PASS Statement on Mgen
We have seen the recent conversations across our community about Mycoplasma genitalium, or Mgen, and we want to address them directly and honestly.
There is also an FAQ below on rectal Mgen.
The Data
Mgen prevalence in our community remains very low. The most recent monthly screening data shows a positivity rate under 3 percent, consistent with what we have seen over time. That reflects the strength of a community that tests regularly and takes its health seriously. A single positive result, or a wave of conversation about one, does not change the underlying picture that Mgen is not widespread in the adult industry.
Some context on testing itself.
Outside the adult industry, routine screening of people without symptoms for Mgen is generally not recommended. Major guidelines, including the CDC's STI Treatment Guidelines, advise against screening asymptomatic individuals, largely because of concerns about antibiotic resistance, limited treatment options, and genuine uncertainty about whether treating an asymptomatic infection provides meaningful benefit. We operate in a unique context, where rates of close contact are higher than in the general population, sexual networks are more close knit, and there are more limitations in partner management strategies; that context shapes our approach. However, we hold that approach alongside the same caution the broader medical community has about over-testing and over-treatment. Getting this balance right is one of the novel challenges we have spoken about before, and PASS’s guidance will continue to evolve as the evidence does.
Clearance is a clinical determination.
The decision to return to work is made by a licensed clinician, based on appropriately timed testing and medical history, not on whether a person feels fine or has no symptoms. With Mgen, a test can remain positive after successful treatment, because it detects genetic material rather than live, transmissible infection. A persistent positive can also mean that a first course of treatment did not clear the infection. Telling those situations apart requires a clinician and a properly timed test of cure. No one, ourselves included, should substitute a general rule or a gut feeling for that judgment.
Shame has no place here.
A positive test is a health result. It is not a moral failing, and it is not a measure of anyone's worth or professionalism. Stigma does not make anyone safer; it does the opposite. It discourages the testing, honesty, and open communication that our entire model depends on. We will not take part in it, and we ask our community to hold that same standard with one another.
Mgen is a relatively new infection, and our recommendations remain subject to change as we learn more. PASS is committed to following the evidence, being transparent about what we do and do not yet know, and protecting both the health and the dignity of everyone in our community. We will keep you informed as our understanding grows.
In community,
PASS
See our FAQ on Rectal Mgen Below
Rectal Mgen FAQ
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Description First, there is no FDA-cleared test for rectal Mgen. The FDA-cleared test is validated only for urogenital samples, such as urine and vaginal, cervical, urethral, or penile swabs. No test has been cleared for rectal or oral specimens. A lab can technically run the test on a rectal sample, but that is off-label use, and the result no longer carries the same regulatory backing or established accuracy.
Second, there is even more uncertainty about rectal Mgen than about genital Mgen. Asymptomatic rectal Mgen appears to be fairly common, and the medical community does not yet understand what, if anything, it means for a person’s health. Major guidelines recommend against routine rectal Mgen testing for that reason.
Third, the risk is not well documented. Genital Mgen has established associations, for example with cervicitis and pelvic inflammatory disease. While Rectal Mgen has some causal links with proctitis, it does not have a comparable body of evidence linking it to harm.
Finally, screening for something we have no evidence is a problem does real harm of its own. It creates moments of fear and panic over a result whose meaning no one can yet explain, and it can lead to unnecessary antibiotic use at a time when antibiotic resistance in Mgen is a genuine concern. Testing should not create anxiety, but answer a question worth asking.
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In everyday language people say “FDA-approved,” but for diagnostic tests the more precise terms are “cleared” or “authorized.” It means the FDA has reviewed the test and confirmed it performs accurately and reliably for a specific, defined use.
The important part is “specific, defined use.” A test is authorized for particular sample types, not for any sample in general. Think of it like a tool rated for a specific job: a ladder certified to hold a certain weight is only certified at that weight. Use it outside those conditions and the certification no longer applies, even if the ladder might still work. The FDA-cleared Mgen test is authorized for urogenital samples. It is not authorized for rectal samples.
This matters for an industry-wide standard. Individual labs may be able to develop and validate individual tests outside of FDA regulation, but these are only able to be used with the specific lab it was validated for. When PASS sets a testing requirement that the whole community relies on, we want it resting on tests validated for the way they are actually being used, not on off-label work that each lab would have to validate on its own.
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PASS does not screen for rectal Mgen, for all the reasons above, so it is not part of the standard panel or a standard clearance question. If a person learns they have rectal Mgen, it is due to the testing of a specific provider, not a PASS standard.
If that situation comes up, clearance is a clinical determination. A licensed clinician, not a PASS rule and not a person’s own read on how they feel, decides what it means for their work status. The evidence that rectal Mgen causes harm or drives transmission is so thin, a positive result does not map neatly onto a work restriction the way some infections do. That judgment belongs to a clinician who knows the specifics.
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As Mgen drew more attention in recent years, we faced a choice: ignore an emerging infection, react to it with alarm, or try to understand it. We chose to understand it.
Prior to the development of any policy, PASS partnered on a no-cost Mgen screening and treatment pilot so we could learn whether and how much Mgen was actually present in our community, since it may be more widespread among sexually active adults than people realize and is rarely tested for outside of symptoms. Our role is to translate emerging science onto the specific population we serve, and you cannot do that responsibly without data. Looking at Mgen was about gathering that evidence and protecting the community, not assuming the worst.
That same evidence-gathering is what now lets us be measured, including about where screening is and is not useful.
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Our Mgen guidance is provisional by design. Mgen is a relatively new infection and the science around it is not settled, so we will adjust our recommendations as the evidence grows.
We weigh major medical guidance, expert opinion, available technology, and the counsel of our Medical Advisory Board against the unique context of our community. As that picture changes, our guidance will too, and we will communicate any changes to you clearly and openly.
Mgen is new ground for everyone, and we would rather be honest about uncertainty than pretend to a certainty no one has. If you have a question that is not answered here, reach out to us.
Updated 6-19-26
