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Sexual health testing guide · 2026
M. genitalium is a genuine pathogen with a resistance problem serious enough that guidelines advise against testing people who have no symptoms.
Mycoplasma genitalium is a recognised cause of urethritis, cervicitis and pelvic inflammatory disease, detected only by PCR — it cannot be cultured routinely. Macrolide resistance is now very common in many regions, so guidelines recommend that a positive result is followed by macrolide resistance marker testing to guide treatment. Because of that resistance, and because many carriers never develop disease, screening asymptomatic people is specifically not recommended. Testing is for symptomatic urethritis or cervicitis, pelvic inflammatory disease, persistent symptoms after treatment for another STI, and current partners of positive cases.
| Method | PCR only — the organism cannot be cultured routinely |
|---|---|
| Resistance testing | Macrolide resistance markers should be tested on positive samples |
| Test when | Symptomatic urethritis or cervicitis, PID, persistent symptoms, or partner positive |
| Do not test | Asymptomatic people, as routine screening is not recommended |
| Price | Listed on the MedEx STD and STI testing page and the lab test catalogue |
| If positive | Same-day doctor consultation for treatment and partner advice |
Mycoplasma genitalium is one of the smallest known self-replicating bacteria and lacks a cell wall, which is why cell-wall-targeting antibiotics such as penicillins have no effect on it.
It is a recognised cause of non-gonococcal urethritis in men, accounting for a meaningful share of cases, and is associated with cervicitis and pelvic inflammatory disease in women. Rectal infection occurs and is usually asymptomatic.
What complicates the picture is that many people carry it without ever developing symptoms, and it can clear spontaneously. That is the core reason guidelines advise against untargeted screening — finding it in someone with no symptoms leads to antibiotic exposure that may be unnecessary and that drives resistance in the wider population.
Macrolide resistance in M. genitalium has risen sharply and now exceeds 50% in many settings. Resistance is conferred by mutations in the 23S rRNA gene, and these can be detected directly on the same PCR sample, without needing culture.
Current guidance therefore recommends a resistance-guided approach: treat according to whether macrolide resistance markers are present. Quinolone resistance is also increasing, which narrows options further, and salvage treatment for multi-resistant infection is genuinely difficult.
Two practical implications. First, when booking, check that the laboratory offers resistance marker testing rather than PCR detection alone — you can compare what is available in the MedEx lab directory. Second, treatment should always be prescribed by a clinician who has the resistance result, not empirically. Arrange this through a doctor consultation.
Symptoms that have not settled after treatment? Ask for M. genitalium with resistance testing.
Guidelines do not recommend testing asymptomatic people, including as part of a general sexual health screen. If your multiplex panel included it and returned positive without symptoms, discuss with a clinician before accepting a prescription — the answer is not automatically to treat. The wider principle is covered in the STI PCR panel guide.
Treatment is typically sequential: an initial agent to reduce bacterial load, followed by a second agent chosen according to the resistance result. Single-dose regimens are no longer adequate. Because of the resistance picture, adherence matters more here than with most STIs — an incomplete course is a common route to a harder-to-treat infection.
A test of cure is recommended after treatment, typically several weeks later to avoid detecting residual genetic material. Follow the interval your clinician gives.
Current partners should be tested and treated where positive, using the same resistance-guided approach. Avoid sex until both partners have completed treatment and any test of cure is clear.
Persistent or recurrent infection after two treatment courses warrants specialist input — a specialist teleconsultation is appropriate at that point rather than another empirical course.
Not if you have no symptoms. Guidelines specifically advise against screening asymptomatic people, because many carriers never develop disease and unnecessary treatment drives antibiotic resistance.
Macrolide resistance now exceeds 50 percent in many settings. Resistance markers can be detected on the same PCR sample, allowing treatment to be chosen based on the result rather than empirically.
Not routinely. It is extremely slow and difficult to grow, so PCR is the only practical diagnostic method, with resistance markers detected genetically.
In men, non-gonococcal urethritis with discharge or pain on passing urine. In women, cervicitis and pelvic inflammatory disease. Rectal infection is usually asymptomatic.
Yes, a test of cure is recommended, typically several weeks after treatment to avoid detecting residual genetic material from cleared organisms.
Persistent or recurrent infection after two courses warrants specialist input rather than another empirical course, since quinolone resistance is also increasing and salvage options are limited.
Positive result needs a resistance-guided prescription, not an empirical one.
Medical disclaimer: This article is general health information and does not replace medical advice, diagnosis or treatment. Laboratory reference ranges differ between laboratories and results must be interpreted alongside your symptoms, medicines and medical history. Speak with a qualified clinician before starting, stopping or changing any treatment. Service details, inclusions and prices can change — confirm them with MedEx before booking.
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