Mycoplasma Genitalium Treatment in Tennessee (Mgen, Nongonococcal Urethritis / Cervicitis)
Tennessee adult care by secure video visit, self pay option starting at $49, MD-only, insurance is not required.
Mycoplasma genitalium (Mgen) is one of the smallest self-replicating bacteria known and an emerging cause of sexually transmitted infections. It accounts for approximately 15 to 20 percent of all nongonococcal urethritis (NGU) cases in men, and up to 40 percent of persistent or recurrent urethritis after standard therapy. In women, Mgen is detected in 10 to 30 percent of cases of clinical cervicitis and has been associated with pelvic inflammatory disease (PID), preterm birth, and spontaneous abortion. A critical challenge with Mgen is rising antibiotic resistance — macrolide resistance markers are detected in 44 to 90 percent of US strains, which is why the CDC 2021 STI Treatment Guidelines now recommend a two-stage, resistance-guided therapy approach rather than standard azithromycin single-dose. TeleDirectMD can evaluate adults in Tennessee who present with a positive Mgen NAAT result or a history of persistent or recurrent urethritis and cervicitis after treatment for chlamydia and gonorrhea, review resistance testing results when available, prescribe CDC-recommended sequential therapy, and provide partner treatment guidance. TeleDirectMD does not perform STI testing — patients should be tested at a local clinic, lab, or sexual health center and bring results to the visit. This page is for adults located in Tennessee, including Nashville, Memphis, Knoxville, Chattanooga, Clarksville, Murfreesboro, Franklin, Jackson, Johnson City, Bartlett, and surrounding areas.
Quick navigation:
- Self pay option starting at $49
- MD-only care (no mid-levels)
- Insurance is not required
- Licensed telehealth care for patients located in Tennessee at the time of the visit
Last reviewed on 2026-03-23 by Parth Bhavsar, MD
ICD-10 commonly used: A49.3, N34.1, or N72 (final coding depends on clinical details and presentation)
Online MD-Only Mycoplasma Genitalium Care in Tennessee
- Evaluation of persistent or recurrent urethritis and cervicitis symptoms after standard STI treatment
- Review of positive Mgen NAAT results and resistance testing when available
- CDC 2021 guideline-based resistance-guided therapy (doxycycline followed by moxifloxacin or azithromycin)
- Partner treatment guidance and co-testing recommendations (HIV, chlamydia, gonorrhea, syphilis)
Adults 18+ only. TeleDirectMD is not an emergency service. Go to the ER or urgent care now for pelvic pain with fever (possible PID requiring IV antibiotics), severe testicular pain and swelling (possible epididymitis), or signs of sepsis. Moxifloxacin carries an FDA black box warning — screening for QT prolongation risk, tendon history, and pregnancy is performed before prescribing. TeleDirectMD does not prescribe controlled substances. TeleDirectMD does not perform STI testing — bring your test results to the visit.
Mycoplasma Genitalium Telehealth Eligibility Checklist for Tennessee
You are likely eligible for a TeleDirectMD video visit if ALL of these are true:
✓ You Are Eligible If
- You are 18 years old or older
- You are physically located in Tennessee at the time of the visit
- You have a positive Mgen NAAT result from a clinic or lab, OR you have persistent or recurrent urethritis or cervicitis that did not resolve after completing treatment for chlamydia and gonorrhea
- You do not have pelvic pain with fever suggesting pelvic inflammatory disease (PID)
- You do not have severe testicular pain and swelling suggesting complicated epididymitis
- You are not pregnant (moxifloxacin is contraindicated in pregnancy; in-person care is recommended)
- You do not have a history of QT prolongation, myasthenia gravis, or prior tendon rupture with fluoroquinolones (relevant for moxifloxacin prescribing)
- Insurance is not required. A self pay option is available.
✗ You Are Not Eligible If
- You are under 18 years old
- You have pelvic pain with fever suggesting PID (needs in-person evaluation and possibly IV antibiotics)
- You have severe testicular pain and swelling (needs in-person evaluation for epididymitis)
- You are pregnant (moxifloxacin is contraindicated; in-person prenatal care is recommended)
- You have signs of tubo-ovarian abscess or complicated upper tract infection
- You have documented multi-drug resistant Mgen with treatment failure after moxifloxacin (needs specialist referral)
- You do not have a positive test result and symptoms are not consistent with persistent or recurrent urethritis or cervicitis
If you have pelvic pain with fever, severe testicular pain, or systemic signs of infection, seek in-person care immediately. TeleDirectMD is not an emergency service.
How Online Mycoplasma Genitalium Treatment Works in Tennessee
Get tested at a local clinic or sexual health lab
TeleDirectMD does not perform STI testing. Get tested for Mycoplasma genitalium using a NAAT (nucleic acid amplification test) at your local clinic, sexual health center, or lab. The FDA-cleared Aptima Mycoplasma genitalium Assay (Hologic) and Cobas TV/MG Assay (Roche) are the currently approved tests. Resistance testing for macrolide susceptibility (if available at your lab) helps guide whether azithromycin or moxifloxacin is used in step two of therapy. Have your test results available for the video visit. If you have not been tested but have persistent or recurrent urethritis or cervicitis that did not clear after chlamydia and gonorrhea treatment, that clinical picture is also appropriate to discuss.
Book your video visit and see a Tennessee licensed MD
Insurance is not required. No referral needed. Many visits are available same day, depending on scheduling. We review your test results, symptom history including prior antibiotic use, sexual history, allergy history, and screen for red flags including PID, epididymitis, and moxifloxacin safety concerns (QT prolongation risk, tendon history, pregnancy, myasthenia gravis). We also recommend co-testing for HIV, chlamydia, gonorrhea, syphilis, and trichomonas if not already done.
Get a treatment plan and sequential prescription
If treatment is clinically appropriate based on your test results and clinical presentation, we send e-prescriptions to common Tennessee pharmacies such as CVS Pharmacy, Walgreens, Walmart Pharmacy, Kroger Pharmacy, Publix Pharmacy. CDC-recommended two-stage therapy: doxycycline 100mg twice daily for 7 days (step one, to reduce organism load), followed by either azithromycin (if macrolide-sensitive) or moxifloxacin 400mg daily for 7 days (step two). We provide partner notification guidance, abstinence instructions, and co-testing recommendations.
Tennessee Telehealth Regulations for Online Mycoplasma Genitalium Care
Tennessee Code Annotated Section 63-1-155 establishes the framework for telehealth services and permits licensed healthcare providers to deliver care using telecommunications and information technologies. The Tennessee Board of Medical Examiners authorizes the establishment of a provider-patient relationship through telehealth and requires compliance with the same standard of care as in-person encounters.
Location matters: you must be physically in Tennessee during the visit. Insurance is not required. TeleDirectMD does not prescribe controlled substances.
TeleDirectMD vs Other Care Options for Mycoplasma Genitalium in Tennessee
Here is how TeleDirectMD compares to common care settings for adult Mycoplasma genitalium evaluation in Tennessee:
| Care option | Typical cost | Wait time | Provider type | Best for |
|---|---|---|---|---|
| TeleDirectMD | Self pay option starting at $49 | Same day, often within hours | Board-certified MD only (no mid-levels) | Review of positive Mgen NAAT results, evaluation of persistent or recurrent urethritis or cervicitis, CDC-guided sequential antibiotic prescribing, partner treatment guidance, and co-testing recommendations |
| Urgent Care | $150 to $300+ (before insurance) | 1 to 3 hours typical | MD, DO, PA, or NP | STI testing and treatment in one visit, uncertain diagnosis, or when in-person exam is needed |
| Emergency Room | $500 to $3,000+ (before insurance) | 2 to 6 hours typical | Emergency medicine MD or DO | Pelvic pain with fever (PID), severe testicular pain and swelling (epididymitis), or signs of sepsis |
| Primary Care | $100 to $350+ (varies) | Days to weeks typical | Family medicine or internal medicine MD or DO | Comprehensive STI screening, ongoing sexual health management, and complex cases requiring coordination with urology or gynecology |
| Sexual Health or STI Clinic | Varies; sliding scale often available | Same day to 2 to 3 days | Varies by clinic | On-site Mgen NAAT testing, resistance testing, in-person exam, complicated presentations, and treatment failure requiring specialist input |
Bottom line: TeleDirectMD is a strong fit for adults who already have a positive Mgen test result or persistent post-treatment urethritis or cervicitis, need a CDC-guided sequential antibiotic prescription quickly, and want partner treatment guidance — without the time and cost of an in-person visit.
Should I Use TeleDirectMD for Mycoplasma Genitalium in Tennessee? Decision Guide
Do you have any emergency or red-flag symptoms?
- Pelvic pain with fever suggesting pelvic inflammatory disease (PID)
- Severe testicular pain and swelling suggesting complicated epididymitis
- Signs of sepsis: high fever, chills, rapid heart rate, or confusion
- You are pregnant (moxifloxacin is contraindicated; in-person care is recommended)
- Symptoms consistent with tubo-ovarian abscess
If yes, seek in-person care or go to the ER immediately
If no, continue to Step 2
Are you 18+ and currently in Tennessee?
If yes, continue to Step 3
If no, use in-person care as appropriate
Do you have a positive Mgen NAAT result or persistent urethritis or cervicitis after treatment?
- Positive Mgen NAAT (Aptima or Cobas assay) from a clinic or lab
- OR persistent or recurrent urethritis or cervicitis that did not resolve after completing treatment for chlamydia and gonorrhea
- No pelvic pain with fever, no severe testicular pain
- Not pregnant
- No known QT prolongation, myasthenia gravis, or prior tendon rupture with fluoroquinolones
If yes, continue to Step 4
If you have not been tested yet, get tested at a local clinic or sexual health lab first; if symptoms are different or more severe, in-person evaluation is preferred
You may be appropriate for a TeleDirectMD video visit
TeleDirectMD can review your positive Mgen test result and resistance testing data (if available), evaluate your symptom history and prior antibiotic use, screen for moxifloxacin safety concerns, prescribe CDC-recommended two-stage sequential therapy (doxycycline followed by moxifloxacin or azithromycin based on resistance results), provide partner notification guidance, and recommend co-testing for HIV, gonorrhea, chlamydia, syphilis, and trichomonas. If your situation suggests PID, complicated epididymitis, or multi-drug resistant Mgen after moxifloxacin failure, we will direct you to appropriate in-person care.
What Does Mycoplasma Genitalium Treatment Cost in Tennessee?
Transparent options. Insurance is not required.
TeleDirectMD Video Visit
$49
Self pay option. Insurance is not required.
- MD evaluation and red-flag screening (PID, epididymitis, moxifloxacin safety)
- Review of positive Mgen NAAT and resistance test results
- CDC 2021 guideline-based sequential antibiotic prescriptions when clinically appropriate
- Partner notification guidance and co-testing recommendations (HIV, chlamydia, gonorrhea, syphilis, trichomonas)
- Clear follow-up instructions including test of cure guidance and when to seek specialist referral
Typical Cost Comparison
Common ranges people see before insurance. Actual costs vary.
Prescription costs at your pharmacy are separate and vary by medication and pharmacy. STI testing costs are separate. Moxifloxacin may have higher pharmacy costs than doxycycline — ask your pharmacist about generics.
No hidden fees. If medication is not clinically appropriate, you still receive a complete evaluation, guidance, and clear instructions on what level of care you need next.
What Is Mycoplasma Genitalium?
Mycoplasma genitalium (Mgen) is one of the smallest known self-replicating bacteria and a sexually transmitted pathogen first identified in the 1980s. Unlike most bacteria, Mgen has no cell wall, which makes it intrinsically resistant to beta-lactam antibiotics (penicillins and cephalosporins) and requires specialized nucleic acid amplification testing (NAAT) for diagnosis since it cannot be cultured in routine clinical laboratories. Mgen is transmitted through vaginal, anal, and oral sexual contact. In the general US population, urogenital prevalence is approximately 1.7 percent (NHANES 2017–2018), representing roughly 3 million infected persons aged 14 to 59 years. In higher-risk populations attending sexual health clinics, prevalence ranges from 9 to 25 percent or higher.
Mgen causes approximately 15 to 20 percent of all nongonococcal urethritis (NGU) cases in men, and is responsible for up to 40 percent of persistent or recurrent urethritis — making it a critical diagnosis to consider when symptoms do not resolve after standard chlamydia and gonorrhea treatment. In women, Mgen is detected in 10 to 30 percent of cases of clinical cervicitis and has been associated with pelvic inflammatory disease (PID), preterm delivery, and spontaneous abortion. A defining feature of Mgen is rising antimicrobial resistance: macrolide resistance markers (which predict azithromycin failure) are detected in 44 to 90 percent of US strains, and quinolone resistance markers have also been reported. This resistance profile is why the CDC 2021 STI Treatment Guidelines recommend resistance-guided two-stage sequential therapy as the preferred approach.
TeleDirectMD can evaluate adults in Tennessee who present with a positive Mgen NAAT result or persistent or recurrent urethritis or cervicitis after prior STI treatment, prescribe CDC-recommended sequential therapy, provide partner treatment guidance, and direct patients with complications such as PID or epididymitis to appropriate in-person care. TeleDirectMD does not perform STI testing — patients should get tested at a local clinic, lab, or sexual health center and bring results to the visit.
Causes and Risk Factors
Mycoplasma genitalium is caused by the bacterium Mycoplasmoides (Mycoplasma) genitalium and is transmitted through sexual contact. Several factors increase the risk of acquisition and of antibiotic-resistant infection.
- Sexual transmission: Mgen is transmitted through vaginal, anal, and oral sexual contact with an infected partner. Like chlamydia, many Mgen infections are asymptomatic, so transmission can occur from partners who have no symptoms.
- Multiple or new sexual partners: Having multiple partners or a new partner increases the risk of Mgen acquisition, consistent with patterns seen for other bacterial STIs.
- Inconsistent condom use: Condoms reduce but do not eliminate the risk of Mgen transmission when used consistently and correctly.
- History of prior STI or prior antibiotic exposure: A history of prior STIs is associated with higher Mgen prevalence. Importantly, prior azithromycin treatment (including single-dose azithromycin used for chlamydia) can select for macrolide-resistant Mgen strains, making subsequent treatment more difficult.
- Persistent or recurrent urethritis or cervicitis: Mgen should be specifically suspected when urethritis or cervicitis symptoms persist or recur after completing standard treatment for chlamydia and gonorrhea, as it is the most common cause of this clinical scenario.
- Younger age and certain demographic groups: Mgen prevalence is higher in persons aged 20 to 29 years and in non-Hispanic Black individuals based on NHANES 2017–2018 national survey data.
Because many Mgen infections are asymptomatic and routine screening is not currently recommended (due to high resistance rates and unclear implications of asymptomatic infection), targeted diagnostic testing is reserved for individuals with symptomatic persistent or recurrent urethritis, cervicitis, or PID where other common pathogens have been excluded. Resistance-guided therapy is strongly preferred when resistance testing results are available.
Symptoms and Red Flags for Mycoplasma Genitalium in Tennessee
Use this table to understand which presentations are appropriate for telehealth evaluation and which patterns suggest complications requiring immediate in-person care.
| Symptom or situation | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Positive Mgen NAAT result with no or mild symptoms | Mgen infection detected; treatment needed to prevent complications and transmission | Yes | No |
| Urethral discharge and burning with urination in men (persistent after chlamydia/gonorrhea treatment) | Persistent NGU — Mgen is the most common cause after prior STI treatment | Yes, with test results | If accompanied by testicular pain and swelling |
| Abnormal vaginal discharge or intermenstrual spotting in women | Possible Mgen cervicitis | Yes, with positive test | If accompanied by pelvic pain and fever |
| Persistent or recurrent cervicitis after doxycycline or azithromycin | Possible Mgen as underlying cause | Yes, with evaluation of prior treatment history | If fever is present or exam-level pelvic tenderness is suspected |
| Pelvic pain with fever in a woman | Possible pelvic inflammatory disease (PID) | No | Urgent in-person evaluation — may need IV antibiotics or hospitalization |
| Testicular pain and swelling in a man | Possible epididymitis | No | Urgent in-person evaluation needed |
| Pregnancy with suspected or confirmed Mgen | Moxifloxacin is contraindicated; requires careful in-person management | No | In-person prenatal care required — moxifloxacin contraindicated in pregnancy |
| Treatment failure after completing moxifloxacin regimen | Possible quinolone-resistant Mgen or multi-drug resistant strain | Discuss with MD — specialist referral likely needed | Infectious disease or sexual health specialist referral recommended |
Differential Diagnosis: Mycoplasma Genitalium vs Other Conditions
Several STIs and urogenital conditions share symptoms with Mgen infection. A positive Mgen NAAT confirms the diagnosis, but co-infections are common and TeleDirectMD screens for concurrent infections and complications as part of every evaluation.
Sometimes Appropriate for Telehealth Guidance
- Mgen with positive NAAT result and uncomplicated urethritis or cervicitis — sequential therapy prescription and partner guidance
- Persistent or recurrent NGU after documented chlamydia and gonorrhea treatment — clinical evaluation and empiric or resistance-guided Mgen therapy
- Asymptomatic positive Mgen NAAT result without red flags — treatment discussion and partner notification guidance
- Co-testing recommendations for HIV, gonorrhea, chlamydia, syphilis, and trichomonas
- Partner treatment guidance and abstinence instructions during therapy
Often Requires In-Person Evaluation
- Pelvic inflammatory disease (PID): pelvic pain, fever, cervical motion tenderness — may need IV antibiotics or hospitalization
- Epididymitis or epididymo-orchitis: testicular pain, swelling, and tenderness — requires physical examination
- Concurrent gonorrhea requiring intramuscular ceftriaxone injection — cannot be administered via telehealth
- Pregnancy with confirmed or suspected Mgen — moxifloxacin is contraindicated and in-person prenatal management is needed
- Multi-drug resistant Mgen with treatment failure after moxifloxacin — infectious disease specialist referral required
- Tubo-ovarian abscess — emergency in-person evaluation
Mgen vs Chlamydia
Chlamydia and Mgen both cause urethritis and cervicitis with overlapping symptoms including discharge and dysuria. The critical clinical clue for Mgen is persistence after completing standard chlamydia treatment (doxycycline 7 days). Mgen is also more commonly associated with recurrent urethritis. Testing distinguishes them — Mgen NAAT is now FDA-cleared separately from chlamydia NAAT. Treatment differs significantly: chlamydia uses doxycycline alone; Mgen requires sequential two-stage therapy due to resistance concerns.
Mgen vs Trichomonas
Trichomonas vaginalis and Mgen both cause persistent urethritis in men and can co-occur. The CDC recommends testing men with recurrent NGU for both Mgen and trichomonas. Treatment is different — trichomonas responds to metronidazole or tinidazole, while Mgen requires the sequential doxycycline plus moxifloxacin or azithromycin approach. Co-testing for both is recommended in persistent or recurrent NGU.
Mgen vs Nonspecific Urethritis (NSU)
Nonspecific or nongonococcal urethritis (NGU/NSU) without an identified pathogen is common. Mgen accounts for 15 to 40 percent of NGU cases, making it the second most common cause after chlamydia. When NGU persists after standard doxycycline treatment, Mgen is the most likely culprit. FDA-cleared NAAT testing for Mgen should be performed before empiric retreatment to guide antibiotic selection and avoid further resistance selection.
If your symptoms suggest PID, complicated epididymitis, concurrent gonorrhea, pregnancy, or multi-drug resistant Mgen after moxifloxacin failure, TeleDirectMD will direct you to appropriate in-person or specialist care.
When Is a Video Visit Appropriate?
When a Video Visit Is Appropriate
- You have a positive Mgen NAAT result from an FDA-cleared assay
- You have persistent or recurrent urethritis or cervicitis after completing chlamydia and gonorrhea treatment
- No pelvic pain with fever, no severe testicular pain or swelling
- Not pregnant (moxifloxacin is contraindicated in pregnancy)
- No history of QT prolongation, myasthenia gravis, or prior tendon rupture with fluoroquinolones
- No prior moxifloxacin failure suggesting multi-drug resistant Mgen
- Located in Tennessee at time of visit
Red Flags Requiring In-Person or ER Care
- Pelvic pain with fever suggesting PID
- Severe testicular pain and swelling suggesting complicated epididymitis
- Signs of sepsis: high fever, chills, rapid heart rate, or confusion
- Pregnancy (moxifloxacin contraindicated; in-person prenatal care required)
- Concurrent gonorrhea requiring intramuscular ceftriaxone
- Treatment failure after completing moxifloxacin regimen (possible multi-drug resistant Mgen — specialist referral needed)
- Signs of tubo-ovarian abscess
If any red-flag symptoms are present, seek in-person care or go to the ER immediately. TeleDirectMD is not an emergency service.
Treatment Options
The CDC 2021 STI Treatment Guidelines recommend a two-stage, resistance-guided sequential therapy approach for Mycoplasma genitalium. This strategy uses doxycycline first to reduce the organism load (improving the efficacy of the second-stage antibiotic), then targets the organism with either azithromycin (if macrolide-sensitive) or moxifloxacin (if macrolide-resistant or resistance testing is unavailable). This approach achieves cure rates above 90 percent when resistance testing guides therapy, compared to much lower rates with empiric azithromycin alone. A 1-gram single dose of azithromycin alone should no longer be used for Mgen due to high resistance rates and evidence that it actively selects for resistant strains.
Stage one: Doxycycline (for all patients, regardless of resistance status)
Doxycycline 100mg orally twice daily for 7 days is given as the first stage for all patients with confirmed or suspected Mgen infection. Doxycycline is not curative for Mgen but reduces the bacterial load, which significantly improves the efficacy of the second-stage antibiotic. This 7-day doxycycline course is completed first before beginning the second-stage medication.
Stage two: Resistance-guided therapy (macrolide-sensitive infections)
If macrolide resistance testing shows the Mgen strain is sensitive to macrolides, high-dose azithromycin is used for stage two: azithromycin 1g orally on day 1, followed by 500mg orally once daily for 3 additional days (2.5g total). This four-day azithromycin regimen achieves high cure rates for macrolide-sensitive strains. This approach requires access to resistance testing results.
Stage two: Resistance-guided therapy (macrolide-resistant infections or resistance testing unavailable)
If macrolide resistance testing shows the Mgen strain is resistant, or if resistance testing is not available, moxifloxacin 400mg orally once daily for 7 days is used for stage two. Moxifloxacin carries an FDA black box warning for tendinitis and tendon rupture, QT prolongation, peripheral neuropathy, and exacerbation of myasthenia gravis. It is also contraindicated in pregnancy. The MD screens for these risks before prescribing. While the majority of Mgen strains remain sensitive to moxifloxacin, resistance has been reported, and this should be used as the preferred second-stage agent when macrolide resistance is confirmed or suspected.
Partner treatment and public health
Sex partners of patients with symptomatic Mgen infection can be tested, and those with a positive result should be treated. If partner testing is not possible, providing the same antibiotic regimen used for the patient is an option. Partner treatment reduces the risk of reinfection, though no studies have definitively proven this reduces reinfection rates. Abstinence from sexual activity during both stages of treatment is recommended.
What TeleDirectMD Does Not Manage
- Pelvic inflammatory disease (PID) requiring in-person evaluation and possibly IV antibiotics or hospitalization
- Complicated epididymitis or epididymo-orchitis requiring in-person physical examination
- Concurrent gonorrhea requiring intramuscular ceftriaxone injection (cannot be administered via telehealth)
- Mgen in pregnancy — moxifloxacin is contraindicated; in-person prenatal management required
- Multi-drug resistant Mgen with treatment failure after moxifloxacin — requires infectious disease or sexual health specialist referral
- Tubo-ovarian abscess or suspected complicated upper tract infection
Common Medication Options
These are the CDC 2021-recommended medication regimens for adult Mycoplasma genitalium treatment. The actual medications, doses, and sequencing are determined by the MD after reviewing your test results, resistance testing data, symptom history, allergy profile, and safety screening. Resistance-guided therapy is the strongly preferred approach.
| Medication | Typical dose | Duration | Key considerations |
|---|---|---|---|
| Doxycycline (stage one — all patients) | 100 mg by mouth twice daily | 7 days (stage one) | Given first to all patients regardless of resistance status. Reduces Mgen bacterial load and improves efficacy of second-stage antibiotic. Not curative for Mgen alone. Contraindicated in pregnancy. Take with food and water. Avoid dairy within 2 hours. Sun sensitivity. |
| Moxifloxacin (stage two — macrolide-resistant or resistance testing unavailable) | 400 mg by mouth once daily | 7 days (stage two, begins after completing doxycycline) | CDC-preferred second-stage agent when macrolide resistance is confirmed or resistance testing unavailable. FDA black box warning: tendinitis and tendon rupture (avoid if prior tendon rupture history), QT prolongation (avoid if QTc prolonged or on QT-prolonging drugs), peripheral neuropathy, exacerbation of myasthenia gravis. Contraindicated in pregnancy. Higher pharmacy cost than doxycycline. |
| Azithromycin extended regimen (stage two — macrolide-sensitive only) | 1 g by mouth on day 1, then 500 mg daily for 3 additional days (2.5 g total) | 4 days (stage two, begins after completing doxycycline) | Used only when macrolide resistance testing confirms susceptibility. A 1g single dose of azithromycin alone should NOT be used for Mgen — it leads to treatment failure and resistance selection. This extended regimen achieves high cure rates for sensitive strains. Contraindicated as sole agent; must follow doxycycline stage one. |
| Doxycycline — PID with Mgen (extended) | 100 mg by mouth twice daily | 14 days | For women with PID in whom Mgen is detected, standard PID empiric regimens (including a 14-day doxycycline course) are not effective against Mgen alone. If Mgen is confirmed in PID, moxifloxacin 400mg daily for 14 days may be needed after the initial empiric PID treatment. This scenario warrants close follow-up and is often managed in collaboration with gynecology. |
Important: Example regimens only. The actual medication, dose, and sequence are determined by the MD after reviewing your test results (including resistance testing when available), symptom history, prior antibiotic use, allergy profile, and safety screening for moxifloxacin (QT prolongation, tendon history, pregnancy, myasthenia gravis). Abstain from sexual contact during all stages of treatment. Test of cure is recommended 21 days after completing therapy for symptomatic patients to confirm eradication. TeleDirectMD does not prescribe controlled substances.
Home Care, Recovery, Partner Notification, and Follow-up
What to Do Now
- Take all medications exactly as prescribed — complete both stages of therapy in sequence (doxycycline first, then the second-stage antibiotic)
- Abstain from all sexual contact throughout both stages of treatment until you and your partner(s) have completed therapy and are symptom-free
- Notify sex partners so they can be tested and treated — this is essential to prevent reinfection
- If taking doxycycline, take with food and a full glass of water; avoid lying down for 30 minutes after; avoid dairy products within 2 hours of doses; use sun protection
- If prescribed moxifloxacin, contact your provider or go to urgent care if you develop tendon pain or swelling, irregular heartbeat, numbness or tingling, or muscle weakness — these are warning signs of serious side effects
- Mgen is treatable — with proper sequential therapy following CDC guidelines, the infection can be cleared
What to Watch For After Treatment
- Pelvic pain with fever developing at any point in women (possible PID — seek in-person care immediately)
- Testicular pain and swelling in men (possible epididymitis — seek in-person care immediately)
- Symptoms not improving or returning after completing both stages of treatment (possible treatment failure or reinfection — contact your provider)
- Tendon pain, swelling, or rupture while taking moxifloxacin (stop the medication and seek care immediately — this is a black box warning)
- Heart palpitations or irregular heartbeat while taking moxifloxacin (seek evaluation — moxifloxacin can cause QT prolongation)
- Numbness, tingling, or weakness while taking moxifloxacin (seek evaluation — possible peripheral neuropathy)
Partner Notification and Follow-up
- Test of cure is recommended 21 days after completing all therapy for symptomatic patients — unlike chlamydia, confirmatory testing after Mgen treatment helps confirm eradication and detect treatment failure
- If test of cure is positive or symptoms persist after completing the full two-stage regimen, expert consultation with an infectious disease or sexual health specialist is recommended
- Ensure all recent sex partners are notified, tested, and treated to prevent reinfection
- If you were not already tested for HIV, gonorrhea, chlamydia, syphilis, and trichomonas, discuss co-testing with your provider
- Use condoms consistently to reduce the risk of reinfection and other STIs
- If any red-flag symptoms develop at any time, seek in-person care immediately
When Not to Use TeleDirectMD for Mycoplasma Genitalium in Tennessee
TeleDirectMD is designed for uncomplicated Mgen evaluation and treatment. We are direct about when telehealth is not appropriate.
You Should Not Use TeleDirectMD If
- You are under 18 years old
- You have pelvic pain with fever suggesting pelvic inflammatory disease (PID)
- You have severe testicular pain and swelling suggesting epididymitis
- You are pregnant (moxifloxacin is contraindicated; in-person prenatal care required)
- You have concurrent gonorrhea requiring intramuscular ceftriaxone injection
- You have had prior treatment failure after completing moxifloxacin (possible multi-drug resistant Mgen — specialist referral needed)
- You have signs of tubo-ovarian abscess or complicated upper tract infection
- You do not have a positive Mgen NAAT result and your symptoms are not consistent with persistent or recurrent urethritis or cervicitis
- You are not physically in Tennessee at the time of the visit
Alternative Care Options
- Emergency room: pelvic pain with high fever (PID), severe testicular pain and swelling, or signs of sepsis or tubo-ovarian abscess
- Urgent care or sexual health clinic: STI testing and treatment in one visit, uncertain diagnosis, concurrent gonorrhea needing injection, or need for in-person pelvic or genital exam
- Infectious disease specialist: treatment failure after moxifloxacin, suspected multi-drug resistant Mgen, or complex cases requiring specialty guidance
- OB/GYN or gynecology: PID management, pregnancy-associated Mgen, or complicated upper tract infections
- Primary care: comprehensive STI screening, ongoing sexual health management, and coordination with urology or gynecology for complex or recurrent cases
Mycoplasma Genitalium Treatment FAQs for Tennessee
Can I get treatment for Mycoplasma genitalium online in Tennessee?
Yes, if you are an adult 18+ located in Tennessee and have a positive Mgen NAAT result, or if you have persistent or recurrent urethritis or cervicitis that did not resolve after completing treatment for chlamydia and gonorrhea. TeleDirectMD can evaluate your test results, prescribe CDC-recommended sequential therapy (doxycycline followed by moxifloxacin or azithromycin based on resistance results), provide partner notification guidance, and recommend co-testing for other STIs. You must have your test results available for the visit. TeleDirectMD does not perform STI testing.
How much does an online Mycoplasma genitalium visit cost in Tennessee?
TeleDirectMD offers a transparent self pay option starting at $49 for an adult video visit in Tennessee. Insurance is not required. Prescription costs at your pharmacy and STI testing costs are separate. Note that moxifloxacin may have higher pharmacy costs than doxycycline — ask your pharmacist about generics.
What is the CDC recommended treatment for Mycoplasma genitalium?
The CDC 2021 STI Treatment Guidelines recommend a two-stage sequential approach. Stage one is doxycycline 100mg twice daily for 7 days (for all patients, regardless of resistance status — reduces bacterial load). Stage two depends on resistance testing: if macrolide-sensitive, azithromycin 1g on day 1 followed by 500mg daily for 3 more days (2.5g total); if macrolide-resistant or resistance testing is unavailable, moxifloxacin 400mg daily for 7 days. A single 1g dose of azithromycin alone should no longer be used for Mgen due to very high failure rates from resistance.
Why can't I just take azithromycin like I did for chlamydia?
Mycoplasma genitalium has developed very high rates of resistance to azithromycin in the United States — macrolide resistance markers are found in 44 to 90 percent of tested strains. A single 1g dose of azithromycin alone fails in the majority of Mgen cases and can actually promote further resistance in strains that were initially sensitive. This is why the CDC 2021 guidelines moved to a two-stage approach with doxycycline first and then a second-stage antibiotic guided by resistance testing.
Is moxifloxacin safe? What are the black box warnings?
Moxifloxacin is effective for macrolide-resistant Mgen but carries FDA black box warnings that must be screened for before prescribing. These include: tendinitis and tendon rupture (avoid if you have a history of tendon problems or prior tendon rupture with a fluoroquinolone); QT prolongation (avoid if you have a prolonged QT interval or are taking other QT-prolonging medications); peripheral neuropathy (a risk that may be permanent); and exacerbation of myasthenia gravis (avoid if you have this condition). Moxifloxacin is also contraindicated in pregnancy. The MD screens for all of these factors before prescribing. If any concern exists, therapy will be individualized or you will be directed to in-person care.
How do I know if I have Mycoplasma genitalium?
Mgen is diagnosed by nucleic acid amplification testing (NAAT) — a laboratory test that detects Mgen genetic material. The FDA-cleared tests include the Aptima Mycoplasma genitalium Assay (Hologic) and the Cobas TV/MG Assay (Roche), which can be performed on urine, urethral swab, endocervical swab, or vaginal swab. Some labs also offer resistance testing (for macrolide resistance markers) at the same time. Mgen cannot be diagnosed by gram stain or standard culture. You should be tested at a local clinic, sexual health center, or lab. Consider Mgen specifically if you have symptoms of urethritis or cervicitis that did not resolve after completing standard chlamydia and gonorrhea treatment.
Do my partners need treatment?
Yes. Sex partners of patients with symptomatic Mgen should be tested, and those with a positive test should be treated. If testing the partner is not immediately possible, providing them with the same antibiotic regimen used for the patient is recommended to reduce reinfection risk. Both partners should abstain from sexual activity through all stages of treatment and until both are confirmed treated and symptom-free.
Do I need a test of cure after Mgen treatment?
Yes — unlike chlamydia (where test of cure is not routinely recommended), a test of cure is recommended for Mgen approximately 21 days after completing all stages of therapy in symptomatic patients. This confirms that the infection was eradicated and helps detect treatment failure early. If the test of cure is positive or symptoms persist after completing both stages of therapy, expert consultation with an infectious disease or sexual health specialist is recommended.
What if my symptoms persist after completing treatment?
Persistent symptoms after completing the full two-stage Mgen regimen may indicate treatment failure, which can be caused by reinfection from an untreated partner, poor medication adherence, or — most concerning — multi-drug resistant Mgen. If symptoms persist and the test of cure is positive after completing moxifloxacin, the CDC recommends expert consultation with an infectious disease or sexual health specialist. TeleDirectMD will direct you to appropriate specialist care in this situation.
Does Tennessee allow telemedicine for Mycoplasma genitalium treatment?
Yes. Tennessee allows licensed professionals to provide telemedicine within their scope when appropriate and according to accepted standards of care. You must be physically located in Tennessee at the time of the visit.
Can TeleDirectMD provide Mgen care in other states?
Yes. TeleDirectMD offers adult evaluations via video visits across multiple states. You must be physically located in the state where you are requesting care at the time of the visit.
Can Mycoplasma genitalium be cured?
Yes — with appropriate sequential antibiotic therapy following CDC 2021 guidelines, Mgen can be successfully treated. The two-stage doxycycline plus moxifloxacin approach achieves cure rates above 90 percent when resistance testing is used to guide therapy. The key is completing the full course of both stages, ensuring partners are treated to prevent reinfection, and confirming eradication with a test of cure 21 days after completing all therapy.
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Insurance is not required. Adult-only video visits. MD-only care. Safety-first red-flag screening, CDC 2021 guideline-based sequential treatment, moxifloxacin safety screening, partner notification guidance, and prescriptions when clinically appropriate.
References
- CDC STI Treatment Guidelines 2021 — Mycoplasma genitalium
- CDC STI Treatment Guidelines 2021 — Urethritis and Cervicitis
- Mycoplasma genitalium Management in Adults (NYSDOH AIDS Institute Clinical Guidelines, 2022) — NCBI Bookshelf NBK583532
- Torrone EA, et al. Prevalence of Urogenital Mycoplasma genitalium Infection, United States, 2017 to 2018. Sex Transm Dis. 2021;48(11):e160-e162.
- Mycoplasma Infections — StatPearls (2023), NCBI Bookshelf NBK536927
- Mgen in the US (MyGeniUS): Surveillance Data from Sexual Health Clinics in 4 US Regions. Clin Infect Dis. 2023;77(10):1449.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual urgent care for adults (18+) in Tennessee using secure video visits to evaluate Mycoplasma genitalium test results and persistent urethritis or cervicitis presentations, provide CDC 2021 guideline-based sequential antibiotic prescriptions when clinically appropriate, and screen for complications requiring in-person care. Insurance is not required. You must be physically located in Tennessee at the time of your video visit. TeleDirectMD does not prescribe controlled substances. TeleDirectMD does not perform STI testing — bring your test results to the visit.
TeleDirectMD is not an emergency service and is not a replacement for in-person care during pelvic inflammatory disease, complicated epididymitis, concurrent gonorrhea requiring intramuscular injection, pregnancy-associated Mgen, multi-drug resistant Mgen after moxifloxacin failure, or tubo-ovarian abscess. Moxifloxacin carries an FDA black box warning — the MD screens for QT prolongation risk, tendon history, pregnancy, and myasthenia gravis before prescribing. This service is intended for uncomplicated Mgen evaluation based on positive test results or clinical pattern of persistent urethritis or cervicitis after prior STI treatment.
Online Mycoplasma genitalium treatment in Tennessee. Mgen antibiotics online. Persistent urethritis treatment online. Nongonococcal urethritis treatment by video visit. STI telehealth Tennessee.
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