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Bacterial STI Curable

Mycoplasma genitalium testing

Mycoplasma genitalium (MG) is an emerging bacterial STI with a critical catch: the antibiotics most people have heard of don't work against it. Its lack of a cell wall makes it immune to penicillins and cephalosporins, and years of azithromycin monotherapy have driven macrolide resistance above 50–62% in US clinics. Most people — especially women — have no symptoms at all, while in men it shows up as a persistent, recurrent urethritis that won't clear with standard NGU treatment. Testing requires a specific NAAT, treatment must be sequenced carefully to outpace resistance, and partners should be notified to break the transmission chain. Find discreet testing options and clinics below.

Curable
Yes
Resistance-guided two-step regimen: doxycycline first, then azithromycin (if macrolide-sensitive) or moxifloxacin (if resistant or unknown)
Macrolide resistance
>50–62%
In US STI clinic populations; single-dose azithromycin monotherapy now fails in the majority of cases
Routine screening
Not recommended
CDC does not recommend screening asymptomatic people; test those with symptoms of NGU, cervicitis, or treatment failure
Asymptomatic in women
Frequent
Cervicitis and PID can occur without symptoms, making the complication risk real even without a warning sign

Where to get tested

Find mycoplasma genitalium testing near you

Choose your test and enter your city — we'll take you straight to local mycoplasma genitalium testing: nearby clinics and labs, prices, hours and county rates.

Test from home

At-home STD testing in the U.S.

if you'd rather skip the trip, an at-home kit ships to the U.S., you collect the sample privately, and mail it back to a CLIA-certified lab. Results come online in days, with a clinician available if anything is positive. Same labs as a clinic, no waiting room — and you can read how accurate at-home STD tests are before you order.

Want a free option first? The CDC-supported TakeMeHome program mails free at-home HIV self-test kits — and, in many areas, free STI kits — to your door, with no insurance or payment needed. The paid kits below add broader panels and faster turnaround.

  • Best range — couples & full panels

    myLAB Box

    $79 & up

    Screens for:
    Up to 14 infections — incl. HIV, syphilis, chlamydia, gonorrhea, hepatitis & herpes
    Sample:
    Self-collect: swab, urine, finger-prick
    Results:
    2–5 days, online
    • Free phone consult if positive
    • CLIA-certified labs
    • Couples & subscription options
    • Discreet packaging
    Order online myLAB Box review

  • Best for simplicity & support

    LetsGetChecked

    $89 & up

    Screens for:
    5–6 common STIs incl. chlamydia, gonorrhea, HIV, syphilis & trichomoniasis
    Sample:
    Finger-prick + urine/swab
    Results:
    2–5 days, online
    • 24/7 nurse support
    • Prescription for positives
    • CLIA-certified labs
    • Free shipping both ways
    Order online LetsGetChecked review

  • Best value — single tests

    Everlywell

    $49 & up

    Screens for:
    Chlamydia & gonorrhea, up to a 6-test panel adding HIV, syphilis, trichomoniasis & hep C
    Sample:
    Finger-prick + swab
    Results:
    Days, online
    • Telehealth visit if positive
    • CLIA-certified labs
    • HSA/FSA eligible
    • Subscription savings
    Order online Everlywell review

Every kit uses CLIA-certified labs. At-home testing is for screening; a reactive result should be confirmed and treated by a clinician. Prices and panels shown are illustrative and change often — confirm current details on the provider's site.

Understanding mycoplasma genitalium

What is mycoplasma genitalium?

Mycoplasma genitalium is a slow-growing bacterium that lacks a cell wall entirely — the target that penicillins and cephalosporins attack — making the entire beta-lactam antibiotic class useless against it. This structural quirk, combined with a decade of widespread azithromycin use for urethritis and chlamydia, has created a resistance crisis: macrolide-resistance mutations have been detected in over 50–62% of MG isolates at US STI clinics, which means the antibiotic that once cleared most NGU with a single dose now fails more often than it works.

The infection is classified as an emerging STI because it was only identified as a distinct pathogen in 1981 and added to CDC treatment guidelines relatively recently. Prevalence data are limited — MG is not a nationally notifiable infection — but it is estimated to cause 15–25% of non-chlamydial NGU in men, and it is increasingly implicated in recurrent or treatment-refractory cervicitis in women. Most infected people, particularly women, are asymptomatic; in men, persistent or recurring urethral symptoms after standard NGU treatment are the signature presentation.

The central problem in managing MG is that macrolide-resistance testing — the test that would tell a clinician which branch of treatment to use — is not commercially available in the United States. Clinicians must therefore decide whether to treat with the azithromycin arm (effective if the infection is macrolide-sensitive) or default directly to the moxifloxacin arm (effective but broader-spectrum). The CDC's 2021 guidelines endorse a two-step approach that starts with doxycycline to reduce the bacterial load before layering the second antibiotic, which improves cure rates regardless of resistance status.

Untreated, MG in women can ascend from the cervix to the fallopian tubes and uterus, causing pelvic inflammatory disease (PID) with roughly twofold increased risk of infertility and elevated risk of preterm delivery. In men, the main consequence is persistent or recurring NGU — uncomfortable and disruptive, and a signal to test for MG if standard doxycycline or azithromycin has already failed. Neither sex should delay evaluation when symptoms persist or recur after a treated episode of NGU or cervicitis.

Screening guidance

Who should get tested for mycoplasma genitalium?

Because mycoplasma genitalium is usually silent, the CDC and U.S. Preventive Services Task Force recommend routine screening for the groups most likely to have it — not just people with symptoms.

  1. 1

    Men with persistent or recurrent NGU

    The classic trigger for MG testing in men: urethral discharge or painful urination that either does not resolve after a standard doxycycline or azithromycin course, or that clears and returns within weeks. Standard NGU treatment often fails MG — especially the single azithromycin dose, which now misses macrolide-resistant strains more than half the time. Re-confirm urethritis is still present (discharge or abnormal microscopy), rule out re-exposure, and test specifically for MG with a NAAT.

  2. 2

    Women with persistent or recurrent cervicitis

    Cervicitis (inflammation of the cervix) that doesn't clear after standard chlamydia treatment, or that keeps recurring, is a clinical indicator for MG testing. Women with cervicitis have a mucopurulent discharge from the cervix or cervical friability (bleeding easily on contact). Because many women with MG have no symptoms, persistent cervicitis on examination — even with minimal patient complaints — warrants a NAAT for MG alongside repeat chlamydia and gonorrhea testing.

  3. 3

    Women with pelvic inflammatory disease (PID)

    MG is an established cause of PID and may account for some of the PID cases that don't respond as expected to standard regimens. Test for MG at the same time as chlamydia and gonorrhea when evaluating PID, particularly when symptoms or exam findings persist after initial treatment.

  4. 4

    Sexual partners of someone diagnosed with MG

    Partners from the past 60 days should be evaluated and tested. If MG is confirmed in a partner, presumptive treatment is recommended — the same resistance-guided regimen used for the index case. Partners can have MG without symptoms, and untreated partners will re-infect the original patient even after successful treatment.

Symptoms

What are the symptoms of mycoplasma genitalium?

The majority of people with MG — particularly women — have no symptoms at all. In studies, MG is detected in cervicitis without the patient reporting discharge or pelvic discomfort. This means complications (PID, infertility) can develop silently. Asymptomatic women are not routinely screened; the infection is found when symptoms prompt testing or when a partner is diagnosed. When symptoms occur in men, they typically develop 2–5 weeks after exposure. In women, symptoms of cervicitis or PID may be absent entirely, or so mild they are attributed to other causes. The lag between infection and clinical presentation (if it appears at all) means exposure history is often unhelpful in timing a diagnosis. That's exactly why testing matters — you can have it, pass it on, and never feel a thing.

In men

  • Urethral discharge — mucoid, watery, or purulent; may be subtle and only apparent when expressed
  • Painful or burning urination (dysuria)
  • Urethral itching or tingling, particularly in the morning
  • Symptoms that recur weeks after completing a standard NGU antibiotic course — the hallmark of MG or macrolide-resistant MG
  • No symptoms in some men — MG can be a silent urethral colonization

In women

  • Often none — most women with MG are asymptomatic even when cervicitis is present on examination
  • Abnormal vaginal discharge — watery or mucopurulent, often indistinguishable from chlamydia discharge
  • Pelvic pain or lower abdominal cramping — when MG has ascended and caused PID
  • Bleeding between periods or after sexual intercourse (intermenstrual or post-coital bleeding) — from cervical inflammation
  • Painful urination — less common than in men, can mimic a UTI

If you have been treated for NGU or cervicitis and symptoms return within weeks, MG — particularly a macrolide-resistant strain — should be specifically tested for. Standard NGU panels and point-of-care tests do not detect MG; a specific NAAT is required.

Left untreated

Why mycoplasma genitalium is worth catching early

Treated early, mycoplasma genitalium clears with antibiotics and causes no lasting harm. Left untreated, it can climb into the reproductive tract and beyond:

Pelvic inflammatory disease (PID) in women

MG can ascend from the cervix through the endometrium to the fallopian tubes, causing PID with pelvic pain, fever, and uterine or adnexal tenderness. Subclinical or "silent" PID — with minimal symptoms — is particularly concerning because the inflammation and scarring proceed without prompting treatment. Repeated episodes compound the scarring risk.

Infertility and ectopic pregnancy risk

Studies show roughly a twofold increased risk of tubal-factor infertility in women with MG antibodies, comparable to the risk from untreated chlamydia. Fallopian tube scarring from MG-related PID also raises the risk of ectopic pregnancy, which can be life-threatening. Treatment before complications develop is the most effective prevention.

Preterm delivery

MG detected during pregnancy is associated with higher rates of preterm birth and preterm labor. Testing pregnant people with symptoms of cervicitis or recurrent urethritis is appropriate; treatment in pregnancy is limited by antibiotic safety concerns (moxifloxacin is contraindicated; azithromycin is used for macrolide-sensitive strains).

Persistent or recurrent urethritis in men

Repeated episodes of NGU — particularly post-gonorrhea or post-chlamydia — significantly impact quality of life and may signal an MG infection cycling between partners. Treatment failure with azithromycin alone is now the rule rather than the exception for MG; escalation to moxifloxacin is frequently required.

U.S. data

How common is mycoplasma genitalium in the U.S.?

M. genitalium prevalence estimates range from 1–2% of sexually active adults in the general population to 15–25% of men with non-chlamydial NGU presenting to STI clinics. It disproportionately affects people with recurrent or treatment-refractory urethritis or cervicitis. Not a nationally reportable condition; no official US incidence figures are published.

50–62%
Macrolide resistance rate in US STI clinic populations — the key driver of treatment failure

Where you test and what it costs vary by location — see the by-location links below for mycoplasma genitalium testing where you live. Source: CDC 2021 STI Treatment Guidelines (Mycoplasma genitalium).

How testing works

How a mycoplasma genitalium test works

Mycoplasma genitalium is detected with a nucleic-acid amplification test (NAAT) — the most accurate method — on a urine sample or a swab. You can do it at a lab, a clinic, or at home.

When to test

Test when symptoms of NGU or cervicitis are present, especially if they persist or recur after standard antibiotic treatment. For partners of diagnosed patients, test at the time of evaluation regardless of symptoms — asymptomatic infection is common.

After treatment

Urine works well for men. Vaginal or endocervical swabs are used for women. Rectal swabs can detect rectal MG in people with anal exposure. Confirm the lab runs an FDA-cleared or validated NAAT for M. genitalium specifically — routine chlamydia/gonorrhea panels do not detect it.

NAAT (urine or swab) Most accurate
Sample
First-void urine (men), vaginal or endocervical swab (women), or rectal/throat swab for exposed sites
Results
2–5 days at reference labs; not available as a rapid point-of-care test

FDA-cleared NAATs for MG exist (e.g., Aptima MG assay) but are offered by specialty and reference labs, not every clinic. Confirm availability before ordering.

Culture
Sample
Urethral or cervical swab — requires specialized slow-growth media
Results
Weeks — impractical for routine clinical use

Not used in routine clinical practice; primarily a research tool. Some reference labs can perform macrolide-resistance testing on culture isolates, but this is not commercially standardized in the US.

What it costs: $80–$200 for a standalone MG NAAT at a reference lab or specialty STI clinic; often bundled with an NGU or comprehensive STI panel at no extra charge. Available at some local health department STI clinics, especially for symptomatic patients or contacts of confirmed cases. Coverage varies; often included when billed as part of persistent NGU or cervicitis workup.

If your result is positive

How is mycoplasma genitalium treated?

Resistance-guided two-step regimen always starts with doxycycline (to reduce bacterial load), then layers a second antibiotic based on likely resistance: azithromycin for presumed macrolide-sensitive strains, moxifloxacin for macrolide-resistant or unknown strains. Single-dose azithromycin alone is no longer recommended.

Treat partners

All sex partners from the past 60 days should be evaluated and tested; presumptive treatment is recommended if the partner cannot be tested.

In pregnancy

Moxifloxacin is contraindicated in pregnancy. For macrolide-sensitive strains, azithromycin (after doxycycline) is acceptable. Consult an infectious disease specialist for macrolide-resistant MG in pregnancy.

Re-test after treatment

Test of cure is recommended 3–4 weeks after completing therapy in all patients, given the significant treatment-failure rate. Re-treat with the alternative step-2 arm if initial therapy fails.

Treatment & online care

Resistance note: Over 50–62% of MG strains in US STI clinic populations carry macrolide-resistance mutations, driven by years of azithromycin monotherapy. Because macrolide-resistance testing is not commercially available in the US, the two-step doxycycline-then-moxifloxacin approach is now the practical default in many clinical settings.

Prevention

How to prevent mycoplasma genitalium

  • Consistent condom use

    Condoms used correctly and consistently reduce transmission risk. Because MG spreads through the same mucosal contact as chlamydia and gonorrhea, condom use at every act of sex with a partner of unknown status is the primary prevention measure.

  • Partner notification and concurrent treatment

    Treating all recent partners at the same time prevents re-infection — the "ping-pong" cycle where treated and untreated partners re-infect each other repeatedly. Even asymptomatic partners should be evaluated and treated.

  • Avoid azithromycin monotherapy for NGU

    Single-dose azithromycin given empirically for NGU selects for macrolide-resistant MG even in patients who test negative for MG — resistance emerges in the residual MG that was present below the detection threshold or acquired shortly after treatment. The current CDC recommendation is doxycycline 7 days as the first-line NGU regimen precisely because it has lower selection pressure for MG resistance.

Who is most at risk

Who is most at risk for mycoplasma genitalium?

Anyone who is sexually active can contract mycoplasma genitalium, but certain groups face significantly higher risk — and should test more frequently.

Men with recurrent or persistent NGU
The most common clinical scenario prompting MG testing — standard NGU regimens fail MG at high rates, making recurrent urethritis after treatment the key flag.
15–25% of non-chlamydial NGU cases
MSM — men who have sex with men
Particularly at risk for rectal MG, which requires rectal swab testing and is frequently asymptomatic. Higher partner turnover rates also increase exposure probability.
People with prior STI
A history of other STIs signals the sexual exposures that also transmit MG — and the antibiotic courses used to treat chlamydia/NGU may have selected for MG resistance.

Why it matters

Why STD testing matters

Find mycoplasma genitalium testing
  • MG causes 15–25% of non-chlamydial NGU — missing it means the infection keeps coming back
  • Most women have zero symptoms while complications (PID, infertility, preterm birth) can develop silently
  • Single-dose azithromycin — once the standard for NGU — now fails >50% of MG cases due to resistance
  • Only a specific NAAT detects it; routine chlamydia/gonorrhea panels miss it entirely
  • The two-step doxycycline-first regimen improves cure rates regardless of resistance status

Browse by location

Mycoplasma genitalium testing by state & city

Jump to local mycoplasma genitalium testing — clinics and labs, prices and county rates — in your state or a popular city, or explore another test.

Popular cities

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Keep reading

More on mycoplasma genitalium

Deeper guides from our editorial library on mycoplasma genitalium and related topics.

Living with mycoplasma genitalium

Questions to ask your provider about mycoplasma genitalium

Mycoplasma genitalium is common, treatable, and nothing to be ashamed of — millions of Americans are diagnosed every year. The most useful next step after a positive result (or before a first test) is a direct conversation with a clinician. Here are the questions that matter most:

  • Is my mycoplasma genitalium test result definitive, or do I need a confirmatory test?
  • What treatment options are available to me, and how long until I'm no longer contagious?
  • Should I notify my recent partners, and can your office help me do that confidentially?
  • How soon can I re-test to confirm the infection has cleared?
  • Are there other STIs I should test for at the same visit?
  • Can this affect my fertility, pregnancy, or long-term health if left untreated?

Good to Know

Mycoplasma genitalium testing FAQs

Common questions about mycoplasma genitalium and mycoplasma genitalium testing, answered.

What is Mycoplasma genitalium and why haven't I heard of it?

M. genitalium is a bacterium discovered in 1981 that is increasingly recognized as a significant cause of urethritis and cervicitis. It wasn't included in most STI guidelines until recently because it was hard to culture and tests weren't widely available. Now that NAAT testing exists, it's being found in 15–25% of men with non-chlamydial NGU. It's not yet a nationally reportable infection, so it doesn't appear in the CDC's headline statistics — but that doesn't mean it's rare.

Why does standard NGU treatment fail for MG?

Standard single-dose azithromycin was used for NGU for years, and M. genitalium was repeatedly exposed to it without being reliably cleared. This created strong selection pressure for resistant strains. Over 50–62% of MG in US STI clinic populations now carry macrolide-resistance mutations. A single 1 g azithromycin dose that cures chlamydia easily often does nothing to MG, while selecting for even more resistant bacteria.

Do I need to test my partner if I have MG?

Yes. All sex partners from the past 60 days should be tested and treated at the same time. MG cycles back and forth between untreated partners, and one partner can re-infect the other even after successful treatment. Asymptomatic partners can still have the infection and pass it back.

Is there a test I can take at home for MG?

No approved at-home MG test currently exists. M. genitalium requires a specific FDA-cleared NAAT run at a reference or specialty lab — not a rapid lateral-flow type test. Self-collected swabs or urine samples can be sent to a lab via some at-home STI testing services, but confirm the specific service includes an MG assay, as many standard STI panels do not.

Can MG cause infertility?

Yes, particularly in women. Studies show roughly a twofold increased risk of tubal-factor infertility in women with evidence of past MG infection — similar to the risk from untreated chlamydia. MG causes PID, and the fallopian tube scarring from repeated or untreated episodes is the mechanism. Treating MG early — especially when cervicitis or PID is present — is the most effective way to reduce this risk.

What is the two-step treatment and why does it start with doxycycline?

Doxycycline is given first (100 mg twice daily for 7 days) not because it cures MG on its own — it only clears 30–40% of MG infections alone — but because it significantly reduces the bacterial load before the second antibiotic is applied. A lower bacterial burden means fewer resistant organisms to mutate and escape when azithromycin or moxifloxacin is added, which meaningfully improves cure rates. It's the sequence that matters, not doxycycline alone.

How long does it take for symptoms to go away after treatment?

Discharge and painful urination typically begin to improve within a few days of starting doxycycline, though the full treatment course must be completed. The second-step antibiotic (azithromycin or moxifloxacin) should still be taken even if symptoms have resolved. A test of cure 3–4 weeks after finishing the full regimen is recommended for all patients given the significant failure rate — symptoms clearing is not the same as the infection clearing.

Editorial standards

Medically reviewed · Updated

Reviewed by Dr. Amara Okafor, MD, MPH · Infectious Disease & Epidemiology

Board-certified in infectious disease with a focus on STI epidemiology and public-health screening programs. Leads testing, diagnosis and the data-driven 'state of STDs' reporting.

2 Sources

Data & references

  1. CDC — Mycoplasma genitalium (STI Treatment Guidelines, 2021) https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm
  2. NYSDOH/Johns Hopkins — M. genitalium Management (NCBI Bookshelf) https://www.ncbi.nlm.nih.gov/books/NBK583532/