Can a sexually active man be tested for Mycoplasma genitalium?

Can Men Be Tested for Mycoplasma genitalium?

Yes, sexually active men can and should be tested for Mycoplasma genitalium using nucleic acid amplification tests (NAATs) on first-void urine or urethral swab specimens when they present with urethritis symptoms, but routine screening of asymptomatic men is not recommended. 1, 2

When to Test Men for M. genitalium

Clear Indications for Testing

• Men with symptomatic urethritis (urethral discharge, dysuria, or urethral discomfort) should be tested for M. genitalium because it causes 15–25% of nongonococcal urethritis cases 2, 3

• Men with persistent or recurrent urethritis after treatment for gonorrhea and chlamydia should be tested, as M. genitalium is a major cause of treatment-refractory NGU 2, 4

• Sexual partners of patients diagnosed with M. genitalium must be evaluated and tested simultaneously, regardless of symptoms, to prevent reinfection and ongoing transmission 1

When NOT to Test

• Asymptomatic men should NOT be screened for M. genitalium, even in high-risk populations, because most untreated infections resolve spontaneously without developing disease and cost-effectiveness has not been demonstrated 2, 3, 4

• Testing asymptomatic individuals leads to inappropriate antibiotic use and accelerates antimicrobial resistance 4, 5

Specimen Collection Methods

Recommended Specimens

• First-void urine is the preferred specimen in men because it is non-invasive and provides comparable sensitivity to urethral swabs with modern NAATs 1, 2

• Urethral swabs are an acceptable alternative and can be used interchangeably with urine on validated platforms 1, 2

Additional Sites (When Indicated)

• Rectal specimens can be tested in men who engage in receptive anal intercourse, but require laboratory validation as no FDA-cleared tests exist for this site 1

• Pharyngeal specimens can be tested but also require laboratory validation 1

Diagnostic Method

Only Acceptable Test

• NAATs are the sole reliable diagnostic method for M. genitalium detection because culture is impractical due to the organism's extremely slow growth characteristics (weeks to months) 1, 2, 6

• Serologic assays suffer from cross-reactivity and are not recommended 2

Critical Regulatory Limitation

• No FDA-cleared commercial NAAT is currently available in the United States for M. genitalium detection, although three FDA-approved tests became available recently 1, 4

• Laboratories may offer validated molecular tests that meet CLIA requirements, but clinicians must verify assay availability with their specific laboratory before ordering 2

• Several assays are CE-marked in Europe but not FDA-cleared in the U.S. 6

Testing Algorithm for Men with Suspected Urethritis

Step-by-Step Approach

1. Document urethritis objectively using Gram stain (≥5 WBC per high-power field) or urine microscopy before testing 2

2. Perform simultaneous NAATs for Neisseria gonorrhoeae and Chlamydia trachomatis as first-line testing, since these are more common and have FDA-cleared tests 2

3. Add M. genitalium NAAT if:

   • Symptoms persist despite negative gonorrhea/chlamydia results, OR
   • The patient has recurrent nongonococcal urethritis, OR
   • The patient is a sexual contact of someone with confirmed M. genitalium 2, 4

4. Conduct antimicrobial resistance testing for M. genitalium when available, because macrolide resistance is now common in many countries (though no FDA-approved resistance tests currently exist in the U.S.) 2, 4

Important Clinical Context

Natural History in Men

• Most M. genitalium infections in men are asymptomatic and likely resolve spontaneously without treatment 3, 5

• The incubation period is longer than for C. trachomatis, possibly explaining delayed symptom onset 3

• The risk of sexual transmission appears lower than for C. trachomatis 3

Prevalence Patterns

• M. genitalium is an uncommon STI in the general population but prevalence rates are higher in patients attending sexual health clinics and in men with NGU 3, 5

• It is recognized as an emerging STI of public health concern requiring partner notification 1

Critical Pitfalls to Avoid

• Do NOT screen asymptomatic men without symptoms or known exposure—this wastes resources, promotes antimicrobial resistance, and lacks cost-effectiveness data 2, 3, 4

• Do NOT assume all laboratories offer M. genitalium testing—verify availability before ordering, as no FDA-cleared assay is universally available 1, 2

• Do NOT test for Ureaplasma in men with urethritis, as high colonization rates among asymptomatic sexually active individuals make results uninterpretable 2

• Do NOT perform test-of-cure earlier than 3 weeks after treatment completion, as false-positives from dead organisms are common with NAATs 1

• Do NOT retreat based on symptoms alone without documenting objective signs of urethral inflammation or laboratory evidence of persistent infection 2