Can men be tested for Mycoplasma genitalium, and what is the preferred testing method?

Testing Men for Mycoplasma genitalium

Yes, men can and should be tested for Mycoplasma genitalium when presenting with urethritis symptoms, using nucleic acid amplification tests (NAATs) on either urine or urethral swab specimens. 1

Preferred Testing Method

NAATs are the only viable diagnostic option for M. genitalium detection in men, as culture is impractical and serologic tests have cross-reactivity issues. 1 The Centers for Disease Control and Prevention recognizes M. genitalium as a major cause of nongonococcal urethritis in males, accounting for 15-25% of cases. 1

Specimen Collection Options

• First-void urine specimen is the preferred non-invasive option for testing in men, offering comparable sensitivity to urethral swabs when using NAATs 2
• Urethral swab specimens are equally effective, particularly in symptomatic men with urethral discharge 2
• Both specimen types can be used interchangeably with modern NAAT platforms 1, 2

Important Testing Limitations

FDA Clearance Status

No FDA-cleared assays are currently available for M. genitalium detection. 1 However, multiple laboratories have validated molecular assays that meet CLIA requirements and can be used clinically. 1 You must confirm with your specific laboratory whether they offer validated M. genitalium testing before ordering. 1

Clinical Context for Testing

Testing should be targeted to specific clinical scenarios rather than used for routine screening:

• Symptomatic men with urethritis showing >5 WBCs per oil immersion field on urethral smear or >10 WBCs per high power field on first-void urine microscopy 3
• Persistent or recurrent nongonococcal urethritis after treatment for chlamydia and gonorrhea 4, 5
• Nonchlamydial, nongonococcal urethritis when C. trachomatis and N. gonorrhoeae testing is negative 4, 6

Testing Algorithm

When evaluating men with suspected urethritis:

1. Document urethritis first through Gram stain or urine microscopy 3
2. Test simultaneously for N. gonorrhoeae and C. trachomatis using NAATs as first-line 1, 3
3. Add M. genitalium testing if available and symptoms persist despite negative results for gonorrhea/chlamydia, or if recurrent urethritis occurs 1, 4
4. Consider antimicrobial resistance testing for M. genitalium when available, as macrolide resistance is now common in many countries 1, 4

Critical Caveats

• Asymptomatic screening is not recommended for M. genitalium in men, as most asymptomatic infections resolve spontaneously without treatment and cost-effectiveness has not been demonstrated 4
• Culture for Ureaplasma is not recommended due to high colonization rates in asymptomatic sexually active individuals 1
• Partner testing and treatment should be pursued when M. genitalium is detected, though transmission risk appears lower than for C. trachomatis 7, 4
• Quantitative PCR assays can detect as few as 5 genome copies and may be useful for monitoring treatment response, with higher bacterial loads correlating with symptomatic urethritis 8