Mycoplasma genitalium (M. gen) is a common sexually transmitted infection (STI) that often goes unnoticed because it frequently causes no symptoms. This bacterial infection of the urogenital tract is highly persistent, meaning it rarely clears on its own without medical intervention. The bacteria can establish a long-term presence in the body, leading to a state of chronic infection that may last for months or even years. Seeking professional medical treatment is necessary to prevent serious and lasting health complications, as the body’s natural defenses are typically insufficient to eliminate the organism.
The Unique Characteristics of Mycoplasma Genitalium
Mycoplasma genitalium is a bacterium distinguished by its extremely small size and its lack of a rigid cell wall. This structural difference is significant because it allows the organism to evade certain common antibiotics, such as penicillins, which target the cell wall for destruction.
The bacterium possesses a specialized tip organelle, which it uses to attach firmly to the host’s epithelial cells in the genital and urinary tracts. This adherence mechanism, combined with its ability to avoid the immune system, enables it to colonize the urethra, cervix, and rectum. Its fastidious nature makes it difficult to culture in a laboratory setting and challenging to detect without highly sensitive molecular tests.
The Chronic Nature of Untreated Infection
The answer to how long Mycoplasma genitalium lasts without treatment is that it generally establishes a chronic, persistent state that can endure indefinitely. Unlike some acute infections the immune system can successfully clear, M. gen often remains in the urogenital tract for a prolonged duration. This persistence is partly due to the organism’s ability to adhere closely to host cells and evade the body’s immune response.
Untreated M. gen infection can persist for an extended period. Reports indicate a median duration of persistence in men ranging from a few months up to 143 days. The infection can linger quietly as an asymptomatic carrier state, meaning the individual feels healthy while the bacteria multiply and can still be transmitted to sexual partners. This prolonged, often silent, carriage causes ongoing subclinical inflammation. The bacteria can continue to cause low-grade damage to the reproductive and urinary tracts, and the risk of transmission continues throughout the entire period the infection remains active.
Long-Term Health Risks of Persistence
The most serious consequence of an untreated Mycoplasma genitalium infection is the progression to severe and potentially permanent health problems. The persistent, low-grade inflammation caused by the bacteria can ascend from the initial site of infection into the upper reproductive tract.
Complications in Women
M. gen is a cause of cervicitis (inflammation of the cervix) and urethritis (inflammation of the urethra). It is strongly associated with Pelvic Inflammatory Disease (PID), an infection that spreads to the uterus, fallopian tubes, and ovaries. PID can lead to scar tissue that blocks the fallopian tubes, significantly increasing the risk of infertility and ectopic pregnancy.
Complications in Men
For men, the untreated infection commonly results in persistent urethritis, causing symptoms like a watery discharge and pain during urination. If the infection spreads, it can lead to epididymitis, the painful swelling of the epididymis. This condition has the potential to impact male fertility.
Persistent M. gen infection has also been linked to sexually acquired reactive arthritis (SARA) in both men and women, a type of joint inflammation. The chronic inflammatory effects of persistent M. gen can also increase an individual’s susceptibility to acquiring or transmitting other STIs, including HIV. In pregnant individuals, an untreated infection may also be associated with adverse outcomes, such as preterm delivery and pregnancy loss.
Why Medical Intervention Is Necessary
Given the organism’s high potential for persistence and the severe complications from chronic inflammation, medical intervention is mandatory to achieve a cure. The infection rarely resolves spontaneously, making treatment necessary even when the individual is completely asymptomatic. Treatment prevents long-term damage and stops the transmission of the bacteria to others.
Accurate diagnosis relies on laboratory methods, primarily nucleic acid amplification tests (NAAT), which detect the organism’s genetic material. These tests are far more reliable than traditional culturing methods for this fastidious bacterium. Treating M. gen involves a course of antibiotics, often a two-step regimen, to ensure eradication.
The high prevalence of macrolide-resistant strains makes it important to use appropriate, resistance-guided therapy. Following a positive diagnosis, notifying and treating sexual partners is also a critical step to prevent reinfection and limit the further spread of the infection within the community.