STI testing has become more accessible in recent years, but accessibility alone does not guarantee better care. As more people search for STI testing, many are offered increasingly broad panels without clear explanations of what those results actually mean or how they should guide treatment decisions.
Two organisms that frequently come up together, and have received more attention lately are Mycoplasma genitalium and Ureaplasma. While they are often discussed as if they are the same, they are clinically very different. Treating them as interchangeable can lead to unnecessary anxiety, unnecessary antibiotics, and confusion for people simply trying to take care of their sexual health.
What is Mycoplasma genitalium
Mycoplasma genitalium, often called Mgen, is a sexually transmitted bacterial infection that has gained increased attention over the past decade. According to the Centers for Disease Control and Prevention, Mgen is now recognized as a significant cause of urethritis and cervicitis and has been associated with pelvic inflammatory disease and persistent genitourinary symptoms.
One of the challenges with Mycoplasma genitalium is that it is frequently asymptomatic. Research published in the Journal of Infectious Diseases shows that approximately 8 to 15 percent of asymptomatic individuals who undergo STI testing may test positive, while 10 to 16 percent of people tested due to symptoms are positive for Mgen.
Another reason Mgen matters is antibiotic resistance. Studies summarized by the CDC have shown increasing resistance to some first-line antibiotics, which means that identifying the infection correctly is essential for selecting the appropriate treatment regimen. When diagnosed accurately, clinicians can use second-line therapies that remain effective.
Because Mycoplasma genitalium is sexually transmitted, clinically actionable, and meaningfully impacts treatment decisions, Testie includes Mgen testing in select panels at launch.
What is Ureaplasma
Ureaplasma is different. Ureaplasma species are bacteria that can live in the urogenital tract of people of all genders. Unlike Mycoplasma genitalium, ureaplasma is extremely common and often detected in people with no symptoms at all.
Clinical guidance from the American College of Obstetricians and Gynecologists and European STI experts indicates that ureaplasma can appear in roughly 30 to 40 percent of vaginal tests, even in people who feel completely well. In many cases, ureaplasma is considered part of the normal urogenital microbiome rather than an active infection.
Because of this, many clinicians view ureaplasma as colonization rather than disease unless symptoms are present and other causes have been ruled out.
The problem with over-testing
When STI testing panels include organisms that are commonly present but not clearly linked to disease, several issues arise.
People may receive positive results that do not actually require treatment, which can cause unnecessary worry. Providers may feel pressure to prescribe antibiotics even when evidence does not support improved outcomes. Overuse of antibiotics can disrupt the vaginal or urinary microbiome, increase the risk of yeast infections or gastrointestinal side effects, and contribute to antibiotic resistance.
The European STI Guidelines Editorial Board has noted that routine screening for ureaplasma often results in high positivity rates without clear clinical benefit. Detecting bacteria does not always mean diagnosing disease.
For people seeking STI testing outside of traditional clinical settings, results should lead to clear and actionable next steps. Testing that creates confusion instead of clarity does not improve care.
Why Testie is not testing for ureaplasma at launch
After extensive clinical discussion, Testie made the deliberate decision not to include ureaplasma testing at launch.
This decision is grounded in evidence-based testing, antibiotic stewardship, and patient clarity. Our goal is to ensure that every test result meaningfully informs care and reduces unnecessary interventions.
This does not mean ureaplasma can never cause symptoms or that research will not evolve. It means that, at this time, routine screening for ureaplasma in asymptomatic individuals is more likely to result in overtreatment than benefit.
In cases where someone has persistent symptoms and other STIs have been ruled out, ureaplasma testing may be appropriate under provider guidance. However, it does not belong on a broad direct-to-consumer STI testing panel today.
Testing smarter
People looking for STI testing deserve clarity, not confusion. More testing is not always better testing, especially when positive results do not clearly indicate disease or guide treatment. The most responsible approach to sexual health testing prioritizes infections that are sexually transmitted, clinically meaningful, and supported by strong evidence.
Mycoplasma genitalium meets these criteria. Ureaplasma, at this point in the research, often does not.
As sexual health science continues to evolve, so should testing practices. Panels should change as evidence changes, with a focus on avoiding unnecessary treatment while ensuring real infections are identified and managed appropriately. Responsible testing is not about detecting everything possible, but about using data, context, and clinical judgment to support better outcomes.
