Mycoplasma genitalium, or Mgen, is a sexually transmitted bacterial infection. It was first discovered in London in 1980 from two men who had urethritis, or chronic urethral irritation, and tested negative for gonorrhea. Mgen is an atypical bacteria, meaning that the structure of the cell varies so not all antibiotics can effectively treat it. While interest in Mgen has started to grow in recent years, it is not very well researched and there are still many things the medical community is still learning.

Mycoplasmas are the smallest free living bacteria and have no cell membrane. They are slow growing but fast mutating. This means that cultures cannot successfully diagnose a mycoplasma infection. Instead, samples for testing are obtained through urine samples and run through a Nucleic Acid Amplification Test or NAAT. Mycoplasma genitalium, mycoplasma hominis, and ureaplasma are mycoplasmas that can be transmitted through genital to genital contact as well as genital to oral contact. All three mycoplasma infections have similar but different symptoms. Mycoplasma hominis and ureaplasma can both be found in the genital tract of healthy adults, however Mycoplasma genitalium cannot. Mycoplasma genitalium’s prevalence is significantly higher than other mycoplasma infections.

Mycoplasma genitalium affects the body similarly to how a urinary tract infection or gonorrhea infection would. However, the symptoms can vary and it is possible that a majority of infections are asymptomatic.

Symptoms include:

• Watery penile discharge

• Burning or stinging when urinating

• Urethral discomfort

• Abnormal discharge

• Pain during sex

• Bleeding after sex

• Bleeding between periods

• Pain in lower pelvis area

Mycoplasma genitalium can be transmitted through genital to genital contact as well as genital to oral contact, although genital to oral is less common.

Mgen can be treated through various antibiotics. There is potential risk of resistance to one of the antibiotics used in treatment called azithromycin. In patients who have been previously treated for chlamydia, azithromycin resistance could be a potential barrier to treatment. Current federal standards do not suggest the testing or treatment of asymptomatic individuals, however more research needs to be done to determine the ability for the infection to be transmitted by an asymptomatic patient. If you are asymptomatic for Mgen and test positive, you should have a discussion with your clinician about treatment options.

There is currently a lack of data to accurately establish the prevalence of mycoplasma. However, select studies in London have shown that in patients who have symptoms but test negative for gonorrhea and chlamydia, the disease burden is between 10-35%. In the United States, as of 2017-18, there was a 1.7% disease burden from the National Health and Nutrition Examination Survey. While we do not have any data regarding the prevalence within the adult industry, PASS has received increasing anecdotal reports of mycoplasma infections within this last year.

As with all infections, there is a risk of complications due to a lack of treatment.

Mgen can cause complications such as epididymitis or Epididymo-orchitis, or inflammation of the testicles, pelvic inflammatory disease, cervitis, sexually acquired reactive arthritis, and possible infertility and miscarriage. In cases of asymptomatic patients, untreated Mgen infection is a risk for complications.