MYCOPLASMA EDUCATION
Updated: 4 days ago
Mycoplasma is one of the co-infections that is easy to overlook. It is one of the smallest bacteria, it can hide inside our cells, and it is tricky to test for. I wanted all the information from my most trusted sources in one place, so you can understand it and talk with your doctor about it.
Short on time or energy? A quick-view graphic with the key points is at the bottom of this post.
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WHAT ILADEF SAYS (ILADS'S EDUCATIONAL FOUNDATION)
- Mycoplasma are small bacteria. Some live in people without causing harm, and some cause illness.
- Direct contact is the main accepted way it spreads.
- Some species, mainly Mycoplasma fermentans, have been found in Ixodes ticks (the ticks that carry Lyme).
- It can flare back up when the immune system is busy fighting something else, like a Borrelia (Lyme) infection.
- Early symptoms include fatigue and muscle pain.
- Later, it can affect the nerves, heart, blood, gut and skin, and it can also infect the genital and urinary tract, the brain and spinal cord, and the joints.
- It can hang on even after antibiotics.
- Testing is done with antibody tests or PCR, but there are many species and most tests only look for one.
- Symptoms can look very different when Lyme or other infections are also present.
- Having more than one infection at the same time may add to lingering symptoms and treatment failure, so your history and your doctor's clinical judgment are key.
- In a 2024 ILADEF interview, Dr. Richard Horowitz explains that he includes Mycoplasma species on his 16-point MSIDS map, the checklist he uses to find all the overlapping causes of a patient's symptoms.
WHAT ILADS SAYS
- ILADS says Lyme patients who stay sick may also carry other infections, including Mycoplasma, EBV, CMV, HHV-6, Chlamydia pneumoniae, parvovirus and candida.
- ILADS describes these as opportunistic infections not tied to ticks, and says how they interact with Lyme is not well understood.
- So how people catch Mycoplasma is still debated: ILADEF notes some species have been found in ticks, while ILADS groups it with infections not tied to ticks.
WHAT IT IS
- Mycoplasma is one of the smallest bacteria known to cause illness in people.
- It has no cell wall, so antibiotics that work by breaking down cell walls (like penicillin-type drugs) don't work on it.
- Mycoplasma pneumoniae is the most common species (Dr. Bill Rawls). It causes "walking pneumonia" (atypical pneumonia).
- Mycoplasma fermentans is the species most often linked to ticks.
- Other species include Mycoplasma genitalium, Mycoplasma hominis, Mycoplasma penetrans and Ureaplasma.
- Dr. Rawls lists several ways it can spread: biting insects (including ticks), sexual contact, contaminated food and droplets in the air (2020, older source, still worth reading).
HOW COMMON IS IT WITH LYME?
- In Dr. Horowitz's review of 200 chronic Lyme patients, 82% had evidence of exposure to Mycoplasma (Mycoplasma pneumoniae, Mycoplasma fermentans and Mycoplasma penetrans). Mycoplasma species also persisted in some patients despite common antibiotic courses. Older study (2019), still worth reading.
- A 2021 French study of 104 patients with symptoms that may be tied to a tick bite found Mycoplasma by PCR in 87.5%, mostly in saliva and urine, and more often than Borrelia. The researchers say it could also be harmless carriage or contamination, so more study is needed.
- A 2025 case series by Dr. Rosalie Greenberg of 37 young people diagnosed with pediatric bipolar disorder found Mycoplasma pneumoniae in 38%.
COMMON SYMPTOMS
- Fatigue
- Muscle pain
- Cough and breathing problems
- Joint pain
- Ringing in the ears
- Bladder irritation
- Anemia (Mycoplasma pneumoniae can cause a type called hemolytic anemia)
- Heart inflammation
- Gut issues like nausea and leaky gut
- Nerve pain, like burning and tingling in the hands and feet
- Brain and nerve effects
- Brain fog
- Insomnia
- Depression and anxiety
- Skin rashes
Sources for this list: ILADEF (fatigue, muscle pain, joints, anemia, heart, gut, nerves, urinary tract), Dr. Bill Rawls (breathing problems, ringing in the ears, bladder irritation, joint pain, heart, gut, nerve pain, brain fog, insomnia, depression and anxiety) and MedlinePlus (cough, rashes).
WHY IT MATTERS
- Dr. Horowitz's 2022 paper describes a 40-patient double-dose dapsone study in which 45% stayed free of all active Lyme symptoms for a year or more, as long as there were no signs of active co-infections like Babesia, Mycoplasma or Bartonella.
- Dr. Rawls (LymeDisease.org, 2025) lists Mycoplasma among the chronic Lyme co-infections linked to damage of the myelin, the protective coating on nerves.
- Dr. Charlotte Mao, a pediatric infectious disease doctor, in a 2024 talk shared by Bay Area Lyme Foundation, puts Mycoplasma pneumoniae high on the list of co-infections to consider in children with neuropsychiatric symptoms.
WHY A POSITIVE TEST DOESN'T ALWAYS MEAN ACTIVE INFECTION
- Dr. Rawls estimates that somewhere between a third and two-thirds of people have at least one kind of Mycoplasma in their body with no symptoms (2020, older source, still worth reading).
- A 2025 study of healthy farm and forestry workers and veterinarians in eastern Poland found Mycoplasma pneumoniae IgG antibodies in 63.6% of the samples tested. IgG antibodies often reflect an earlier exposure.
- Dr. Marty Ross explains that our bodies hold many bacteria the immune system keeps quiet, so a positive antibody or PCR test doesn't prove Mycoplasma is active or causing problems. His own estimate is lower than Dr. Rawls's: about 5% of healthy people show signs of Mycoplasma or Chlamydia pneumoniae. He points to research by Garth Nicolson, PhD, which suggests these infections show up more often in people with fatiguing illnesses.
TESTING
- Antibody tests and PCR are used. Most tests only check one species (ILADEF).
- A 2024 review of Mycoplasma pneumoniae testing in children calls PCR the gold standard. IgM usually shows up about a week after symptoms start and IgG about two weeks after infection. IgG can stay positive for a long time. One IgG result alone can't tell a new infection from an old one, so doctors compare two samples taken about two weeks apart. Harmless carriage can make PCR results hard to read too.
- Dr. Rawls (2020) notes standard PCR tests only look for a few species, mostly to catch sudden lung or genital infections. He suggests asking about a wider PCR panel that includes Mycoplasma fermentans, Mycoplasma genitalium, Mycoplasma hominis, Mycoplasma penetrans, Mycoplasma pneumoniae, Mycoplasma synoviae and Ureaplasma urealyticum.
- In Dr. Horowitz's 2019 review, not every patient was tested for every Mycoplasma species, which shows how easy it is to miss some.
- A 2025 case report described a rash that looked like a Lyme bullseye but was caused by Mycoplasma pneumoniae. The person's Lyme IgM stayed positive, but Lyme IgG never did. Tests can overlap and confuse the picture.
- This is why clinical diagnosis by a Lyme-literate doctor matters:
EARLY RESEARCH
- A 2023 lab study found Mycoplasma fermentans could infect and kill human nerve cells in the lab. This was lab work only, not tested in people.
- A small 2026 study of 27 people with fibromyalgia linked memory test scores ("fibro fog") with several infection markers, including Mycoplasma pneumoniae IgG antibodies and Borrelia.
MY EXPERIENCE
My Mycoplasma treatment was mixed in with treating everything else, so I can't say which piece helped it most.
SOURCES
ILADEF, "Tick-Borne Diseases Other Than Lyme" (April 2, 2024)
ILADEF, "How Does Dapsone Work?" with Dr. Richard Horowitz (September 12, 2024)
ILADS, "Lyme Disease Basics for Providers" (2018, older source, still worth reading)
Horowitz and Freeman, "Precision medicine: retrospective chart review and data analysis of 200 patients on dapsone combination therapy for chronic Lyme disease/post-treatment Lyme disease syndrome: part 1," International Journal of General Medicine (February 18, 2019, older source, still worth reading)
Horowitz and Freeman, "Efficacy of Short-Term High Dose Pulsed Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome (PTLDS) and Associated Co-Infections: A Report of Three Cases and Literature Review," Antibiotics (July 7, 2022)
Lacout and others, "Real time micro-organisms PCR in 104 patients with polymorphic signs and symptoms that may be related to a tick bite," European Journal of Microbiology and Immunology (November 3, 2021)
Greenberg, "Investigating the frequency of tick-borne infections in a case series of 37 youth diagnosed with pediatric bipolar disorder," Frontiers in Child and Adolescent Psychiatry (November 6, 2025)
LymeDisease.org, "How are multiple sclerosis and chronic Lyme related?" by Dr. Bill Rawls (April 21, 2025)
Bay Area Lyme Foundation, "Young Hearts, Hidden Battles: A pediatric infectious disease physician's perspective on Lyme disease and neuropsychiatric manifestations" by Dr. Charlotte Mao (May 28, 2024)
Wójcik-Fatla and others, "Seroprevalence of Borrelia, Anaplasma, Bartonella, Toxoplasma, Mycoplasma, Yersinia, and Chlamydia in Human Population from Eastern Poland," Pathogens (January 18, 2025)
Gao and Sun, "Laboratory diagnosis and treatment of Mycoplasma pneumoniae infection in children: a review," Annals of Medicine (August 3, 2024)
Almeida-Silva and others, "Serologies in Lyme disease can be deceiving: a rare case of mycoplasma-induced figurate erythema with persistent IgM Lyme antibodies," Oxford Medical Case Reports (November 26, 2025)
Sim and others, "Mycoplasma fermentans infection induces human necrotic neuronal cell death via IFITM3-mediated amyloid-β (1-42) deposition," Scientific Reports (April 26, 2023)
Puri and others, "Hippocampal Function and Markers of Citrullinated Proteins and Bacterial and Viral Infection in Fibromyalgia," Current Rheumatology Reviews (2026)
MedlinePlus, "Mycoplasma pneumonia" (reviewed August 19, 2024)
Dr. Bill Rawls, "Should I Test for Mycoplasma if I Think I Have It?" (March 18, 2022)
Dr. Bill Rawls, "Mycoplasma: The No. 1 Lyme Coinfection + How to Outsmart It" (updated December 9, 2020, older source, still worth reading)
Dr. Marty Ross, "Target Viruses, Mycoplasma, & Chlamydia in Lyme? Maybe Not" (2023)
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Disclaimer: Rise Above Lyme makes no claims about any possible benefit of using any product mentioned within this site. Always consult with your doctor before adding anything. The information shared is based on personal experience, years of accumulated researched resources from Lyme Literate doctors and polls conducted within Lyme groups from actual patient experience using these solution ideas.
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