Intended for healthcare professionals

Practice Practice Pointer

Mycoplasma genitalium infection

BMJ 2019; 367 doi: (Published 18 October 2019) Cite this as: BMJ 2019;367:l5820
  1. Nicolas Pinto-Sander, specialist registrar in sexual health and HIV,
  2. Suneeta Soni, consultant physician in sexual health and HIV
  1. Sexual Health and HIV, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5B, UK
  1. Correspondence to: N Pinto-Sander nicolas.pinto-sander{at}

What you need to know

  • Mycoplasma genitalium is a sexually transmitted infection that is asymptomatic in most people but can cause urogenital symptoms

  • Testing is indicated in men with non-gonococcal urethritis and in women with pelvic inflammatory disease, and their current partners, but screening is not recommended

  • Testing and management of M genitalium are complex and should be undertaken in a genitourinary setting

  • Treatment options are limited because of high rates of macrolide resistance, which have probably resulted from the overuse of single dose azithromycin

  • Azithromycin 1 g as a single dose should no longer be used for any sexually transmitted infection

Mycoplasma genitalium has been dubbed the latest superbug by the media.1 While the inference that this sexually transmitted infection is untreatable is incorrect, the relative ease by which M genitalium develops resistance is of great concern and presents challenges in treatment. This practice pointer provides an overview of M genitalium infection including practical advice for non-specialists on diagnosis and management.

What is Mycoplasma genitalium?

M genitalium is the smallest known self replicating bacterium.2 It lacks a cell wall and hence cannot be detected on Gram staining of a specimen.2 M genitalium is predominantly found in the genitourinary tract of both sexes. It evades the adaptive immune system by establishing intracellular infection (possibly due to its tip-like structure), but also by antigenic and phase variation of its surface-expressed proteins.23

M genitalium infection may persist for months or years in asymptomatic individuals. It is found in genital specimens of 15-25% of men with non-gonococcal urethritis2 and 10-13% of women with pelvic inflammatory disease.45 Although the pathological consequences of M genitalium infection are thought mainly to be due to host response, M genitalium has been shown to directly cause cilial damage in human fallopian cell culture.26

Who gets M genitalium?

The prevalence of M genitalium …

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