No, Mycoplasma genitalium and Bacterial Vaginosis Are Distinct Conditions
Mycoplasma genitalium is a sexually transmitted infection that is completely separate from bacterial vaginosis (BV), though they can occasionally coexist. 1, 2
Key Differences Between the Two Conditions
Bacterial Vaginosis
- BV is a syndrome caused by replacement of normal H₂O₂-producing Lactobacillus species with an overgrowth of multiple anaerobic bacteria including Bacteroides species, Mobiluncus species, Gardnerella vaginalis, Prevotella species, Porphyromonas species, Peptostreptococcus species, and Mycoplasma hominis (not M. genitalium). 1, 3
- BV represents an ecological disruption of the vaginal microbiome rather than infection with a single pathogen—it is vaginal dysbiosis, not a traditional sexually transmitted infection. 3
- BV is not considered exclusively an STD, and treating male partners does not prevent recurrence in women. 1
Mycoplasma genitalium
- M. genitalium is a distinct sexually transmitted pathogen that causes non-gonococcal urethritis in men and cervicitis, endometritis, and pelvic inflammatory disease in women. 4, 2
- M. genitalium is transmitted sexually and requires specific antibiotic treatment, typically with azithromycin or moxifloxacin. 4, 2
- M. genitalium is NOT associated with bacterial vaginosis according to multiple studies. 2
The Relationship Between M. genitalium and BV
Evidence Shows No Clear Association
- Research specifically demonstrates that M. genitalium is not associated with bacterial vaginosis. 2
- However, one recent study found that women with symptomatic BV had a higher prevalence of concurrent M. genitalium infection (7.0% vs 3.6% in non-BV vaginitis), suggesting BV may increase susceptibility to acquiring this STI. 5
Clinical Implication
- The presence of BV may create conditions that increase risk of acquiring sexually transmitted infections like M. genitalium, but BV itself does not cause M. genitalium infection, and M. genitalium does not cause BV. 5, 6
- BV-associated dysbiosis disrupts the protective Lactobacillus barrier, potentially making women more vulnerable to STI acquisition including M. genitalium. 6
Diagnostic Distinction
BV Diagnosis
- Requires 3 of 4 Amsel criteria: homogeneous white discharge, clue cells on microscopy, vaginal pH >4.5, and positive whiff test. 1, 7, 8
- Gram stain showing mixed bacterial morphotypes with decreased Lactobacillus is the gold standard. 7
M. genitalium Diagnosis
- Requires nucleic acid amplification testing (NAAT), as the organism grows poorly or slowly in culture. 4, 2
- Cannot be diagnosed using standard BV testing methods. 4
Critical Clinical Pitfall to Avoid
- Do not assume vaginal discharge or symptoms are solely due to BV without considering concurrent STIs like M. genitalium, especially in sexually active women with multiple partners or persistent symptoms despite BV treatment. 5