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Mycoplasma genitalium Management in Adults

Lead Author: , MD, MPH; Writing Group: , MD, AAHIVS, , MD, MPH, AAHIVS, , MD, PhD, , MD, FACP, FIDSA, AAHIVS, , MD, FIDSA, , MD, MPH, PhD, FACP, AAHIVS, , MD, MSPH, , MD, , MPH, MS, , MD, MPH, MSc, FACP, , DO, MPH, and , MD; on behalf of Medical Care Criteria Committee .

Baltimore (MD): Johns Hopkins University; .
Updates, Authorship, and Related Resources

Developer and funding source

New York State Department of Health AIDS Institute (NYSDOH AI)

Intended users

Clinicians who manage sexually transmitted infections in adults aged 18 years and older

Development

See Supplement: Guideline Development and Recommendation Ratings

Updates

June 10, 2026
  • Global: Discussion and references updated throughout
  • Laboratory Testing and Diagnosis section: Pelvic inflammatory disease (PID) added to the following recommendation: Clinicians should test for M. genitalium in individuals with persistent or recurrent urethritis or cervicitis, or with PID. (B2)
  • Treatment section:
    • New recommendation: When managing M. genitalium treatment failure, clinicians should obtain macrolide resistance testing to guide antimicrobial selection. (A2)
    • New recommendation: For ongoing sex partners of individuals with symptomatic M. genitalium infection, clinicians should offer testing and treat those with positive M. genitalium test results. (B3)
    • Recommendation removed: When M. genitalium testing is unavailable, clinicians should treat patients when there is a high clinical index of suspicion for M. genitalium infection and other STIs have been reasonably excluded from the differential diagnosis. (B3)
    • Table 1 updated: Section removed on what to do if M. genitalium nucleic acid amplification testing is unavailable, as testing is now widely available

Author and writing group conflict of interest disclosures

See Conflict of Interest statement*

Related NYSDOH AI resources

Guidance

Podcast

Purpose of This Guideline

Date of current publication: June 10, 2026 Lead author: Daniela E. DiMarco, MD, MPH Writing group: Rona M. Vail, MD, AAHIVS; Sanjiv S. Shah, MD, MPH, AAHIVS; Steven M. Fine, MD, PhD; Joseph P. McGowan, MD, FACP, FIDSA, AAHIVS; Samuel T. Merrick, MD, FIDSA; Asa E. Radix, MD, MPH, PhD, FACP, AAHIVS; Anne K. Monroe, MD, MSPH; Marguerite A. Urban, MD; Jessica Rodrigues, MPH, MS; Brianna L. Norton, DO, MPH; Christopher J. Hoffmann, MD, MPH, MSc, FACP; Charles J. Gonzalez, MD Committee: Medical Care Criteria Committee Date of original publication: September 28, 2020

The New York State Department of Health AIDS Institute (NYSDOH AI) Clinical Guidelines Program developed this guideline to address the care of adults with and without HIV who have acquired sexually transmitted Mycoplasma genitalium infection, with the goals of:

  • Assisting clinicians in recognizing common clinical manifestations of M. genitalium infection
  • Providing clinicians with evidence-based recommendations on screening, diagnostic testing, and treatment of M. genitalium infection
  • Ensuring New York State recommendations for M. genitalium screening, diagnosis, and treatment reflect the rapidly evolving evidence on the organism, infection, potential complications, and implications of drug resistance

M. genitalium is a well-recognized cause of sexually transmitted infections (STIs) worldwide and is linked to urethritis, cervicitis, and pelvic inflammatory disease, yet much is still unknown about the organism, infection, and potential complications. Treatment of M. genitalium infection is challenging in an era of increasing antimicrobial resistance across multiple drug classes. Emerging antimicrobial resistance worldwide has become a concern, and specific testing strategies and treatment recommendations in the United States and elsewhere have been implemented to address this issue.

Prevalence of M. genitalium infection: The prevalence of M. genitalium infection varies depending on the clinical setting and population being tested. In a large U.S. cohort of participants with and without STI symptoms in varied clinical settings, overall M. genitalium prevalence was approximately 10% [Gaydos, et al. 2019]. In the MyGeniUS study, which examined M. genitalium prevalence and resistance mutations in STI clinics across the United States, overall prevalence was slightly higher at 16.6% [Manhart, et al. 2023]. Prevalence has consistently been higher among individuals younger than 21 years [Manhart, et al. 2023; Menezes, et al. 2023]. M. genitalium prevalence among people with HIV in North America is estimated to be 20% [Zhang, et al. 2025]. Data from multiple countries and populations that include a mix of symptomatic and asymptomatic individuals suggest that asymptomatic M. genitalium infection is common [Calas, et al. 2021; Gesink, et al. 2016; Huppert, et al. 2008; Manhart, et al. 2007].

Clinical Manifestations

Although asymptomatic infection is common, Mycoplasma genitalium infection has been associated with the clinical syndromes of urethritis, cervicitis, and pelvic inflammatory disease (PID). The relationships between M. genitalium and cervicitis and urethritis have been established, with the strongest association seen with urethritis [CDC 2021; Dehon, et al. 2016; Lis, et al. 2015; Lusk, et al. 2011; Gaydos, et al. 2009; Wikström and Jensen 2006; Mena, et al. 2002; Totten, et al. 2001]. Symptoms are typically similar to those seen with chlamydial urethritis (nonpurulent urethral discharge) as opposed to gonococcal urethritis (frankly purulent discharge).

A 2023 systematic review and meta-analysis found that M. genitalium, detected by nucleic acid amplification testing, was associated with 67% greater odds of PID [Htaik, et al. 2024]. A randomized trial comparing the addition of metronidazole or placebo to standard PID treatment (ceftriaxone plus doxycycline) noted a statistically significant reduction in detection of M. genitalium 30 days after treatment in the metronidazole arm [Wiesenfeld, et al. 2021]. More recently, in a study conducted in sexually transmitted infection clinics in the United States, infection with M. genitalium was associated with bacterial vaginosis (odds ratio, 3.08; 95% confidence interval, 1.58–5.99, P=.0113), although control for other factors associated with BV was limited [Schwebke, et al. 2024]. Some experts suggest these findings implicate the influence of the vaginal microbiome on M. genitalium, but further investigation is needed [Mitchell, et al. 2021].

M. genitalium has been identified at various anatomic sites [Baiers, et al. 2024; Yazdy, et al. 2023]. Currently there is no evidence that M. genitalium is a cause of pharyngitis and insufficient evidence that it is a cause of vaginitis, proctitis, or epididymo-orchitis [Baiers, et al. 2024; Yazdy, et al. 2023; Manhart, et al. 2022; Read, et al. 2019; Horner and Martin 2017].

Laboratory Testing and Diagnosis

RECOMMENDATIONS

Laboratory Testing and Diagnosis

  • Clinicians should not routinely screen for Mycoplasma genitalium in asymptomatic individuals. (A3)
  • Clinicians should test for M. genitalium in individuals with persistent or recurrent urethritis or cervicitis, or with PID. (B2)
  • When testing is indicated, clinicians should use NAAT to diagnose M. genitalium infection, with reflex to resistance testing when available. (A1)

Abbreviations: NAAT, nucleic acid amplification testing; PID, pelvic inflammatory disease.

M. genitalium has no cell wall and can take months to grow in culture; thus, traditional methods of diagnosis with gram stain or culture are not useful. Diagnosis was difficult until NAAT became available. NAAT is the preferred U.S. Food and Drug Administration (FDA)-approved diagnostic method for M. genitalium infection. FDA-approved tests currently cleared for use on urine, vaginal, endocervical, urethra, and penile meatus specimens are the Aptima Mycoplasma Genitalium Assay (Hologic Inc) and Cobas TV/MG Assay (Roche Molecular Systems, Inc.). The latter detects both M. genitalium and Trichomonas vaginalis from a single specimen. For both assays, FDA labeling indicates vaginal specimens are preferred for females and urine specimens are preferred for males. Specimens may be self-collected or clinician collected. The Alinity m STI assay (Abbott Molecular, Inc.) detects M. genitalium, T. vaginalis, Neisseria gonorrhoeae, and Chlamydia trachomatis from a single specimen and is validated for self-collected or clinician-collected vaginal swabs or urine specimens. The cobas® liat CT/NG/MG (Roche Molecular Systems, Inc.) assay, a point-of-care Clinical Laboratory Improvement Amendments of 1988 (CLIA)-waived assay for use by nonlaboratory personnel, was approved in 2025 and detects C. trachomatis, N. gonorrhoeae, and M. genitalium from a clinician- or self-collected vaginal swab or urine specimen.

The specimen and site of optimal sensitivity for testing in transgender individuals with a neopenis or neovagina have not been evaluated.

Screening: Available evidence does not support routine screening for M. genitalium in asymptomatic individuals or in any specific population [ASHM 2025; Soni, et al. 2025; Baiers, et al. 2024; Manhart, et al. 2023; Yazdy, et al. 2023; Brehony, et al. 2022; Jensen, et al. 2022; Manhart, et al. 2022; CDC 2021; Golden, et al. 2017; Horner and Martin 2017], and the Centers for Disease Control and Prevention (CDC) recommends against routine screening of asymptomatic individuals [CDC 2021]. Prevalence estimates of M. genitalium in the general population are low, antimicrobial resistance is increasing, the implications of asymptomatic infection are unknown, and treatment options are limited [CDC 2021; Fernández-Huerta, et al. 2020; Baumann, et al. 2018; Golden, et al. 2017; Horner and Martin 2017]. Spontaneous clearance of asymptomatic M. genitalium has been described in both men and women and is often cleared with standard treatment for sexually transmitted infection (STI) syndromes when either azithromycin or doxycycline are included in the regimen [Berdoyes, et al. 2026; Roy, et al. 2026; Ring, et al. 2022].

At present, there is insufficient evidence regarding pregnancy complications and treatment benefits to recommend for or against screening in asymptomatic pregnant individuals [Chen, et al. 2023; Frenzer, et al. 2022; Wiesenfeld and Manhart 2017].

Diagnostic testing: The 2021 CDC STI treatment guidelines specify that M. genitalium testing not be performed in initial testing for presenting STI syndromes of cervicitis or urethritis, and to consider testing in individuals with PID [CDC 2021]. The recommended use of diagnostic testing for M. genitalium in the United States has been limited to individuals with persistent or recurrent symptoms, because of low rates of detection and because many empiric treatment regimens for STIs include drugs that have activity against M. genitalium and have been demonstrated to clear infection in approximately 56% to 86% of cases [Roy, et al. 2026]. The standard of care for PID (as recommended by the CDC) includes metronidazole, which has activity against M. genitalium, and its inclusion in PID treatment was demonstrated to reduce M. genitalium in follow-up [Wood, et al. 2023; CDC 2021; Wiesenfeld, et al. 2021].

Vaginal symptoms have not been strongly associated with detection of M. genitalium, different from the diagnoses of cervicitis or urethritis, specifically [Manhart, et al. 2023; Yazdy, et al. 2023; Brehony, et al. 2022; Latimer, et al. 2022]. Diagnoses of persistent, recurrent urethritis in STI clinics have been increasing since 2015, and it is suspected that M. genitalium and other pathogens not identified by routine testing may play a role [Llata, et al. 2024]. San Francisco City Clinic implemented doxycycline as initial therapy for nongonococcal urethritis (NGU) along with M. genitalium testing at initial visits, and found that this strategy reduced visits for persistent or recurrent NGU from 8% to 3% (P<.0001) [Johnson, et al. 2023]; however,  it is unclear which intervention led to this change, as more than half of infections may be cured by doxycycline alone, and 69% of patients had no microbiologic diagnosis, compared with 82% before intervention.

International guidelines recommend that M. genitalium testing be reserved for symptomatic individuals and ongoing sex partners of individuals who test positive; however, recommendations for timing of testing (e.g., initial for acute symptoms or STI syndromes vs. second-line for persistent/recurrent symptoms) differ [ASHM 2025; Soni, et al. 2025; Jensen, et al. 2022; Public Health Agency of Canada 2022].

This evolving body of evidence demonstrates that the optimal timing for diagnostic testing for M. genitalium remains uncertain. This committee suggests limiting M. genitalium testing to circumstances in which STI signs or symptoms persist despite empiric treatment for gonorrhea and chlamydia.

Testing of sex partners: There is little evidence to date to guide the management for sex partners of individuals diagnosed with M. genitalium infection. The CDC and most international guidelines suggest limiting M. genitalium testing and treatment to ongoing sex partners of individuals diagnosed and treated for symptomatic M. genitalium infection (see guideline section Treatment > Partner Treatment for more detail).

KEY POINT
  • Routine screening is not recommended, and diagnostic testing is reserved for individuals who:
    • Have persistent symptoms of urethritis, cervicitis, or PID despite therapy for gonorrhea and chlamydia
    • Are current sex partners of individuals treated for symptomatic M. genitalium infection

Resistance testing: Molecular tests that detect both M. genitalium and antibiotic-associated resistance mutations are available. ARUP Laboratories and LabCorp offer macrolide reflex testing approved for use in New York State for NAAT-positive specimens. The association of certain resistance mutations with clinical treatment failure is inconsistent for quinolone antibiotics [Yuan, et al. 2025; Conway, et al. 2020], and quinolone resistance assays are not currently available commercially in the United States. However, resistance testing has been demonstrated to be a clinically useful tool to guide treatment, resulting in high cure rates, as evidenced by the resistance-guided antimicrobial therapy model (see guideline section Treatment) [Durukan, et al. 2020]. To optimally deliver 2-step resistance-guided therapy, diagnostic testing should include reflex to macrolide resistance testing when available.

Treatment

RECOMMENDATIONS

Treatment

  • Clinicians should treat patients with urethritis (A2), cervicitis (A2), and PID (B2) caused by Mycoplasma genitalium infection as recommended in Table 1: Recommended Antimicrobial Regimens for Mycoplasma genitalium Treatment.
  • When managing  M. genitalium treatment failure, clinicians should obtain macrolide resistance testing to guide antimicrobial regimen selection. (A2)
  • For ongoing sex partners of individuals with symptomatic M. genitalium infection, clinicians should offer testing and treat those with positive M. genitalium test results. (B3)

Abbreviation: PID, pelvic inflammatory disease.

Azithromycin, doxycycline, and moxifloxacin are the most frequently used antibacterial agents for treatment of M. genitalium infection (see Table 1, below). There is geographic variability in cure rates and prevalence of antimicrobial resistance with respect to these antibiotics. Rates of microbiologic cure with use of single-antibiotic regimens in a New York City population, excluding sequential therapy, were 82% with moxifloxacin, 43% with single-dose azithromycin, 31% with a multiday course of azithromycin, and 60% with doxycycline [Mullis, et al. 2024]. In France, however, the cure rate with single-dose azithromycin was relatively high at 86% (18/21) of cases, and doxycycline cured 55.6% (10/18) [Roy, et al. 2026].

Antimicrobial Resistance

In the MyGeniUS study, the prevalence of macrolide resistance-associated mutations among included sexually transmitted infection (STI) clinics across 4 regions in the United States was 59.1%, with values ranging from 51.3% to 70.6% [Manhart, et al. 2023]. Although not statistically significant, a systematic review examining resistance mutations in M. genitalium globally through 2023 noted an overall downward trend in macrolide resistance mutations to 33.3%, and stable overall prevalence of the primary mutation conferring fluoroquinolone resistance at 14% [Chua, et al. 2025]. Factors associated with macrolide resistance mutations include male-to-male sexual contact, use of HIV pre-exposure prophylaxis, a recent STI, recurrent bacterial STIs, STI coinfection, and use of antibiotics within the previous 30 days [Chua, et al. 2025; Sokoll, et al. 2023; De Baetselier, et al. 2022; Bercot, et al. 2021; Broad, et al. 2021; De Baetselier, et al. 2021; de Salazar, et al. 2021; Latimer, et al. 2020; Li, et al. 2020; Anagrius, et al. 2013].

Several medications have been studied for M. genitalium treatment after initial treatment failure. Minocycline cured 67% to 71% of M. genitalium infections in small observational studies [Clarke, et al. 2023; Bachmann, et al. 2020; Doyle, et al. 2020]. Metronidazole and tinidazole have activity against M. genitalium, and when metronidazole has been combined with minocycline or doxycycline, cure rates are 80% or higher [Htaik, et al. 2025; Wood, et al. 2023; Wiesenfeld, et al. 2021]. Monotherapy with nitroimidazoles may also be effective, but evidence is limited to case reports and in vitro data [Liscynesky, et al. 2025; Wood, et al. 2023]. Newer agents such as omadacycline, zoliflodacin, and gepotidacin have demonstrated activity against M. genitalium in vitro [Waites, et al. 2022; Jensen, et al. 2020; Damiao Gouveia, et al. 2018], but no in vivo efficacy data are available. A 2023 case report from the United Kingdom describes successful treatment with chloramphenicol for persistent urethritis with macrolide resistance [Goodfellow, et al. 2023]. Pristinamycin (of varying dosing strategies) has demonstrated cure rates of approximately 75%, and case reports describe its use in combination with other medications discussed above, but pristinamycin is not available in the United States [Raccagni, et al. 2023; Doyle, et al. 2020].

Two-Step Treatment Approach

Updates to treatment recommendations in the United States and elsewhere address the emerging concern of antimicrobial resistance across multiple drug classes. With evidence of increasing macrolide resistance and treatment failures associated with a single dose of azithromycin 1 g, in 2021, the Centers for Disease Control and Prevention (CDC) recommended against use of this regimen in favor of 2-step antibiotic therapy [Horner, et al. 2018; Gesink, et al. 2016; Manhart, et al. 2013]. Pretreatment with doxycycline has been shown to decrease the overall bacterial burden, making treatment with a second follow-up drug more efficacious [Durukan, et al. 2020; Anagrius, et al. 2013; Björnelius, et al. 2008].

Table 1, below, outlines recommended antimicrobial regimens for M. genitalium treatment.

Table 1Recommended Antimicrobial Regimens for Mycoplasma genitalium Treatment [a]

Selected Conditions Oral Regimens Considerations
Resistance testing unavailable

or

Macrolide resistant

Doxycycline 100 mg twice daily for 7 days

followed by

moxifloxacin 400 mg once daily for 7 days
  • Pregnancy: Doxycycline and moxifloxacin are generally not recommended [b].
  • Preferred for PID: 14-day moxifloxacin-containing regimen [c]
Macrolide susceptible

or

Moxifloxacin unavailable

Doxycycline 100 mg twice daily for 7 days

followed by

azithromycin 1 g on day 1

followed by

azithromycin 500 mg once daily for 3 days
  • Persistent symptoms: If regimen is used in the absence of macrolide-susceptibility testing, perform test of cure 21 days after treatment completion [CDC 2021].
  • Pregnancy: Doxycycline is generally not recommended [b].

Abbreviations: FDA, U.S. Food and Drug Administration; NAAT, nucleic acid amplification testing; PID, pelvic inflammatory disease; STI, sexually transmitted infection.

Notes:

a

M. genitalium detected by FDA-approved NAAT.

b

See guideline section Treatment > Pregnancy.

c

A 14-day regimen containing moxifloxacin (400 mg per day) is effective for PID treatment [Ovens, et al. 2020; Latimer, et al. 2019; Judlin, et al. 2010; Ross, et al. 2006], in addition to an empiric 14-day regimen for PID that contains doxycycline [CDC 2021]. The evaluation and treatment of PID are not limited to the management discussed here.

The CDC 2021 sexually transmitted infection (STI) Treatment guidelines include treatment recommendations for uncomplicated chlamydial infections, nongonococcal urethritis, and cervicitis with oral doxycycline 100  mg twice daily for 7 days [CDC 2021]. This facilitates use of a 2-step doxycycline-containing regimen for individuals with persistent or recurrent urethritis or cervicitis who return for follow-up. Standard empiric therapy for PID also includes doxycycline as a component. The CDC recommends that when testing results become available after treatment initiation in cases of PID attributed to M. genitalium, moxifloxacin should be added to the empiric PID regimen rather than given sequentially [CDC 2021]. For PID related to M. genitalium or the PID clinical syndrome in general, a 14-day course of moxifloxacin was found to be effective [Ovens, et al. 2020; Latimer, et al. 2019; Judlin, et al. 2010; Ross, et al. 2006]. Because of emerging resistance overall and a lack of treatment alternatives, Australian, Canadian, and European STI guidelines do not recommend moxifloxacin for initial empiric treatment of M. genitalium infection [ASHM 2025; Soni, et al. 2025; Jensen, et al. 2022; Public Health Agency of Canada 2022], although, notably, access to antimicrobial resistance testing outside the United States is more widely accessible to guide treatment selection.

Australian and British treatment guidelines also recommend a 2-step treatment approach [ASHM 2025; Soni, et al. 2025]. In Australia, cure rates reached more than 90% with the implementation of resistance-guided therapy (RGT) [Vodstrcil, et al. 2022; Durukan, et al. 2020]: Individuals with an STI syndrome received 7 days of oral doxycycline 100  mg twice daily empirically and then, if found to have M. genitalium infection without macrolide resistance, received 2.5 g oral azithromycin over 4 days (1 g on day 1 and 500  mg once daily on days 2 through 4). After initial treatment with doxycycline, individuals with macrolide-resistant M. genitalium infection received oral moxifloxacin 400 mg once daily for 7 days. A test of cure was performed 2 to 4 weeks after treatment. The cure rate with the RGT approach was 92%, even in regions with reported quinolone resistance of 15% to 20% [Durukan, et al. 2020]. Use of doxycycline followed by moxifloxacin or sitafloxacin (not available in the United States) continued to result in high cure rates [Yuan, et al. 2025; Vodstrcil, et al. 2022].

Treating asymptomatic M. genitalium infection: Asymptomatic M. genitalium infection is common, and the benefit of treating asymptomatic individuals has not been clearly demonstrated. There is a theoretical benefit to treating asymptomatic ongoing partners of individuals with symptomatic infection (see Partner Treatment, below); treatment of asymptomatic M. genitalium is otherwise not recommended.

Test of cure: The timeframe used for test of cure in the published literature is highly variable. Testing too soon after treatment carries the risk of detecting residual noninfectious particles. The CDC recommends a test of cure at 21 days for those treated with the 2-step doxycycline plus azithromycin regimen (see Table 1, above) who did not complete macrolide resistance testing [CDC 2021]. This committee prefers that test of cure be reserved for patients who remain symptomatic and obtained no sooner than 21 days after treatment.

STI coinfection: When coinfection with another STI is present, it remains unclear based on available evidence whether M. genitalium is a true pathogen requiring treatment. If M. genitalium is detected in a patient with another STI, this committee recommends reserving treatment for M. genitalium for those with persistent symptoms despite appropriate treatment of the other infection (e.g., gonorrhea, chlamydia, trichomoniasis).

Managing Treatment Failure

It is important to distinguish between reinfection and treatment failure; see Partner Treatment, below. To aid in management of M. genitalium infection, macrolide resistance testing (if not already performed at diagnosis) should be obtained to help guide antimicrobial regimen selection going forward. For individuals with persistent infection despite treatment with recommended 2-step therapy, minocycline 100 mg orally twice daily for 14 days is an option supported by observational data [Clarke, et al. 2023; Doyle, et al. 2020]. If this regimen is unsuccessful, nitroimidazoles may be considered, although optimal drug choice and dosing vary. In cases of treatment failure across multiple drug classes and detected macrolide resistance, treatment options with case reports of success include the following: 1) minocycline 100 mg orally twice daily combined with metronidazole 500 mg orally twice daily for 14 days (tinidazole 2 g orally once daily may be substituted for the twice daily metronidazole), and 2) tinidazole 2 g orally once daily for 7 days [Htaik, et al. 2025; Liscynesky, et al. 2025; Wood, et al. 2023].

KEY POINT
  • Consult an infectious disease or STI expert for individuals who have persistent infection despite salvage therapy, for consideration of alternative therapies and drug combinations (see Antimicrobial Resistance, above).

Pregnancy

Moxifloxacin and doxycycline are generally not recommended for pregnant individuals. An azithromycin-only course of treatment (e.g., azithromycin 1 g on day 1 followed by 500 mg once daily on days 2, 3, and 4) can be considered with acknowledgment of the risk of treatment failure (see discussion above). Given the high rates of azithromycin resistance, shared decision-making is warranted after considering the potential risks of untreated M. genitalium infection during pregnancy and the potential risk of adverse drug events associated with antibiotics not generally used during pregnancy. Some individuals may elect to postpone treatment until after delivery, depending on individual circumstances [Jensen, et al. 2022]. International guidelines advise caution when selecting treatment for pregnant individuals, generally proposing initial treatment with azithromycin monotherapy (with varying dosing strategies), with some suggesting pristinamycin (not available in the United States) as an alternative and acknowledging its limited safety data [Drew and Eogan 2024].

Some studies have raised concerns about associations between M. genitalium infection and infertility and pregnancy complications, although the evidence is limited and insufficient to demonstrate causation. A meta-analysis of available studies suggested significant associations with preterm birth and spontaneous abortion [Lis, et al. 2015]. In this same analysis, the risk of infertility was described as elevated but was not statistically significant [Lis, et al. 2015]. A systematic review that examined multiple mycoplasma species and spontaneous abortion, specifically, found that the presence of M. genitalium (as detected by polymerase chain reaction [PCR] test) was not associated with spontaneous abortion [Chen, et al. 2023]. Some studies have reported associations between M. genitalium infection and preterm birth and low birth weight, but the lack of control for confounding within these studies limit the strength of the analyses [Scoullar, et al. 2024; Frenzer, et al. 2022]. Much of the existing data are from observational studies and are further limited by confounding and use of serology before 2019 [Frenzer, et al. 2022].

Partner Treatment

There is insufficient evidence to determine whether sex partners of individuals with symptomatic M. genitalium infection should receive treatment only if infection is detected through a laboratory test [ASHM 2025; Soni, et al. 2025; Jensen, et al. 2022; Public Health Agency of Canada 2022] or regardless of test results. In alignment with CDC guidelines, to prevent potential reinfection of the index patient, this committee recommends offering testing to ongoing sex partners and limiting treatment to those with positive test results. Partners can be treated with the same regimen as the index patient [CDC 2021].

All Recommendations

RECOMMENDATIONS

Laboratory Testing and Diagnosis

  • Clinicians should not routinely screen for Mycoplasma genitalium in asymptomatic individuals. (A3)
  • Clinicians should test for M. genitalium in individuals with persistent or recurrent urethritis or cervicitis, or with PID. (B2)
  • When testing is indicated, clinicians should use NAAT to diagnose M. genitalium infection, with reflex to resistance testing when available. (A1)

Treatment

  • Clinicians should treat patients with urethritis (A2), cervicitis (A2), and PID (B2) caused by Mycoplasma genitalium infection as recommended in Table 1: Recommended Antimicrobial Regimens for Mycoplasma genitalium Treatment.
  • When managing  M. genitalium treatment failure, clinicians should obtain macrolide resistance testing to guide antimicrobial regimen selection. (A2)
  • For ongoing sex partners of individuals with symptomatic M. genitalium infection, clinicians should offer testing and treat those with positive M. genitalium test results. (B3)

Abbreviations: NAAT, nucleic acid amplification testing; PID, pelvic inflammatory disease.

References

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Footnotes

Conflict of Interest: There are no author or writing group conflict of interest disclosures.

Created: September 2020; Last Update: June 2026.

Copyright © Johns Hopkins University Clinical Guidelines Program 2000-2026. The Clinical Guidelines Program, a collaborative effort of the NYSDOH AI and the Johns Hopkins University School of Medicine, Division of Infectious Diseases, encourages the use, reproduction, and distribution of original documents and related graphics from this program website accompanied by a full citation of source that includes: Author(s). Committee. Title. Date of publication. Full URL. Date accessed. Links to pages on this Clinical Guidelines Program website are also encouraged and may be created without seeking permission. Requests to adapt material, i.e., to change or alter in any way material from this website for inclusion in another publication, should be sent to aiguidelines@jhmi.edu. Please include detailed information about the intended use and desired adaptations.

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Bookshelf ID: NBK583532PMID: 36070499

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