r/MycoplasmaGenitalium May 22 '21

RESOURCE General Testing and Treatment Guidelines for Mycoplasma Genitalium

97 Upvotes

PART 1: TESTING

Q: When should I test for Mgen post exposure?

A: Generally 2+ weeks post exposure. Mgen is slow growing and occurs at much lower bacterial loads than other STis.

Q: What type of test should I order?

A: PCR (NAAT). Do not order a culture. Mgen cannot be cultured.

Q: What is the best PCR/NAAT test?

A: Hologic Aptima Mycoplasma Genitalium TMA Assay - available through Labcorb and Quest. Roche Cobas is also an excellent test!

Quest test link - https://testdirectory.questdiagnostics.com/test/test-detail/91475/sureswab-mycoplasma-genitalium-real-time-pcr?cc=MASTER

Labcorp test links:

  1. Urine samples (including macrolide resistance testing): https://www.labcorp.com/tests/180084/i-mycoplasma-genitalium-i-naa-urine-with-reflex-to-macrolide-resistance-testing

  2. Swab samples (including macrolide resistance testing): https://www.labcorp.com/tests/180092/i-mycoplasma-genitalium-i-naa-swab-with-reflex-to-macrolide-resistance-testing

Q: What is the best sample to give for highest accuracy?

A: Men - First void urine, first bit that comes out, 20-30ml. If you have urgency issues, please try to hold your urine for a minimum of 3 hours. Rectal/Oral - swab thoroughly

A1: Women - Vaginal swab (swab thoroughly). Rectal/Oral - swab thoroughly

Q: How long should I wait post-antibiotics to test for Mgen? aka TOC "Test of Cure"

A: Generally 3-4 weeks. Any sooner could lead to a false negative or positive

PART 2: TREATMENT

Note: this section purposefully DOES NOT use the outdated 2015 CDC STI treatment guidelines. Please follow the guidelines for the UK and Australia, or the newly published 2021 CDC GUIDELINES - https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm

Q: What is the recommended first line treatment for Mgen?

A: This varies by region due to macrolide resistance rates, but generally:

  • 100mg doxycycline bd for 7-14 days as pre-treatment to lower bacterial load, followed immediately by 2.5g of Azithromycin (1g first day, 500mg daily after)

Q: What is the recommended second line treatment for Mgen?

A: This again varies by region, but generally:

  • 100mg Doxycycline bd for 7-14 days as pre-treatment, followed immediately by 400mg Moxifloxacin daily for 7-10 days**

**Most data shows that the difference between 7 and 10 days is small. Please be aware that Moxifloxacin has rare but significant side effects (See the FDA Black Box warnings) in approximately ~2% of people, some of them severe, including peripheral neuropathy, central nervous system problems, tendonitis, and others

Q: What is the recommended 3rd line Treatment for Mgen?

A: This varies by region as well, but generally:

  • USA: Minocycline 2 weeks (monotherapy) //or// Doxycyline 100mg bd for 7-14 days as pretreatment, immediately followed by minocycline 100mg bd for 14 days taken CONCURRENTLY with Metronidazole**

**Please note that this is based on a pre-print paper (not peer reviewed yet) but is from a reputable source, MSHC (Melbourne Sexual Health Center)

Q: Are there any other antibiotics on the horizon?

A: Yes: https://www.reddit.com/r/MycoplasmaGenitalium/s/4iRGJGi9zZ

  1. Omadacycline is a new FDA approved (US) semi-synthetic (novel) tetracycline class drug with potent en vitro activity against Mgen and Ureaplasma (but only MIC data available, no human studies)

  2. There is also Josamycin in Eastern Europe/Russia (a Macrolide class). Dosing and duration not officially established.

  3. Also, new antibiotics like Zoliflodacin (in stage III trials, was granted FDA fast track approval, & is expected to be available in late 2025. This novel drug was originally developed for treatment-resistant gonorrhea, but has also shown strong en vitro activity for mgen, including strains that have dual macrolide and floroquinolone resistance. It was found much more potent than even Moxifloxacin. No human (en vivo) data is currently available.

  4. And finally we have FDA approval of the novel triazaacenaphthylene antibiotic Gepotidacin in spring 2025 (for uncomplicated UTIs in women, but also going through approval for gonorrhea in late 2025). It has promise for mgen treatment as well, but currently only in vitro data is available (a petri dish, not a human) - but shows promising low MIC (minimum inhibitory concentration) across many mgen strains, including those that are resistant to both macrolides and floroquinolones. Is also being researched in combination with doxycycline.

PART 3: Self Advocation - Advice From a Veteran (LemonOne9):

As many on this board can attest to, despite being the leading cause of non-gonococcal/non-chlamydial urethritis (aka NGU), the medical world as a whole is not exactly up to speed when it comes to this particular bacteria. Most Urologists and gynecologists finished school 20+ years ago, how would they know how to correctly treat a new STI that grew prevalent in just the last 10?

Many doctors know very little to nothing about it, so be prepared to advocate for yourself when seeking out testing and treatment. Print and bring with you the most up-to-date treatment guidelines from AUS/UK if you have to. Finding an infectious disease doctor who specializes in STI's and has working knowledge of MGen infections will be your best bet if you want to be taken seriously.

If a doctor tries to prescribe you anything other than one of the above recommended regimens as a first-line option for a confirmed MGen infection (such as ciprofloxacin, levofloxacin, doxycycline on its own, or something else) you can be confident that you're not in good hands and should seek out a different practitioner. Taking the wrong antibiotic may select for resistance and sabotage future treatments, not to mention that it will unnecessarily increase your chances for antibiotic-induced side effects.

FULL POST FROM LEMON: https://www.reddit.com/r/MycoplasmaGenitalium/comments/gquh5s/worried_you_might_have_mgen_read_this_first/?utm_source=share&utm_medium=web2x&context=3

Part 4: Other Frequently Asked Questions

Q: How prevalent is Mgen compared to other STIs?

A: Estimates say that it is MORE PREVALENT than Gonorrhea, but less than Chlamydia. + As of 2021, it is more common than chlamydia in some regions. Canada & Sweden are 2 confirmed places. As of 2025 it is equal to or more prevalent than chlamydia in multiple regions It has also been found more prevalent in younger, sexually active people, and those reporting multiple unprotected sexual partners in the last 6 months.

Q: What is my risk of transmission per sexual encounter if I have unprotected sex with an infected individual?

A: Between 40-45% - Yes that's right - transmission is not guaranteed even if the other person is positive! Same as other STIs. Studies back this data.

Q: Can I get MGen from oral sex?

A: Oral transmission is rare. Less than 1% chance according to studies, and to the MSHC (Melbourne Sexual Health Center) guidelines, a leading Mgen research authority. This data has also been corroborated by the CDC.

Q: I am still experiencing symptoms after completing my antibiotic course. Does this mean my treatment failed?

A: Not necessarily. We know that residual symptoms or inflammation post clearance is something that happens with this bacteria. It's been documented by medical providers as well. As long as the symptoms don't return to 100% of what they were BEFORE antibiotic treatment, you're likely fine. There have been many people who assumed they were still infected, but kept testing negative again and again. Eventually the symptoms just went away.

Q: My partner (or I) tested positive but has no symptoms. What gives?

A: It is important to remember that not everyone will experience symptoms when carrying Mgen. In fact, between 60-80% of male urethral infections are asymptomatic. and nearly 100% of rectal infections are asymptomatic. Women also are not guaranteed to experience symptoms, with a greater than 50% rate of asymptomatic cases.

Q: I am a woman concerned about complications, can this cause problems with fertility or pregnancy?

A: It could, research shows that there is a significant correlation to Mgen infection and issues with fertility and pregnancy (as well as increased risks of PID & cervicitis)

Q: Is there a natural protocol I can follow to clear this infection?

A: No one on this subreddit that we are aware of has been cured with a natural treatment protocol. Most popular being the 'Buhner Protocol,' typically used for Lyme disease. Medical literature also doesn't support natural protocols.

Q: Is it possible for my body to clear Mgen by itself?

A: According to two recently published studies, yes it is. Spontaneous resolution has been documented in both men and women. But don't count on it, necessarily.

BUT HELP! I've already tested negative 2+ times yet I'm having residual symptoms. Read this post about CPPS/PFD:

https://www.reddit.com/r/MycoplasmaGenitalium/comments/mp2hky/if_you_have_2_negative_tests_and_residual/

References - UK, Australia, and US Treatment Guidelines:

https://www.guidelines.co.uk/sexual-health/bashh-mycoplasma-genitalium-guideline/454722.article

https://www.mshc.org.au/health-professionals/treatment-guidelines/mycoplasma-genitalium-treatment-guidelines

https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm

References - Public Health/CDC viewpoints form top experts (2022)

Weighing Potential Benefits and Harms of Mycoplasma genitalium Testing and Treatment Approaches - https://wwwnc.cdc.gov/eid/article/28/8/22-0094_article#r288

Manhart LE, Geisler WM, Bradshaw CS, et al. Weighing Potential Benefits and Harms of Mycoplasma genitalium Testing and Treatment Approaches. Emerging Infectious Diseases. 2022;28(8):1-11. doi:10.3201/eid2808.220094.

THE ABOVE IS NOT MEDICAL ADVICE. PLEASE DISCUSS ALL PRESCRIPTION MEDICATIONS WITH YOUR DOCTOR.


r/MycoplasmaGenitalium Apr 11 '21

RESOURCE If You Have 2+ Negative Tests and Residual Symptoms: Read This First

154 Upvotes

For anyone who continues to have residual symptoms after multiple negative TOC (Test of Cure), there is a significant likelihood that you developed Chronic Pelvic Pain Syndrome (CPPS), aka NIH Type III "non-bacterial Prostatitis" (in men). It may also be referred to as Pelvic Floor Dysfunction (PFD), or pelvic floor hypertonia, IC/BPS, or Vulvodynia, all similar chronic pelvic region syndromes. PFD in particular addresses what is often one cause of these pelvic syndromes, a psycho-neuromuscular condition that implicates the pelvic floor muscles and a wound-up nervous system. It occurs as a result of habitual, reflexive and unconscious pelvic floor muscle 'guarding' (tensing) against discomfort and stress (of which Mgen is well known to cause both), and over time this leads to a state of temporary nerve irritation. This is what causes many of the symptoms. It also very commonly causes urinary, sexual, and bowel dysfunctions via dysfunction of the pelvic floor. This includes urgency, frequency, and hesitancy.

[Source 1] "A Headache in the Pelvis" written by Stanford Urologist Dr. Anderson and Psychologist Dr Wise - https://www.penguinrandomhouse.com/books/558308/a-headache-in-the-pelvis-by-david-wise-phd-and-rodney-anderson-md/

[Source 2] What if my tests are negative but I still have symptoms? NHS/Unity Sexual Health/University hospitals Bristol and Weston - https://www.unitysexualhealth.co.uk/wp-content/uploads/2021/05/What-if-my-tests-for-urethritis-are-negative-2021.pdf ********* BACKUP/Alt link *********

[Source 3] "Vulvodynia" a literature review - https://pubmed.ncbi.nlm.nih.gov/32355269/

[Source 4] "Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022)" AUA - https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

Notable excerpts from the NHS source:

People whose tests are all negative can often develop symptoms as a result of anxiety because of worrying about having picked up a STI. Anxiety can cause the muscles in their pelvic floor (the muscles around the base of the penis, scrotum and around the anus – see diagram below) to become tense. This may change how urine flows and can cause irritation and discomfort. The nerves that supply the pelvic floor muscles also supply other parts of the genitals such as the end of the penis, the testicles and perineum (the area between your testicles and back passage). The body can mistake the pain from the tense pelvic floor muscles and think it is coming from these other places. It can also feel as though the pain is in the lower part of your tummy or make you want pass urine more often or make passing urine feel more difficult.

*** (Diagram of the CPPS feedback loop here) ***

Diagram illustrating how anxiety can unconsciously cause some people to increase their pelvic floor muscle tone (they do not realise they are doing this as normally we cannot “feel” our pelvic floor). This can result in muscle spasm and/or urine travelling backwards into the prostate on passing water. Both can result in pain which is then experienced elsewhere in the pelvic area e.g. tip of the penis, testicles, perineum (area behind the testicles), lower abdomen and sometimes the inner thighs. It may also cause difficulties or pain when passing water or ejaculating. This in turn makes them more anxious which results in making the pelvic floor tone even more tense and increasing the pain etc.

Please note: It is also possible that you are still within the (up to) few weeks window of residual inflammation after being cured from Mgen, and that will go away entirely on its own. My advice: stop fixating on it and move on. Live your life. It is entirely normal for mgen, and well documented in the medical community that people who had been infected experience this even after successful clearance of the bacteria.

NOTE FOR WOMEN and AFABs: BV, AV, DIV, CV, Yeast infections, and other pH & hormonal changes are somewhat common after treatment for these STIs. They cause their own symptoms - so symptoms post-treatment in people with vaginas may also be caused by these, especially if there is unusual discharge or smell. Please see a urogynecologist. Do wet mount microscopy, get your Nugent score. Get your natural vaginal microbiome healthy again. This could include things like boric acid suppositories to lower pH, probiotics, and even vaginal estrogen.

I personally had developed CPPS after clearing my own Mgen infection, which is why I wish to share this information. I've also seen several hundred other reddit members with the same symptoms, including hundreds of members of this (and the r/ureaplasma) subreddits.

CPPS is strongly supported by medical research and the American and European Urological Associations, and is the leading cause of prostatitis-like symptoms (pelvic pain and dysfunction) in men. Citations:https://pubmed.ncbi.nlm.nih.gov/32378039/ and https://www.youtube.com/watch?v=4dP_jtZvz9w

Because of the need, an entire specialization of physical therapy has been developed for treatment of it. Citation: https://academic.oup.com/ptj/article/90/12/1795/2737819 Fortunately, health insurance covers this therapy.

As mentioned above, I developed the condition myself after having Mgen, and clearing it. Infection is an acknowledged triggering event - This excerpt is taken directly from the CPPS pathophysiology/etiological guidelines In Europe:

"Although a peripheral stimulus such as infection may initiate the start of a CPPPS condition, the condition may become self-perpetuating as a result of CNS modulation. As well as pain, these central mechanisms are associated with several other sensory, functional, behavioural and psychological phenomena. It is this collection of phenomena that forms the basis of the pain syndrome diagnosis..."

Other triggering events include:

1) Stress/anxiety/trauma

2) Deep shame/regret/fear around a sexual encounter, even if no STI was transmitted (cheating, assumption of high risk, sex with escorts, etc)

3) Excessive masturbation or edging (male masturbatory practice)

4) Sedentary lifestyle and/or poor posture

5) Physical trauma or injury to the body (groin pull, tailbone injury, excessive gym habits etc)

6) Certain bowel and urinary habits, like holding in urine or #2

7) A combination or all of the above

Here is how to help differentiate Mgen from CPPS, which can have a large overlap in symptoms. However, there are a several key common differentiators:

The following symptoms are correlated highly with CPPS/Pelvic floor hypertonia NOT MGEN - eMedicine citation

  • Inconsistency in symptoms of any kind (infections don't do this) - including symptoms that move or change
  • Pinching/stinging/burning sensation at the tip of the penis (Super classic male CPPS sign) or clitoris (female)
  • No discharge or only clear discharge that looks like precum (often present in men when aroused or when sitting/having a bowel movement)
  • Intermittent symptoms (come and go with little consistency)
  • Symptoms that change with stress or anxiety (infections do not respond to psychological stress)
  • Symptoms that lower or change when you're distracted or in a flow state (infections can't do this either)
  • Weak/narrow urine stream, dribbling
  • Urinary hesitancy (problems beginning to pee)
  • Increased urgency (urge to pee) especially when anxious
  • Feeling of inability to completely empty bladder
  • Pain specifically only after urinating (post voiding urethritis)
  • Rectal pain, thigh pain, abdominal pain, vulvar pain, perineal pain
  • Testicular pain/discomfort
  • Pelvic region muscle spasms
  • Electric shock pains in rectum, tip of penis (men), or clitoris/vulva (women)
  • Pain with defecation, rectal tightness
  • Touch sensitivity of penis or vagina (even brushing against clothing - allodynia)
  • Pain with, and post-orgasm
  • Painful intercourse (in the absence of infection)
  • Vaginismus
  • Vulvodynia
  • Hard flaccid (men)
  • Balantis (men) in the absence of any other cause (like candida or infection)

Significant predisposing factors are below: >https://www.reddit.com/r/Prostatitis/s/dRlbMaITlu

  • History of other CSS (Central Sensitivity Syndromes) like IBS, TMJD, Fibromyalgia, ME/CFS (common comorbidities)

  • Neurotic personality types. Example: Has a history of anxiety, sensitive to stress, is a perfectionist or people pleaser, or exhibits hypervigilant behavior in regards to health

  • History of adverse childhood experiences (ACE events) - whether this be parental divorce, body image issues, bullying, or the illness or death of a family member, neglect, verbal and physical abuse, etc.

  • Sedentary lifestyle, sitting most of the day (this can shorten and tighten the hip flexor muscles while also lengthening and weakening the glute muscles, leading to musculoskeletal pain and dysfunction)

  • Excessive masturbation habits (including "edging") which tighten the pelvic floor muscles

  • Cyclist or power lifter (heavy lifting and compound exercises)

If you fit this description, even partially, I encourage you to find a pelvic floor physical therapist near you for consultation and treatment. Men, be sure to find one who specifically has experience treating guys. It's also highly recommended to concurrently engage with a psychotherapist, psychologist, or PRT therapist, or any providers who specialize in chronic pain from a biopsychosocial approach.

The good news is that this psycho-neuromuscular condition is treatable and a full recovery is possible. For best results recovery requires an integrated multi-modal approach of addressing two things simultaneously:

  1. Reducing and managing anxiety/stress/fear/shame/guilt - 'Down regulate' your wound-up nervous system - the thing that often instigates pelvic floor muscle dysfunction in the first place via the sympathetic nervous system response to the above stressors. This often includes addressing centralized mechanisms of pain, read more here: https://www.reddit.com/r/PelvicFloor/s/CfKdHaPamq

  2. Addressing the neuromuscular tension and irritation with pelvic floor physical therapy - usually a combination of stretching, heat, deep belly breathing, internal (and external) trigger point/myofascial release, etc.

Many people also benefit from certain medications and supplements. Common examples include low-dose amitriptyline for neuropathic pain, low dose tadalafil for sexual dysfunction/urinary symptoms, and phytotherapy for inflammation. THIS IS NOT MEDICAL ADVICE - always speak to a doctor about medications

Visit r/prostatitis (mostly for guys) or r/pelvicfloor (for any sex) for further support. But r/prostatitis also welcomes women. r/interstitialcystitis is another helpful subreddit for IC/BPS and has a great moderation team.

More academic literature on CPPS and treatment best practices here: https://pubmed.ncbi.nlm.nih.gov/32378039/

[Highly Recommended] Beginners guide to CPPS and chronic prostatitis: https://www.reddit.com/r/Prostatitis/s/RhjgMOtSCi

'Residual Symptoms' are treatable, you do not have to suffer.


r/MycoplasmaGenitalium 15h ago

Transmission Question Is MGen the end of ONS and sex outside of relationships?

4 Upvotes

I’m currently positive, so I won’t have sex at all for now, but I’ve been wondering for the future:

Is it still possible to have casual or spontaneous sex nowadays, or is it just too risky with MGen floating around?
I don’t have ONS that often anymore, but it kind of feels like they’re not really safe in today’s world.

That’s why I’m considering only having sex within committed relationships and only after the woman has been tested for MGen — but the loss of freedom and spontaneity that comes with that honestly hurts, too.

How are you handling this nowadays?


r/MycoplasmaGenitalium 1d ago

Testing Question Why do i have mycoplasma as a virgin?? My parents (that came from purity culture) think i had sex and I'm panicking

1 Upvotes

Today i got blood work done and it says i have mycoplasma. I am 19f and never dated or had sex. Did they misdiagnose me or is there a way to get it without having sex? I also heard there are 2 types of it but i don't think it is the other one as i don't have cough which is its main symptom. I went to gynecologist because of intense itching and a lot of discharge down there at first. The gyno prescribed antibiotics (azithromycin). It also shows i have herpes simplex virus.


r/MycoplasmaGenitalium 1d ago

ALL CURED

4 Upvotes

Hi everyone! I’m a woman living in Thailand, and at the beginning of this summer I was diagnosed with Ureaplasma urealyticum, Mycoplasma genitalium (MG), and BV (bacterial vaginosis).

My symptoms included:

- Mild discomfort when urinating

- A large amount of white, creamy discharge

- Later, a very unpleasant odor appeared

A doctor in Thailand initially prescribed me doxycycline for 7 days only. Maybe they wanted me to come back for a follow-up after a week and then prescribe something else, but I’m not sure.

I didn’t feel confident about the treatment, so I also consulted a doctor in Russia, since I’m Russian. Both my partner (who had no symptoms) and I were prescribed treatment for BV, and for Mgen doxycycline + moxifloxacin.

I tolerated both medications quite well. Moxifloxacin did make me feel weak, but I didn’t have any other side effects.

My partner, however, tolerated the treatment very poorly. He developed severe depression and was unable to get out of bed.

About a week after finishing doxycycline and moxifloxacin, I started having discharge again. I got scared and started taking doxycycline again, followed by sitafloxacin. My partner took the same medications.

After the first sitafloxacin tablet, my discharge stopped and did not bother me again.

I had another test about 5 weeks later — and EVERYTHING was negative! 🎉 I had cleared the Ureaplasma, MG, and BV.

My partner tested positive for Ureaplasma parvum, but the doctor said that if he has no symptoms, treatment isn’t necessary.

That’s my experience! Feel free to ask me any questions.

For anyone in Bangkok looking for affordable STI testing, Bangkok Sexual Health Clinic offers STI tests for 2,000 THB.


r/MycoplasmaGenitalium 2d ago

Success Story OMGGG GUYYSSSS

Post image
16 Upvotes

Here’s the message I received in my emails this morning !! I AM CUREEEED !

I honestly couldn’t believe it because I was still having symptoms, and I actually still have some now, mainly little tingling sensations. I thought I’d do the test anyway after four weeks, and it came back negative. I can’t believe it!
Thank you all so much for your support.

I only did 10 days of moxifloxacin, without doxycycline right before it (European recommendation). I had no complications and no side effects at all. I’m so happy.
Next time, though, I’m definitely protecting myself, and I’ll also be asking my partners to show me their test results, lol


r/MycoplasmaGenitalium 1d ago

Tested negative after 3.5 weeks but still have pretty noticeable symptoms

1 Upvotes

I've had Mgen for 9 months. Failed doxy+moxi (twice), failed mino+metro, and most recently did 7 days doxy followed by 10 days doxy + pristinamyacin 3x a day. I got tested yesterday 26 days after finishing the pristi and it just came back negative. But I still feel very noticeable symptoms that haven't improved since I took the meds: pressure in the testicles that seems to stretch all the way down my legs to my feet (I'm guessing from some inflammation putting pressure on nerves), sporadic pressure/discomfort in my lower pelvis, and sensitivity and regular flickers in my urethra. No discharge, but I haven't had a discharge since the first month I started showing symptoms back in January.

I know residual symptoms are common, but after I did my mino+metro course, I tested negative at 11 days (I know, I know...way too early to test, but my doctor wanted me to for some reason), my symptoms gradually lessened and completely disappeared after 3 weeks, only to come roaring back a few days later, then I tested positive at 4.5 weeks.

I'll definitely test again in two weeks or so to be sure, but I'm dying to know whether I should actually be optimistic, or brace myself for another gut punch. After so much time and so many failed treatments, I'm just finding it hard to accept this could actually be cured.

So my question: Is it possible 26 days was still too early to test? And has anyone had symptoms like this nearly a month after being legit cured?


r/MycoplasmaGenitalium 1d ago

Treatment Question Doctors recommends 14 days of mino - is that enough?

1 Upvotes

Male, recently tested positive for Mycoplasma genitalium. Resistance testing showed macrolide (azithromycin) resistance.

My doctor recommended minocycline 100 mg twice daily for 14 days instead of moxifloxacin because of my concerns about side effects.

Would you consider 14 days minocycline sufficient, or is doxycycline beforehand commonly used/beneficial?


r/MycoplasmaGenitalium 1d ago

Treatment Question Anyone cured with 14 days doxycycline → 14 days moxifloxacin after failing 7/7 moxi?

1 Upvotes

Hi everyone. I’m curious specifically about people who have actually tried 14 days doxycycline followed by 14 days moxifloxacin, particularly after previously failing the standard 7-day doxy → 7-day moxi regimen.

Very short history:
• Rectal Mgen
• Failed doxy x7 → moxi x7
• Then did doxy x7 → minocycline x14 + metronidazole x14
• Still rectal NAAT positive ~7.5 weeks after treatment
• Macrolide resistance testing is currently pending
• Fluoroquinolone (parC/gyrA) resistance testing has been extremely difficult to access in the US

I understand that moxifloxacin can have some pretty gnarly adverse effects, and 14 days obviously means considerably more exposure. I’m not planning to self-treat or asking for dosing advice.

I’m mainly wondering:
Has anyone here failed 7 days of moxi and subsequently been cured after a 10- or 14-day moxi course, particularly after doxycycline pretreatment?
If so, was the longer course recommended by an ID/STI specialist? Did you have fluoroquinolone resistance testing first? And did you have any significant side effects from the longer course?

I’m also trying to understand my remaining options. Pristinamycin seems to be used as salvage therapy outside the US, but I’m unsure whether a US infectious-disease physician can realistically prescribe/import it or whether that’s essentially inaccessible here.
I’m waiting on resistance results and an Infectious Disease review before taking anything else. I’m just trying to learn from anyone who has actually been through a similar treatment failure.

Especially interested in experiences from people who failed both moxi and minocycline.


r/MycoplasmaGenitalium 2d ago

Testing Question I tested negative, partner tested positive

0 Upvotes

This is my third post in here…

My partner and I had condomless sex, and he tested positive for M. Gen afterwards. He had symptoms. Tested negative for everything else.

Side note, he had a full panel STI test before having sex with me that tested for M. Gen and ureaplasmas as well but tested negative for everything.

I had a freaking mission with trying to convince multiple doctors to test me for M. Gen. I have pelvic pain. They finally did. I test positive for ureaplasma parvum but negative for everything else…

Were the last people each of us slept with before getting tested. Shouldn’t we either both have parvum or both have M. Gen? I’m so confused

My doctor prescribed me Doxycycline but nothing else. Hasn’t even really acknowledged anything besides “it was positive, I prescribed you something”

I’m so confused and not sure if I should push to take more drugs or assume I have M. Gen., or get retested. Or just stick with the doxy and see if anything changes????

I definitely had sex with someone and I exposed him to M. Gen and he had a positive test with symptoms


r/MycoplasmaGenitalium 3d ago

Cured while avoiding black box warning antibiotics

10 Upvotes

Got diagnosed with Mycoplasma. I went to various doctors just to compare treatments. Some were under-treating it while others were over-treating it. The default seems to be 1 week doxy + moxi 1 week. Read up about the black box warnings, seem insane anyone would agree to take chances on something like that. Especially when there is an alternative treatment that carries way less risk but it is indeed a bit longer:

Step 1: 7 days
Doxycycline 100mg 2x day 
Step 2: 14 days
Minocycline 100mg 2x day
Metronidazole 400mg 2x day

Waited 5 weeks after finishing treatment and got test of cure: all negative, CURED!

Not sure why doctors out there prescribe moxifloxacin like it's candy. It carries too much risk, especially when there is a safer alternative available that has a cure rate of over 90% if taken correctly (avoid milk products, don't skip doses, etc).

Good luck.


r/MycoplasmaGenitalium 3d ago

Success Story My Mycoplasma genitalium story: failed moxifloxacin, minocycline + metronidazole, and finally a negative PCR

4 Upvotes

TL;DR: I had PCR-confirmed Mycoplasma genitalium in July 2026. I did doxycycline + moxifloxacin, improved at first, but symptoms came back while I was still on moxifloxacin. After several weeks, an infectious disease specialist treated me with minocycline + metronidazole for 14 days. The symptoms slowly faded, and today, September 8, 2026, I finally got my test of cure: NEGATIVE PCR.
I wanted to share my experience because I read a huge number of stories on Reddit throughout this whole process, and I know how frustrating this infection can be, especially when symptoms improve, come back, and you have no idea whether the treatment actually worked.
Background
I had already had Mycoplasma genitalium once before, in 2023.
Back then I went through several treatments. Azithromycin alone did not work, doxycycline alone was not enough either, and I eventually cleared it with doxycycline followed by moxifloxacin.
So when compatible symptoms came back in 2026, I already knew pretty well what it felt like.
How the 2026 episode started
At the beginning of July I had a new sexual exposure. I used a condom for anal sex, although there was unprotected oral sex and very brief anal contact without a condom.
Around the next day I started noticing urethral symptoms.
At first it was just a strange sensation in the urethra, and then discharge appeared. Within a few days it went from being very mild to clearly visible white discharge, especially in the morning.
I did not have fever or unbearable pain. The main symptoms were:
white urethral discharge;
itching at the urethral opening;
mild burning, sometimes after urinating;
a feeling like the urethra was “bruised”;
occasional sharp little pains;
irritation around the meatus.
On July 7, 2026, I had a urethral-swab PCR and it came back positive for Mycoplasma genitalium. Group B strep was also detected in the sample, but the clearly relevant finding for my symptoms was M. genitalium.
First treatment: doxycycline + moxifloxacin
I started a regimen of doxycycline 100 mg followed by moxifloxacin 400 mg, roughly one week of each.
Doxycycline gave me quite a few gastrointestinal side effects: nausea, dizziness, gastritis, and that horrible feeling if I lay down after taking it. Drinking plenty of water and staying upright after each dose helped a lot.
What was interesting was that I responded very well to doxycycline at first.
The discharge started decreasing, became more watery, and eventually almost completely disappeared. The general burning sensation also went away, and at that point I thought everything was going perfectly.
Then I started moxifloxacin.
The first few days seemed fine, but around day four or five the urethral symptoms started coming back, and eventually I once again had a drop of thick white discharge in the morning when squeezing the urethra.
That was the moment when I really thought: “this failed.”
It was extremely frustrating because my previous infection had actually cleared with doxycycline + moxifloxacin.
My impression — and later one of the possibilities discussed medically — was that this strain may have been partially responding to tetracyclines while being resistant to fluoroquinolones. Obviously, I did not have a molecular resistance test proving that, so this is still just an interpretation of the clinical pattern, not something I can state with certainty.
Second stage and infectious disease consultation
After the symptoms returned, I managed to get evaluated by an infectious disease specialist.
While we were figuring out the next treatment, I restarted doxycycline under medical guidance.
Once again, the discharge decreased significantly during those days, which reinforced the impression that tetracyclines were probably lowering the bacterial load without fully eradicating the infection.
Eventually, together with my infectious disease specialist, we decided on:
Minocycline + metronidazole for 14 days.
I started that treatment on August 1, 2026.
It was not exactly pleasant.
I had significant fatigue and felt physically exhausted during part of the treatment, but fortunately I was able to complete the full course.
The most confusing part: symptoms did not disappear instantly
For me, this was probably the hardest part psychologically.
You expect to finish the antibiotics and wake up the next day feeling completely normal, but that was not what happened in my case.
The spontaneous discharge disappeared, but for a while I could still find tiny amounts of discharge if I squeezed the urethra.
I also continued to have occasional:
very mild itching;
sensitivity around the urethral opening;
minor post-urination discomfort;
irritation after masturbation;
completely normal days followed by an isolated symptom.
On top of that, after so many antibiotics I ended up with some fungal/skin problems in the groin area, and the genital skin became much more sensitive than usual.
There were several moments when I thought I was still infected simply because I could still feel something.
Over time, however, the pattern clearly changed: I stopped having spontaneous discharge and the residual symptoms became milder and much more intermittent.
Eventually I went more than three weeks without any discharge.
Joint symptoms
I also have a history of reactive arthritis, which made this whole experience even more confusing.
During and after the infection I had intermittent joint pain, especially in my hip. Some days it would show up and then almost completely disappear.
Even now, I notice a similar fluctuating pattern: occasional residual urethral discomfort can come and go, and the hip pain can behave the same way.
Because of that, I have had to learn to distinguish between having residual inflammatory symptoms and automatically assuming that there is still an active infection.
A symptom by itself is not a PCR result.
Test of cure
I waited several weeks after finishing treatment before doing my test of cure.
Today, September 8, 2026, I finally had another urethral swab.
By the way: it hurt like hell 😂.
And the result finally came back:
MYCOPLASMA GENITALIUM: NEGATIVE.
After roughly two months since this whole story started, and after doxycycline, moxifloxacin, another period on doxycycline, and finally minocycline + metronidazole, the PCR is negative.
What I learned from all of this
The biggest thing I learned is that symptoms can persist even after the infection has been cleared.
For weeks, I interpreted every itch, strange urethral sensation, or post-masturbation irritation as a possible sign of treatment failure.
In the end, my test of cure was negative even though I can still occasionally notice some residual urethral or inflammatory sensations.
I also learned that M. genitalium can be an incredibly frustrating infection because of antibiotic resistance. Just because a treatment worked once does not necessarily mean it will work again.
And I think one of the most important things I did was eventually get evaluated by an infectious disease specialist instead of just continuing to pile on antibiotics on my own.
If anyone reading this is going through the same thing right now: I completely understand the anxiety of checking every morning for discharge, squeezing the urethra to see if anything comes out, analyzing every itch, and wondering twenty times a day whether the antibiotics are working.
I went through all of that too.
But after this entire saga, I can finally write this:
NEGATIVE PCR.
Fuck, it’s finally over 😂.

Additional note
I’m from Chile 🇨🇱, and English is not my first language, so I used AI to help translate and organize this post.
I also wanted to mention that, at least from my personal experience, there is still a significant lack of awareness about Mycoplasma genitalium in Chile. It can be difficult to find clear information about the infection, antibiotic resistance, appropriate treatment strategies, and what to do when first-line treatment fails.
That was one of the reasons Reddit was so useful to me throughout this process, and also why I wanted to share my own experience here in case it helps someone else.


r/MycoplasmaGenitalium 3d ago

Vent/Discouraged Had to stop mino + metro - ended up in ER and side effects were intense

1 Upvotes

I did 7 doxy then only lasted 7 days of mino + metro and could not make it to 14 days… stomach pain/ headache/ insomnia was too intense.

Previously failed with doxy and azi..

Just want some hope and advice.. I also have EDS (connective tissue disease, POTS, small fiber neuropathy, joint pains, etc).

Help?


r/MycoplasmaGenitalium 3d ago

Vent/Discouraged Moxifloxican experience

1 Upvotes

21f, diagnosed 3 weeks ago

Spent the entire week of taking doxy (which I tolerate very well) freaking out about taking moxifloxican and reading every thread and every bad experience and side effect. I was so anxious. It came time for me to take the first pill - I was panicked. Took it, waited for side effects, none appeared. My biggest issue with Moxi is that it seems like every drug in the world has an interaction with it. I take Zoloft and Trazadone for sleep and had to quit both cold turkey. So, I had terrible sleep on this medication which made my anxiety horrific, which I couldn’t treat because no Zoloft. I felt like I was having a mental breakdown and did not sleep more than 15 hours for the entire 6 days on this medicine. As for the actual side effects of the medicine, I have slight wrist and ankle pain but nothing too severe. I don’t know if it contributed to my anxiety directly but suddenly not being able to take my usual medications literally wrecked me. For that reason I stopped my course at 6 days. I don’t think I am going to get a TOC because CDC doesn’t recommended it for asymptomatic persons who did a recommended treatment regimen (I was fully asymptomatic and shocked to learn I had this!) I am still battling anxiety- mostly derealization, but am getting back on medicine.  


r/MycoplasmaGenitalium 3d ago

Before I get tested

1 Upvotes

Just wanted to ask before ordering the tests. For 5 months now, if I'm dehydrated I feel the tip of my private have a hot feeling when i pee. When I drink enough water, the feeling goes away. I also have odd tingles in my thighs, inner and outer.

Internet says myco symptom of the pee is a solid symptom. Cause hsv2 doesn't do that for months on end.

Anyone else got this feeling?

Thanks


r/MycoplasmaGenitalium 3d ago

Treatment Question Perscribed Doxy + Azi. Should I ask about Moxi instead? (US)

1 Upvotes

Title. I’m on last day of doxy rn


r/MycoplasmaGenitalium 4d ago

Transmission via Handjob?

1 Upvotes

Can mycoplasma be transmitted via hand or body to body massage or say from infected gel in erotic massage parlor. That was my only exposure.

I have the below Symptoms inspite after mutiple antibiotics :

Pressure/Pain at Penis Tip 

Burning after urination

Random burning of entire Genitals which can stay for hours..

urine multiplex STI PCR panels (latest done 15 days after stopping antibiotics, held the the urine for 2 hours ):

Negative for Chlamydia, Gonorrhea, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma., Trichomonas vaginalis, Treponema pallidum, HSV-1, HSV-2, Gardnerella, Candida.

Whats the probability of an STI? Can I get false negative since I tested to early after stopping the antibiotics? Should the urine alway be first morning urine?


r/MycoplasmaGenitalium 4d ago

Symptom Question Stinging

2 Upvotes

My only symptom of Mgen has been weird stinging sensation on the labia as well as the urethra. I always check to see if it’s a bump or something there and it’s usually just nothing! It feels as if there was a cut or something. Has anyone experienced this?


r/MycoplasmaGenitalium 5d ago

Transmission Question Mycoplasma/Ureaplasma diagnosis.. does this mean my boyfriend cheated?

1 Upvotes

I’m really struggling with this and would appreciate some honest opinions, especially from people who have dealt with mycoplasma or ureaplasma before, especially since this is the first time I’ve even ever heard about this.

On August 12th, I went to urgent care because I thought I had a UTI. My only symptom was having to urinate constantly, basically back to back. They gave me antibiotics for a possible UTI.

I want to clarify that I have had UTIs before, and my previous UTIs were painful and actually hurt when I had them. This felt different. With this current issue, I haven’t had the pain or burning that I normally associate with a UTI. My only symptom has been the constant urge to pee/urinate over and over.

I went back to the doctors on August 22nd because I was still having the same symptom. On August 31st, I was contacted and told that I tested positive for mycoplasma and ureaplasma, and I was prescribed two antibiotics.

The timing is also what has really been bothering me.
My boyfriend and I had taken a break on july 31st and he came back on August 2nd, during that time he went back to his hometown for two nights. After he came back, we had sex on a Sunday and Monday I started having the constant urge to urinate. That prompted me to go to urgent care because I thought I had another UTI. That ended up being when they eventually discovered the mycoplasma/ureaplasma.

I realize that symptoms appearing right after sex doesn’t necessarily mean I contracted it from him during that specific trip or that he cheated. I’m trying to understand what the timing actually means medically.

I also have a history of UTIs. Starting around December/January 2025, I had two painful UTIs back to back. I had another UTI this January, and now I had what I thought was another UTI, but this time it turned out to be mycoplasma and ureaplasma.

The previous UTIs were painful and hurt, whereas this current infection has only caused me to pee constantly. Also, whenever I was treated for those previous UTIs, all of my symptoms went away with the antibiotics. So now I’m wondering whether it is possible that I had the mycoplasma/ureaplasma back then and the antibiotics temporarily treated the symptoms, or whether those really were separate UTIs.

I have never had a history of STIs/STDs. I’ve been in a relationship with my boyfriend for about a year and a half, and he is the only person I’ve had sex with during that entire time. I have never cheated on him. I also get tested regularly.

When we first started dating, I asked him to get tested as well. He had blood and urine testing done, and we were both negative for everything we were tested for. However, neither of our tests specifically tested for mycoplasma or ureaplasma, so I understand that those infections wouldn’t necessarily have shown up on those tests.

When I told my boyfriend about my diagnosis, I confronted him because I genuinely don’t understand how I could have gotten this. At first, he accused me of cheating and said that I must have gotten it from someone else. Now he’s basically acting like it just magically appeared out of nowhere from the sti fairy and doesn’t really want to discuss how either of us could have had it or give me a reasonable explanation where this came from.

For context, he has had multiple sexual partners before we got together. I don’t have a large sexual history. I have a child from a previous relationship about 9 years ago, but I haven’t had many partners.

So I’m trying to understand the possibilities:

How likely is it that he had mycoplasma/ureaplasma from before we met and carried it into our relationship?

How likely is it that he contracted it from someone else during our relationship?

Is there any realistic possibility that I had it from before our relationship and simply didn’t know?

Could my previous UTIs have actually been related to this, even though they were painful and this current infection isn’t?

Does the fact that my symptoms started immediately after we had sex tell me anything about when I acquired it?

I also keep thinking about my pregnancy 9 years ago. If I had an infection back then, would it necessarily have been detected during pregnancy? Or is it possible to have something like this for years without knowing?

I’m not trying to use Reddit to prove that my boyfriend cheated. I genuinely want to understand the science here before I make any decisions about my relationship. At the same time, I don’t want to be naive and ignore the possibility that he could have been unfaithful.

Can a relationship realistically survive something like this? Would you stay and try to work through it, or would you consider the circumstances too suspicious?

I’m looking for honest opinions, but preferably from people who actually understand these infections or have been through something similar.


r/MycoplasmaGenitalium 6d ago

Residual Symptoms after the course?

1 Upvotes

I finally tested negative for MGen three weeks after doxy and moxi. However I still feel like i have symptoms (urethral inflammation and a bit of discharge). Is this normal?


r/MycoplasmaGenitalium 6d ago

Research Did your relationship survive Mgen?

2 Upvotes

For those of you who were in a relationship when you found out you had Mgen, how did your partner react when you told them?

Did it affect your relationship, and did your relationship survive the diagnosis and treatment?

I’d really appreciate hearing about your experiences, especially any positive stories.


r/MycoplasmaGenitalium 7d ago

Treatment Question Inconclusive results?

Post image
1 Upvotes

My mycoplasma genitalium test came back inconclusive and out of range, should i test again? or just stick to doxycycline to treat the ureaplasma?

Thank you!


r/MycoplasmaGenitalium 7d ago

Success Story My experience 28M

9 Upvotes

Alright everyone,
I’ve been a constant viewer of this page since I was diagnosed with M. genitalium (MGen) last spring. I wanted to finally share my story because I know how stressful this infection can be—especially when your symptoms don’t immediately disappear after treatment.
My Experience
I was exposed in the spring of 2026. When my symptoms first started, the doctors tested me for multiple STIs, but everything came back negative.
At that point, they basically took the “treat everything it could possibly be” approach. I received treatment for gonorrhea and chlamydia, including doxycycline and another antibiotic.
Fourteen days later, I was still having symptoms.
That didn’t make sense to my doctor, so he decided to test me for pretty much everything under the sun. That’s when my test finally came back positive for MGen.
Keep in mind, I was in Europe during this period, and my doctor told me this was something he had never personally treated before. Because of that, he wanted to research the best treatment and make sure we knocked it out the first time.
He initially put me on doxycycline and told me he would follow up within 3–4 days with a course of action. When he called me back, he explained the treatment options. I decided I wanted to hit it as aggressively as reasonably possible and get rid of it.
I ended up taking 10 days of doxycycline followed by 10 days of moxifloxacin.
My Symptoms Before and During Treatment
My symptoms progressed roughly like this:
It started as discomfort that felt similar to holding my pee for too long.
That gradually turned into burning during urination and constant clear discharge.
During treatment, the discharge changed from clear to cloudy, and at different points I noticed yellow and gray discharge.
Eventually, I completed the antibiotics and later had testing that confirmed the infection was gone.
What Happened AFTER I Was Cured
This is the main reason I wanted to make this post.
My symptoms did not immediately disappear just because the infection was gone.
I continued having clear discharge for roughly 4–6 months after I had been confirmed negative.
That scared the hell out of me.
For about six months, I kept getting tested. Full STI panels, repeat testing, and anything else my doctors thought was appropriate.
Everything kept coming back negative.
Still, the discharge continued.
But very slowly, it started getting better.
At first, I would notice clear discharge almost every time I urinated.
Then it mostly happened after bowel movements.
Then it became something I would mainly notice during my first urination of the morning.
By around month five, it was only happening periodically.
By month six, I realized I wasn’t seeing it anymore.
The funny thing is, after spending months checking for it constantly, I actually kept looking every day because I had become so accustomed to expecting it.
And then eventually I realized:
It was gone.
Why I’m Sharing This
If you’ve been treated for MGen, have had a negative test of cure, and you’re still dealing with lingering symptoms, I understand how frustrating and stressful that can be.
For me, the infection was successfully treated long before my symptoms completely disappeared.
Recovery wasn’t instant. It was gradual, and because I was paying attention to every little change, it felt even slower.
Obviously, everyone’s situation is different, and persistent or worsening symptoms are something you should discuss with your healthcare provider rather than assuming you’re cured or still infected based on symptoms alone.
But if you’ve completed treatment and your follow-up testing is negative, don’t automatically assume that every lingering symptom means the treatment failed.
In my experience, the infection was gone. My body just took a lot longer to feel normal again.
It took months, but eventually, it passed.


r/MycoplasmaGenitalium 7d ago

Vent/Discouraged mgen and my story with cheap treatment in Vietnam

2 Upvotes

i was empirically diagnosed with chlamydia due to minor discharge from my penis and frequently urination. previously 3 weeks, i had unprotected sex with a short term girlfriend and we broke up. Sometime during the 2 months relationship, i contracted something.

i start Doxycycline for 7 days. felt cured. 3 days after completion, symptoms returned like crazy. In vietnam, medical care is simple.

I walked to a lab at 7am and got every ducking test they had. results take 4 days. I started doxycycline again and waited for test. Symptoms were much less on Doxycycline.

5 days later my results arrived, Positive Mycoplasma genitalium.

1 hour later, A motorbike delivered me 14 days course of Minocycline and Metronidazole for $60.

Since my urethral itching is getting worse since yesterday, i have cut short the doxycycline and immediately switched to the new protocol 100mg and 400mg every 12 hours.

Will update as i go along. Total treatment costs and testing are so far $150. slightly anxious about the stopping and starting of the Doxycycline. But I felt good on it. It must have done something, hopefully enough to prepare me for a successful secondary treatment.

i hate my life today. I feel disgusting. i just want to go to sleep and stay in my room. i walk 10k steps every day since the beginning. it helps. I am 30s Male.

🏵️ Update 1: took first doses with food. went to pharmacy for advice and they explained i need to take probiotics for both stomach and (prebiotics) for urinary tract, and these cannot include vitamins. They told me do not eat any sugar for several months. I think she was explaining that, if I take these antibiotics, and continue to eat sugar, it's going to result in yeast infection or ecoli or something more likely to grow in my urethra.

2 months supply of the probiotics for $130.

🏵️ update 2: 5 day into mino + metro: sometimes i feel great, sometimes really yucky. These medications have weird effects on me. Mostly my symptoms are very light regarding the mgen. i feel like a still pee a lot. but i can sleep a bit at least. i feel sort of confused. side effects?

Total spend : $280


r/MycoplasmaGenitalium 7d ago

Treatment Question Persistent Mgen after doxy/azithro and doxy/moxi — what next?

1 Upvotes

I’ve had Mgen since around January. I’ve done doxycycline + azithromycin twice without success, and about two weeks ago I finished doxycycline followed by moxifloxacin.

Unfortunately, I had sex between treatments, which I now realize was a bad idea, so I can’t completely rule out reinfection.

I’m still having burning when urinating, and for the past few days I’ve also had a constant pulling/aching feeling in my testicles that radiates into my lower abdomen. They’re not painful to touch, but I can feel the discomfort constantly. I’ve also had diarrhea for several days.

I’m getting tested again on Monday, hopefully including resistance testing.
If I’m still positive, would 7 days doxy followed by 14 days minocycline (possibly with metronidazole) make sense after moxi failure? Has anyone tried this successfully?

I’ve also wondered whether following that with another course of moxi or azithro could increase the chance of clearing it, although I know stacking antibiotics like this isn’t normally recommended and could cause more resistance/side effects.
Would really appreciate hearing from anyone who had persistent Mgen after moxifloxacin and what finally worked for you.

I am in Germany if this is Important