Symptoms of Mycoplasma genitalium Infection
Mycoplasma genitalium causes urethritis with dysuria and discharge in men, while women experience vaginal discharge, dysuria, cervicitis, and pelvic inflammatory disease symptoms including abdominal pain and dyspareunia, though asymptomatic infections are frequent in both sexes. 1
Male Symptoms
In men, M. genitalium is responsible for 10-35% of non-chlamydial non-gonococcal urethritis cases. 1 The predominant clinical manifestations include:
- Urethritis with visible urethral inflammation 1
- Dysuria (painful urination) 1
- Urethral discharge 1
- Asymptomatic infection is common, making detection challenging without specific testing 1, 2
M. genitalium is particularly important in persistent and recurrent non-gonococcal urethritis cases where initial treatment has failed. 2
Female Symptoms
In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease in 10-25% of cases. 1 The clinical presentation includes:
Lower Genital Tract Symptoms
- Vaginal discharge (mucopurulent cervicitis) 1, 3
- Dysuria (painful urination) 1, 4
- Cervicitis with mucopurulent cervical discharge 3, 5
- Urethritis 5
Upper Genital Tract Symptoms (Pelvic Inflammatory Disease)
- Abdominal pain (lower pelvic pain) 1, 4
- Dyspareunia (painful intercourse) 1
- Endometritis (uterine inflammation) 3
Asymptomatic Presentation
- Many women remain asymptomatic despite active infection, which can lead to delayed diagnosis and complications 1, 3
Critical Clinical Context
Asymptomatic infections are frequent in both sexes, making symptom-based screening inadequate for comprehensive detection. 1 The Centers for Disease Control and Prevention emphasizes that symptoms are the main indication for diagnostic testing, but the high rate of asymptomatic carriage means many infections go undetected. 1
M. genitalium has potential to cause ascending infection in women, leading to serious complications including pelvic inflammatory disease and infertility. 2, 3 The evidence for M. genitalium causing PID and infertility is convincing, indicating that a significant proportion of upper tract inflammation may be attributed to this pathogen. 5
Important Clinical Pitfall
The nonspecific nature of symptoms means M. genitalium is often overlooked in routine STI screening, particularly in women presenting with vaginitis or urinary complaints in emergency settings. 4 Health care providers should consider M. genitalium as a differential diagnosis when performing STI screenings on sexually active patients with urinary or vaginal complaints, especially when standard treatments for chlamydia and gonorrhea fail. 4
Diagnosis requires nucleic acid amplification testing (NAAT) as the organism is difficult or impossible to culture, and symptoms alone cannot distinguish M. genitalium from other sexually transmitted infections. 1, 2