Symptoms of Mycoplasma genitalium: The Silent STI Threat
Mycoplasma genitalium (MG) is often called the "stealth STI" because >50% of infected individuals show no symptoms, yet it can cause severe reproductive damage. Recognizing its subtle signs is critical for timely intervention.
🔍 Symptom Presentation by Gender
Symptoms in Men
Urethritis (in 80% of symptomatic cases):
- Burning during urination
- Watery or cloudy urethral discharge
- Redness/itching at penis tip
- Pain during ejaculation
- Rectal symptoms (in MSM): Anal pain, discharge, or bleeding
Symptoms in Women
Cervicitis/Vaginal Issues:
- Abnormal vaginal discharge (yellow/green)
- Post-coital bleeding or spotting
- Pain during deep penetration
- Pelvic/lower abdominal pain
- Dysuria (painful urination) or urinary frequency
⚠️ Key Alert: Symptoms often mimic chlamydia but persist after standard treatment.
🫥 The Silent Threat: Asymptomatic Infections
Studies reveal alarming rates of symptomless carriers:
Up to 94% of men
~56% of women
These "silent spreaders" typically discover infection through:
- Partner notification after diagnosis
- Infertility investigations
- Routine STI screening (high-risk groups)
🆘 Dangerous Complications When Untreated
| Complication | Men | Women |
|---|---|---|
| Reproductive | Epididymitis, prostatitis | PID, tubal scarring |
| Fertility | Reduced sperm quality | Infertility (2-3× higher risk) |
| Pregnancy | – | Miscarriage, preterm birth |
| Systemic | Reactive arthritis | Chronic pelvic pain, dyspareunia |
Critical Warnings:
- Pelvic Inflammatory Disease (PID): Sudden fever + severe pelvic pain requires emergency care
- Antibiotic resistance: 30-50% macrolide resistance rates complicate treatment
🔬 Diagnosis & Testing Essentials
MG is frequently missed due to:
- Non-specific symptoms overlapping with other STIs
- No routine testing in many clinics
- Accurate diagnosis requires:
- NAAT (PCR) testing: First-void urine (men), vaginal/cervical swabs (women)
- Resistance testing: Crucial before antibiotic selection
- Partner testing: All sexual partners within 3 months need evaluation
🚩 When to Suspect MG:
- Persistent urethritis/cervicitis after chlamydia/gonorrhea treatment
- Unexplained pelvic pain or infertility
- Partner diagnosed with MG
💡 Key Takeaways
MG is often asymptomatic – regular STI screens are vital for sexually active individuals
3 Major Red Flags:
- Abnormal genital discharge
- Bleeding after sex
- Pain during urination/sex
Complications are preventable with early detection and proper antibiotic therapy
Confirm cure with a test-of-cure 4-6 weeks post-treatment due to high resistance risks.
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