Guidelines
Mycoplasma genitalium

Mycoplasma genitalium

General Information

Mycoplasma genitalium is a newly described but well established STI pathogen with clinical manifestations similar to those caused by Chlamydia trachomatis. In males it causes acute and persistent urethritis. In females it is usually asymptomatic but may cause cervicitis and/or PID. It is also associated with infertility and adverse pregnancy outcomes.

Testing

On all genital STI samples, Island Health uses a molecular STI Pathogen Panel that tests for Chlamydia trachomatis, Neisseria gonorrhoea and Trichomonas vaginalis. A new molecular assay that tests for Mycoplasma genitalium will be performed when specifically requested.

We recommend testing for Mycoplasma genitalium in:

  1. Symptomatic patients who have tested negative for Chlamydia trachomatis, Neisseria gonorrhoea, and Trichomonas vaginalis on the STI Pathogen Panel.
  2. Patients who have failed to respond to STI treatment with azithromycin or doxycycline.
  3. Contacts of patients with known Mycoplasma genitalium infection.

Preferred testing specimen varies by syndrome. Please ensure the correct STI swab is submitted to avoid rejection:

  • A vaginal swab (can be self collected) is preferred in women.
  • First catch urine can also be done in women but it is somewhat less sensitive than vaginal swab. Volume of urine for STI testing should be no more than 60 mL.
  • First catch urine is preferred in men; a urethral swab can also be collected. Volume of urine for STI testing should be no more than 60 mL.
  • A rectal swab should be collected if proctitis is suspected.
  • Testing can also be performed on other swabs (e.g. conjunctival, throat).

Assessment and Treatment of Contacts

All contacts within the last 60 days, regardless of symptoms or signs, should be treated, preferably after a sample is obtained for testing. If testing is impossible, treatment is still recommended for all contacts.

Please submit all samples to an Island Health laboratory and not LifeLabs as Island Health performs the testing in-house. Please state "M. genitalium contact follow-up" on the requisition.

Test of Cure

Test of cure should be performed in 3-4 weeks under some circumstances.

Test of cure should be performed 3-4 weeks post-treatment. If still positive, treat with:

Test of cure should be performed 3-4 weeks post-treatment. If still positive, treat with:

Test of cure should be performed 3-4 weeks post-treatment, then testing for reinfection should be performed in 3 months.

Patients who have failed azithromycin and have contraindications to moxifloxacin or have failed moxifloxacin should be referred to an STI specialist.