The purpose of this form is to collect clinical information on cases of Mycoplasma genitalium that fail antimicrobial therapy. All reported information will be maintained in the strictest confidence.

Identifying patient information (e.g., patient name, date of birth, medical record number, social security number) should not be included on the form.

Any questions about the M. genitalium case registry can be directed to the CDC DSTDP Clinical Team (

Clinicians in CDC's Division of STD Prevention will review the form and follow up with submitting providers for additional demographic information.

If you are a health care provider whose patient is experiencing persistent symptoms after completing CDC-recommended treatment for Mgen, you can receive consultation for additional treatment options via the STD Clinical Consultation Network. Consults are provided by national experts by phone or email within 1-5 business days, depending on the requestor's preference.

Loading... Loading...
You have selected an option that triggers this survey to end right now.
To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.