genitalium has yet to be defined, significant associations exist between M. genitalium and cervicitis, pelvic inflammatory disease (PID), and tubal infertility (23,25,30). Among female reproductive tract tissues, M. genitalium DNA has been detected in specimens from the vagina, endocervix, endometrium, and the fallopian tubes, suggesting that, after sexual transmission, the organism can disseminate from the lower to the upper tract. Similarly, outbred mice inoculated vaginally showed time-dependent ascension of M. genitalium from the vagina to the cervix, followed by detection in the uterus, fallopian tubes, and ovaries (27). Therefore, the cervix appears to be either a primary or transient target of infection. Considering the clinical associations of M. genitalium with urogenital inflammation, it remains imperative to investigate the basic mechanisms of mucosal infection and disease induced by this organism.Among male and female reproductive tract syndromes for which M. genitalium has been implicated, all could be attributed to long-term colonization of the urogenital tract, which we refer to here as "persistence." Consistent with the ability to survive longterm in urogenital tissues and similar to other sexually acquired urogenital pathogens, it is hypothesized that M. genitalium has evolved specific mechanisms to evade the host immune system. Indeed, persistent cervical infection has been observed in several clinical studies (4,6,10,13) and has been associated with chronic symptoms (4). Persistent infection by M. genitalium is likely mediated, at least in part, by recombinational variation of genes encoding surface-exposed antigens (13,14,22) and through intracellular localization (2,7,17,26,31). Despite these mechanisms for avoiding the host's immune system, M. genitalium appears to induce a significant inflammatory response, as demonstrated with epidemiologic associations with urogenital disease (25, 30) and the observation that human ecto-and endocervical epithelial cells respond to acute infection with proinflammatory cytokine secretion (26). A link to human immunodeficiency virus (HIV) infection has been observed (29) since cervicitis caused by M. genitalium occurs more often in HIV-positive subjects (20) and, importantly, since M. genitalium persists longer in these women (6). In addition, high M. genitalium burden is correlated with increased HIV shedding from the cervix (24). Collectively, under-