo NR, Astete SG, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect 2005; 81:463.
  15. Clausen HF, Fedder J, Drasbek M, et al. Serological investigation of Mycoplasma genitalium in infertile women. Hum Reprod 2001; 16:1866.
  16. Tully JG, Taylor-Robinson D, Cole RM, Rose DL. A newly discovered mycoplasma in the human urogenital tract. Lancet 1981; 1:1288.
  17. Manhart LE. Mycoplasma genitalium: An emergent sexually transmitted disease? Infect Dis Clin North Am 2013; 27:779.
  18. Svenstrup HF, Jensen JS, Björnelius E, et al. Development of a quantitative real-time PCR assay for detection of Mycoplasma genitalium. J Clin Microbiol 2005; 43:3121.
  19. Taylor-Robinson D, Jensen JS. Mycoplasma genitalium: from Chrysalis to multicolored butterfly. Clin Microbiol Rev 2011; 24:498.
  20. Baseman JB, Cagle M, Korte JE, et al. Diagnostic assessment of Mycoplasma genitalium in culture-positive women. J Clin Microbiol 2004; 42:203.
  21. Razin S, Yogev D, Naot Y. Molecular biology and pathogenicity of mycoplasmas. Microbiol Mol Biol Rev 1998; 62:1094.
  22. Jensen JS. Mycoplasma genitalium infections. Diagnosis, clinical aspects, and pathogenesis. Dan Med Bull 2006; 53:1.
  23. Taylor-Robinson D, Furr PM, Tully JG, et al. Animal models of Mycoplasma genitalium urogenital infection. Isr J Med Sci 1987; 23:561.
  24. Ross JD, Jensen JS. Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment. Sex Transm Infect 2006; 82:269.
  25. McGowin CL, Annan RS, Quayle AJ, et al. Persistent Mycoplasma genitalium infection of human endocervical epithelial cells elicits chronic inflammatory cytokine secretion. Infect Immun 2012; 80:3842.
  26. Vandepitte J, Weiss HA, Kyakuwa N, et al. Natural history of Mycoplasma genitalium infection in a cohort of female sex workers in Kampala, Uganda. Sex Transm Dis 2013; 40:422.
  27. Jensen JS. Mycoplasma genitalium: the aetiological agent of urethritis and other sexually transmitted diseases. J Eur Acad Dermatol Venereol 2004; 18:1.
  28. Manhart LE, Broad JM, Golden MR. Mycoplasma genitalium: should we treat and how? Clin Infect Dis 2011; 53 Suppl 3:S129.
  29. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
  30. 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; 48:1649.
  31. Wikström A, Jensen JS. Mycoplasma genitalium: a common cause of persistent urethritis among men treated with doxycycline. Sex Transm Infect 2006; 82:276.
  32. Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis 2015; 61:418.
  33. Casin I, Vexiau-Robert D, De La Salmonière P, et al. High prevalence of Mycoplasma genitalium in the lower genitourinary tract of women attending a sexually transmitted disease clinic in Paris, France. Sex Transm Dis 2002; 29:353.
  34. Huppert JS, Mortensen JE, Reed JL, et al. Mycoplasma genitalium detected by transcription-mediated amplification is associated with Chlamydia trachomatis in adolescent women. Sex Transm Dis 2008; 35:250.
  35. Oakeshott P, Aghaizu A, Hay P, et al. Is Mycoplasma genitalium in women the "New Chlamydia?" A community-based prospective cohort study. Clin Infect Dis 2010; 51:1160.
  36. Bjartling C, Osser S, Persson K. The association between Mycoplasma genitalium and pelvic inflammatory disease after termination of pregnancy. BJOG 2010; 117:361.
  37. Haggerty CL, Totten PA, Astete SG, et al. Failure of cefoxitin and doxycycline to eradicate endometrial Mycoplasma genitalium and the consequence for clinical cure of pelvic inflammatory disease. Sex Transm Infect 2008; 84:338.
  38. Manhart LE, Holmes KK, Hughes JP, et al. Mycoplasma genitalium among young adults in the United States: an emerging sexually transmitted infection. Am J Public Health 2007; 97:1118.
  39. Cazanave C, Manhart LE, Bébéar C. Mycoplasma genitalium, an emerging sexually transmitted pathogen. Med Mal Infect 2012; 42:381.
  40. Walker J, Fairley CK, Bradshaw CS, et al. Mycoplasma genitalium incidence, organism load, and treatment failure in a cohort of young Australian women. Clin Infect Dis 2013; 56:1094.
  41. Svenstrup HF, Dave SS, Carder C, et al. A cross-sectional study of Mycoplasma genitalium infection and correlates in women undergoing population-based screening or clinic-based testing for Chlamydia infection in London. BMJ Open 2014; 4:e003947.
  42. Manhart LE, Kay N. Mycoplasma genitalium: Is It a Sexually Transmitted Pathogen? Curr Infect Dis Rep 2010; 12:306.
  43. Hancock EB, Manhart LE, Nelson SJ, et al. Comprehensive assessment of sociodemographic and behavioral risk factors for Mycoplasma genitalium infection in women. Sex Transm Dis 2010; 37:777.
  44. Mobley VL, Hobbs MM, Lau K, et al. Mycoplasma genitalium infection in women attending a sexually transmitted infection clinic: diagnostic specimen type, coinfections, and predictors. Sex Transm Dis 2012; 39:706.
  45. Tosh AK, Van Der Pol B, Fortenberry JD, et al. Mycoplasma genitalium among adolescent women and their partners. J Adolesc Health 2007; 40:412.
  46. Andersen B, Sokolowski I, Østergaard L, et al. Mycoplasma genitalium: prevalence and behavioural risk factors in the general population. Sex Transm Infect 2007; 83:237.
  47. Wetmore CM, Manhart LE, Lowens MS, et al. Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study. Sex Transm Dis 2011; 38:180.
  48. Vandepitte J, Muller E, Bukenya J, et al. Prevalence and correlates of Mycoplasma genitalium infection among female sex workers in Kampala, Uganda. J Infect Dis 2012; 205:289.
  49. Bradshaw CS, Chen MY, Fairley CK. Persistence of Mycoplasma genitalium following azithromycin therapy. PLoS One 2008; 3:e3618.
  50. Thurman AR, Musatovova O, Perdue S, et al. Mycoplasma genitalium symptoms, concordance and treatment in high-risk sexual dyads. Int J STD AIDS 2010; 21:177.
  51. Musatovova O, Baseman JB. Analysis identifying common and distinct sequences among Texas clinical strains of Mycoplasma genitalium. J Clin Microbiol 2009; 47:1469.
  52. Hjorth SV, Björnelius E, Lidbrink P, et al. Sequence-based typing of Mycoplasma genitalium reveals sexual transmission. J Clin Microbiol 2006; 44:2078.
  53. Ma L, Taylor S, Jensen JS, et al. Short tandem repeat sequences in the Mycoplasma genitalium genome and their use in a multilocus genotyping system. BMC Microbiol 2008; 8:130.
  54. Gaydos C, Maldeis NE, Hardick A, et al. Mycoplasma genitalium compared to chlamydia, gonorrhoea and trichomonas as an aetiological agent of urethritis in men attending STD clinics. Sex Transm Infect 2009; 85:438.
  55. Mena L, Wang X, Mroczkowski TF, Martin DH. Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans. Clin Infect Dis 2002; 35:1167.
  56. Taylor-Robinson D, Renton A, Jensen JS, et al. Association of Mycoplasma genitalium with acute non-gonococcal urethritis in Russian men: a comparison with gonococcal and chlamydial urethritis. Int J STD AIDS 2009; 20:234.
  57. Johnston LG, Paz-Bailey G, Morales-Miranda S, et al. High prevalence of Mycoplasma genitalium among female sex workers in Honduras: implications for the spread of HIV and other sexually transmitted infections. Int J STD AIDS 2012; 23:5.
  58. Månsson F, Camara C, Biai A, et al. High prevalence of HIV-1, HIV-2 and other sexually transmitted infections among women attending two sexual health clinics in Bissau, Guinea-Bissau, West Africa. Int J STD AIDS 2010; 21:631.
  59. Cohen CR, Nosek M, Meier A, et al. Mycoplasma genitalium infection and persistence in a cohort of female sex workers in Nairobi, Kenya. Sex Transm Dis 2007; 34:274.
  60. Lusk MJ, Konecny P, Naing ZW, et al. Mycoplasma genitalium is associated with cervicitis and HIV infection in an urban Australian STI clinic population. Sex Transm Infect 2011; 87:107.
  61. Soni S, Alexander S, Verlander N, et al. The prevalence of urethral and rectal Mycoplasma genitalium and its associations in men who have sex with men attending a genitourinary medicine clinic. Sex Transm Infect 2010; 86:21.
  62. Mavedzenge SN, Van Der Pol B, Weiss HA, et al. The association between Mycoplasma genitalium and HIV-1 acquisition in African women. AIDS 2012; 26:617.
  63. Horner PJ, Taylor-Robinson D. Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis. Sex Transm Infect 2011; 87:38.
  64. Korte JE, Baseman JB, Cagle MP, et al. Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium. Am J Reprod Immunol 2006; 55:265.
  65. Pépin J, Labbé AC, Khonde N, et al. Mycoplasma genitalium: an organism commonly associated with cervicitis among west African sex workers. Sex Transm Infect 2005; 81:67.
  66. Högdahl M, Kihlström E. Leucocyte esterase testing of first-voided urine and urethral and cervical smears to identify Mycoplasma genitalium-infected men and women. Int J STD AIDS 2007; 18:835.
  67. Moi H, Reinton N, Moghaddam A. Mycoplasma genitalium in women with lower genital tract inflammation. Sex Transm Infect 2009; 85:10.
  68. Short VL, Totten PA, Ness RB, et al. Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease. Clin Infect Dis 2009; 48:41.
  69. Jensen JS, Björnelius E, Dohn B, Lidbrink P. Comparison of first void urine and urogenital swab specimens for detection of Mycoplasma genitalium and Chlamydia trachomatis by polymerase chain reaction in patients attending a sexually transmitted disease clinic. Sex Transm Dis 2004; 31:499.
  70. Shipitsyna E, Zolotoverkhaya E, Dohn B, et al. First evaluation of polymerase chain reaction assays used for diagnosis of Mycoplasma genitalium in Russia. J Eur Acad Dermatol Venereol 2009; 23:1164.
  71. Wroblewski JK, Manhart LE, Dickey KA, et al. Comparison of transcription-mediated amplification and PCR assay results for various genital specimen types for detection of Mycoplasma genitalium. J Clin Microbiol 2006; 44:3306.
  72. Lillis RA, Nsuami MJ, Myers L, Martin DH. Utility of urine, vaginal, cervical, and rectal specimens for detection of Mycoplasma genitalium in women. J Clin Microbiol 2011; 49:1990.
  73. Ross JD, Brown L, Saunders P, Alexander S. Mycoplasma genitalium in asymptomatic patients: implications for screening. Sex Transm Infect 2009; 85:436.
  74. Twin J, Taylor N, Garland SM, et al. Comparison of two Mycoplasma genitalium real-time PCR detection methodologies. J Clin Microbiol 2011; 49:1140.
  75. Patel MA, Nyirjesy P. Role of Mycoplasma and ureaplasma species in female lower genital tract infections. Curr Infect Dis Rep 2010; 12:417.
  76. Shipitsyna E, Savicheva A, Solokovskiy E, et al. Guidelines for the laboratory diagnosis of mycoplasma genitalium infections in East European countries. Acta Derm Venereol 2010; 90:461.
  77. Waites KB, Xiao L, Paralanov V, et al. Molecular methods for the detection of Mycoplasma and ureaplasma infections in humans: a paper from the 2011 William Beaumont Hospital Symposium on molecular pathology. J Mol Diagn 2012; 14:437.
  78. Edberg A, Aronsson F, Johansson E, et al. Endocervical swabs transported in first void urine as combined specimens in the detection of Mycoplasma genitalium by real-time PCR. J Med Microbiol 2009; 58:117.
  79. Jensen JS, Bradshaw CS, Tabrizi SN, et al. Azithromycin treatment failure in Mycoplasma genitalium-positive patients with nongonococcal urethritis is associated with induced macrolide resistance. Clin Infect Dis 2008; 47:1546.
  80. Bissessor M, Tabrizi SN, Twin J, et al. Macrolide resistance and azithromycin failure in a Mycoplasma genitalium-infected cohort and response of azithromycin failures to alternative antibiotic regimens. Clin Infect Dis 2015; 60:1228.
  81. Salado-Rasmussen K, Jensen JS. Mycoplasma genitalium testing pattern and macrolide resistance: a Danish nationwide retrospective survey. Clin Infect Dis 2014; 59:24.
  82. Nijhuis RH, Severs TT, Van der Vegt DS, et al. High levels of macrolide resistance-associated mutations in Mycoplasma genitalium warrant antibiotic susceptibility-guided treatment. J Antimicrob Chemother 2015; 70:2515.
  83. Pond MJ, Nori AV, Witney AA, et al. High prevalence of antibiotic-resistant Mycoplasma genitalium in nongonococcal urethritis: the need for routine testing and the inadequacy of current treatment options. Clin Infect Dis 2014; 58:631.
  84. Touati A, Peuchant O, Jensen JS, et al. Direct detection of macrolide resistance in Mycoplasma genitalium isolates from clinical specimens from France by use of real-time PCR and melting curve analysis. J Clin Microbiol 2014; 52:1549.
  85. Couldwell DL, Tagg KA, Jeoffreys NJ, Gilbert GL. Failure of moxifloxacin treatment in Mycoplasma genitalium infections due to macrolide and fluoroquinolone resistance. Int J STD AIDS 2013; 24:822.
  86. Jensen JS, Fernandes P, Unemo M. In vitro activity of the new fluoroketolide solithromycin (CEM-101) against macrolide-resistant and -susceptible Mycoplasma genitalium strains. Antimicrob Agents Chemother 2014; 58:3151.
  87. Lau A, Bradshaw CS, Lewis D, et al. The Efficacy of Azithromycin for the Treatment of Genital Mycoplasma genitalium: A Systematic Review and Meta-analysis. Clin Infect Dis 2015; 61:1389.
  88. Seña AC, Lensing S, Rompalo A, et al. Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy. J Infect Dis 2012; 206:357.
  89. Schwebke JR, Rompalo A, Taylor S, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis 2011; 52:163.
  90. Björnelius E, Anagrius C, Bojs G, et al. Antibiotic treatment of symptomatic Mycoplasma genitalium infection in Scandinavia: a controlled clinical trial. Sex Transm Infect 2008; 84:72.
  91. Anagrius C, Loré B, Jensen JS. Treatment of Mycoplasma genitalium. Observations from a Swedish STD clinic. PLoS One 2013; 8:e61481.
  92. Falk L, Fredlund H, Jensen JS. Tetracycline treatment does not eradicate Mycoplasma genitalium. Sex Transm Infect 2003; 79:318.
  93. Jernberg E, Moghaddam A, Moi H. Azithromycin and moxifloxacin for microbiological cure of Mycoplasma genitalium infection: an open study. Int J STD AIDS 2008; 19:676.