Mycoplasma genitalium has emerged as the causative agent of sexually transmitted syndromes including urethritis in men, cervicitis and pelvic inflammatory disease in women; however, testing should be limited to specific clinical scenarios. Treatment challenges include widespread macrolide resistance and the emergence of multidrug-resistant strains. Treatment failure is not uncommon and resistance-guided therapy currently offers the highest probability of cure.
Mycoplasma genitalium infection is a bacterial sexually transmitted infection (STI). M. genitalium belongs to the bacterial class Mollicutes, distinguished by their tiny genome and absent cell wall (Figure). M. genitalium is an extremely slow-growing and fastidious organism to culture;1 therefore, studies showing its association with genital syndromes really only began to accumulate after the development of the first diagnostic polymerase chain reaction (PCR) test in the early 1990s. Since the isolation of M. genitalium from the urethras of two men with nongonococcal urethritis in the early 1980s, evidence has shown its association with other clinical syndromes, including cervicitis, pelvic inflammatory disease and poor pregnancy outcomes in women.1,2