Clinical Information on Mycoplasma Genitalium

Basic information Mycoplasma Genitalium


  • The bacterium Mycoplasma genitalium was isolated for the first time in 19801
  • There is increasing evidence that the bacterium can cause urogenital symptoms and infection
  • The bacterium is also found in asymptomatic individuals


  • The prevalence of Mycoplasma genitalium depends on the population under study:
    • In a South African study screening among 21-23 year-old men and women were found the prevalence of M.genitalium in women to 2.3% (21/921) in men and 1.1% (8/731)2
    • In a Swedish study from a Venereology clinic found a high incidence of M.genitalium in male patients who presented with persistent or recurrent symptoms of urethritis, after being treated with doxycycline from microscopically verified non-gonorrhoisk urethritis, so 32 / 78 (41%)3

Etiology and pathogenesis

  • The bacterium is found intracellularly and are very difficult to grow
  • Different from other bacteria by the lack of a cell wall; This makes it insensitive to penicillins and cephalosporins
  • An increasing number of studies demonstrating a strong association between M. genitalium and non-gonorrhoisk urethritis (NGU), and especially non-chlamydia NGU (NCNGU) in men and cervicitis in females, as well as an association between endometritis and M.genitalium in women4
  • There is evidence that M. genitalium is transmitted through sexual transmission, including high concordance of M.genitalium genotypes in infected couple
  • More patients with M.genitalium have symptomatic urethritis than asymptomatic urethritis
  • Co-infection with Chlamydia trachomatis is not frequent

predisposing factors

  • Sexual intercourse with infected person


  • U72 Urinrørsbetændelse
  • X74 Pelvic inflammatory disease


  • N34 Urinrørsbetændelse and uretrasyndrom
  • N341 Infectious urethritis UNS
  • N342 Other types of urethritis
  • N343 urethral syndrome UNS
  • N370 urethritis v disease KA


diagnostic criteria

  • Positive PCR for Mycoplasma genitalium
    • The bacteria are difficult to grow
  • In practice, the diagnosis is often the symptoms and exclusion of differential diagnoses:
    • Pain during urination and possible urethral discharge in men and women; possibly slightly increased vaginal discharge in women
    • Negative PCR test for Chlamydia trachomatis and possibly also negative testing for gonorrhea


  • chlamydia
  • gonorrhea
  • Non-specific urethritis for another reason

Medical history

  • in men
    • Urethritis with dysuria and / or discharge
    • Chronic or recurrent urethritis seen in patients who initially for non-gonorrhoisk urethritis have been treated with an inadequate acting antibiotics to M.genitalium
    • It is unclear to what extent M. genitalium is the cause of complications such as epididymitis, prostatitis and reactive arthritis
  • in women
    • Urethritis and cervicitis with dysuria and vaginal discharge
    • There is increasing studies suggest an association between M.genitalium and pelvic inflammatory disease in the form of endometritis and / or salpingitis
    • It is not clear whether, and to what extent, infection with M.genitalium in women is associated with infertility

clinical findings

  • Any urethral or vaginal discharge

Additional studies in general practice

  • Chlamydia PCR test and the detection of gonorrhea
  • Mycoplasma test
    • Urine and cervical or vaginal. The urine sample is given not more than 2 hours after final urination and collected in sterile glass tip.
    • Where urine samples are not available urethral swab (eSwab)
    • The PCR test is the only relevant diagnostic testing to detect M. genitalium ; this is available at Statens Serum Institut, either as single study or in combination with PCR for C. trachomatis and Ureaplasma urealyticum
  • indication
    • Patients with symptoms and discomfort of urethritis / cervicitis
    • Contacts of infection in patients with established infection


Treatment goals

  • Elimination of the microbe

Generally about the treatment

  • Clinical experience and studies have shown that  azithromycin has better effect than  doxycycline and  erythromycinfor eradication is of M. genitalium3But once dose  azithromycin has been shown to induce resistance in a number of cases with urethritis5
  • Verified by microscopic non-gonorrhoisk urethritis, and in response to studies become available, which is treated with tabl.  doxycycline100 mg x 2 for 7 days in order to reduce the risk of developing azithromycinresistens relative to M.genitalium

Medical treatment

  • azitromycin:
    • azitromycin 500 mg x 1 first day of treatment and 250 mg x 1 for the subsequent four days5
  • Detected by mutation, ie azithromycinresistens:
    • moxifloxacin 400 mg x 1 for 7 days

Course, complications and prognosis


  • Commonly is acute urethritis, but it has been documented that the condition may be chronic or recurrent


  • Epididymitis and prostatitis?
  • Can lead to endometritis / salpingitis, and thereby chronic pelvic pain and possibly reduced fertility


  • Good with proper treatment


  • After Checking with new urine sample or urethrapodning and cervical or vaginal should be done 4-5 weeks after treatment
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