Is Mycoplasma genitalium a Sexually Transmitted Infection?
Yes, Mycoplasma genitalium is definitively a sexually transmitted infection (STI) that requires partner notification, evaluation, and treatment just like gonorrhea and chlamydia. 1, 2
Evidence Supporting STI Classification
M. genitalium transmission occurs exclusively through direct mucosal contact during sexual activity, making it a bona fide sexually transmitted pathogen. 2 The organism has been recognized as an emerging STI of public health concern requiring the same partner management protocols as other established STIs. 1
Epidemiologic Evidence
- Prevalence patterns mirror classic STIs: M. genitalium occurs at 7.3% in high-risk populations and 2.0% in low-risk populations, with rates falling between those of Chlamydia trachomatis and Neisseria gonorrhoeae. 3
- Sexual transmission is the only documented route: The organism spreads through sexual contact, not through casual contact, fomites, or other non-sexual means. 2, 4
- Partner concordance rates support sexual transmission: When one partner tests positive, sexual contacts within the preceding 60 days must be evaluated and treated regardless of symptoms, following standard STI partner management protocols. 1, 5
Clinical Syndromes Caused by M. genitalium
In Men
- Urethritis: M. genitalium causes 10-35% of non-chlamydial, non-gonococcal urethritis cases, presenting with urethral discharge and dysuria. 6, 2, 3
In Women
- Cervicitis: Presents with purulent endocervical exudate, sustained endocervical bleeding, abnormal vaginal discharge, and intermenstrual bleeding. 6, 1, 2
- Pelvic inflammatory disease (PID): Strong evidence links M. genitalium to upper tract inflammation and PID. 1, 2, 3
- Potential infertility: Evidence suggests M. genitalium may contribute to reproductive complications, though more research is needed. 7, 3, 4
Why This Matters Clinically
Partner management is mandatory: All sexual partners within the preceding 60 days must be evaluated and treated simultaneously, regardless of symptoms, to prevent reinfection and ongoing transmission. 1, 5 This is identical to the approach for gonorrhea and chlamydia.
Sexual abstinence is required: Patients must abstain from sexual intercourse until 7 days after completing therapy, and partners must abstain until completing their own treatment course. 1, 5
Reinfection rates are high: Most post-treatment infections result from reinfection by untreated partners, not treatment failure, making partner treatment critical. 1 Repeat testing at 3-6 months should be considered due to elevated reinfection risk. 1, 5
Common Pitfalls to Avoid
- Do not treat M. genitalium like a non-sexually transmitted pathogen: It requires the same rigorous partner notification and treatment protocols as gonorrhea and chlamydia. 1
- Do not assume asymptomatic partners are uninfected: Asymptomatic infections are common in both men and women, yet these individuals can transmit the infection and develop complications. 2, 8
- Do not neglect HIV and syphilis testing: Patients diagnosed with M. genitalium should receive testing for other STDs, including syphilis and HIV, as recommended for all new STD diagnoses. 6, 5