Testing for Mycoplasma genitalium in Women With Vaginal Symptoms Should Not Be Performed Routinely

Mycoplasma genitalium (MG) is an emerging sexually transmitted bacterium for which tests have only recently become commercially available. Compared with other sexually transmitted infections (STIs), epidemiologic data on MG are limited. United States national prevalence data in women and men are 1.8% and 1.7%, respectively, using urine nucleic acid amplification tests.1 However, studies among high-risk US populations have noted prevalence estimates between 9% and 50%.2–5 SeveralMGmolecular tests have recently been Food and Drug Administration cleared; laboratory-developed tests are also available.6,7 The 2021 Centers for Disease Control and Prevention (CDC) STI Treatment Guidelines recommend MG testing and treatment only in men with recurrent/ persistent nongonococcal urethritis and women with recurrent/ persistent cervicitis; testing can be considered inwomenwith pelvic inflammatory disease (PID).8 Screening for MG in asymptomatic individuals is not recommended, although asymptomatic sexual partners of patients diagnosed with MG can be tested. With the new commercial availability of MG molecular tests, some of which are multiplexed with tests for other STIs, including those that may cause vaginitis (e.g., Trichomonas vaginalis [TV]),6 testing outside of recommended guidelines, including testing of women who are asymptomatic or have vaginal symptoms without a diagnosis of cervicitis or PID, is commonly occurring. This may be because providers are either failing to consult the guidelines or are confused by or disagree with current guidance. Whether women with vaginal symptoms should be tested for MG remains an unanswered question that current guidelines do not explicitly address. Here, we reviewavailable data regardingMG testing in women with vaginal symptoms. Our focus is on MG; we do not discuss other Mycoplasmas or Ureaplasmas (e.g., Mycoplasma hominis or Ureaplasma species), which are not definitely linked to urogenital disease9 and for which routine testing is not indicated. Because data in transgender populations are lacking, we focus on cisgender women. We also summarize our current clinical practice for MG testing in select women with vaginal symptoms and discuss future research directions. © 2023 Lippincott Williams and Wilkins. All rights reserved.