The vaginal microbiome is home to a whole range of bacteria — some good, some less desirable. Of the latter, Mycoplasma bacteria have been gaining more and more notoriety. Two important types of Mycoplasma that can affect people with vaginas are Mycoplasma genitalium (M. genitalium) and Mycoplasma hominis (M. hominis). 

But despite being part of the same family, they’re two very different bacteria. Keep reading to learn more about the symptoms of Mycoplasma, and how to treat them. 

What is Mycoplasma?

Mycoplasma species are part of the Mollicutes class, which sets them apart from other bacteria due to their lack of a cell wall. This unique characteristic can make them a bit challenging to study and treat, so there’s still a lot we don’t know about them.

Mycoplasma genitalium, also known as Mgen, is the only Mycoplasma species officially recognized by the Centers for Disease Control and Prevention (CDC) as a sexually transmitted infection (STI).

On the other hand, Mycoplasma hominis is typically a part of the normal bacteria present in the genital tract. Around 20-50% of women of reproductive age have M. hominis in their vaginal microbiome.

Unlike M. genitalium, M. hominis isn’t considered an STI. It’s known as a commensal bacterium, meaning it's more of a follower than a leader — it acts disruptive around other disruptive bacteria. M. hominis tends to be found in people with bacterial vaginosis (BV) and increases up to 10,000 times when other BV-associated bacteria are present. 

Mycoplasma symptoms

Like most other STIs, M. genitalium often doesn’t cause any noticeable signs. If you do have symptoms, they can often take a while to appear. Common symptoms include: 

  • Unusual vaginal discharge 
  • Pelvic pain
  • Itching in and around the vagina 
  • Bleeding between periods and/or after sex
  • Pain during sex or while peeing

As for M. hominis, the jury is still out on whether it causes vaginal symptoms. Research shows that other BV-associated bacteria (such as Prevotella and Mobiluncus) are more likely to cause symptoms than M. hominis. 

Having M. hominis present in your vaginal microbiome isn’t necessarily a bad thing — or the reason you’re dealing with uncomfortable symptoms — but it could be a sign that other disruptive bacteria are lurking around and causing trouble. 

Symptoms associated with (but not necessarily caused by) M. hominis can include the trademark signs of bacterial vaginosis: 

  • Thin, watery, and gray vaginal discharge 
  • A foul or fishy smell
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How to treat Mycoplasma infections

My. genitalium

To test for M. genitalium, your healthcare provider might recommend a nucleic acid amplification test (NAAT). This test involves providing a fluid sample through a vaginal swab or, less commonly, a urine sample. The sample is then sent to a lab to check for the presence of M. genitalium. You can also do an at-home STI test, such as Evvy's Vaginal Health Test and Expanded PCR Panel, to see if you have M. genitalium.

M. genitalium can be treated with antibiotics. Even though azithromycin was previously the preferred treatment, recent studies have shown that this type of bacteria has become resistant to it. Now, doctors will test to see if the bacteria has developed resistance to azithromycin. If it hasn't, the recommended treatment is doxycycline and azithromycin. If it has become resistant, doctors recommend doxycycline and moxifloxacin.

M. hominis

If you're dealing with recurrent symptoms, it's completely understandable to want to treat M. hominis. 

Perhaps you took a PCR test to check for M. hominis and your results came back positive. You might have also heard about people online whose symptoms went away after treating M. hominis. This makes sense because, as we explained earlier, Mycoplasma is an indicator species. If levels of M. hominis are high, chances are other disruptive bacteria are also. Antibiotics may get rid of all bacteria, including M. hominis. 

So, suppose you took an antibiotic and your symptoms went away and your levels of M. hominis declined. In that case, chances are that you accidentally treated the underlying cause without realizing it — but that doesn't mean M. hominis was the cause of the symptoms (correlation does not equal causation). It's important to understand what the scientific research currently states, especially before undergoing potentially unnecessary antibiotic treatment, as that can further irritate or imbalance your microbiome.

FAQ

How do you get Mycoplasma?

There are several different species of Mycoplasma. Some are naturally present in the vaginal and urinary tract and don’t cause any issues, like M. hominis. Others — specifically, M. genitalium — are spread through unprotected sexual contact. This includes vaginal sex, anal sex, and oral sex.

Can Mycoplasma go away on its own?

It depends on the species. M. genitalium infections usually don't clear up on their own and need antibiotic treatment to be fully cured. Even if you don't have any symptoms, the bacterium can hang around in your body and lead to serious problems over time, like pelvic inflammatory disease (PID) and cervicitis (inflammation of the cervix). Without proper care, the infection can continue to cause health issues and increase the risk of spreading to others.