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Background Mycoplasma genitalium (MG) is a critical pathogen of sexually transmitted infections (STIs) in men, associated with high antibiotic resistance. Understanding the clinical characteristics of MG infections can improve testing and treatment guidelines.Aims To investigate the clinical features and characteristics of asymptomatic, acute and chronic MG infections in heterosexual males.Methods From January 2018 to September 2023, men diagnosed with urethral STIs using multiplex real-time PCR were enrolled into this cross-sectional study. Testing indications included males with urethritis, suspected STIs and asymptomatic screening. Based on clinical symptoms, participants were classified as acute, chronic or asymptomatic groups. An electronic-based survey was administered to assess demographic, behavioural and clinical information. Univariate and multivariate logistic regression were performed to assess for factors associated with the presence of symptoms.Result Among the 2102 men who have sex with women and were tested for STI, 879 records met the eligibility criteria for further analysis; MG was detected in 14.6% of the 2102 cases. Most patients presented with acute urethral symptoms (75.6%). Among men infected with MG, mono-infection accounted for 52.8%, while Chlamydia trachomatis and Neisseria gonorrhoeae co-infections occurred in 39.3% and 21.3%, respectively. Co-infections were more prevalent among acute urethritis compared with chronic urethritis or asymptomatic groups. Multivariable analysis revealed associations between chronic symptoms with absence of urethral discharge (aOR 0.31; 95% CI 0.2 to 0.47), previous antibiotic use (aOR 6.83; 95% CI 4.47 to 10.4), marriage (aOR 1.66; 95% CI 1.09 to 2.51) and history of STIs (aOR 2.08; 95% CI 1.24 to 3.49).Conclusion Our study revealed a 14.6% prevalence of MG among individuals tested for STIs. Most patients presented with acute urethral symptoms, while chronic symptoms were associated with marriage, antibiotic use history and previous STIs. Routine MG screening of asymptomatic patients is not recommended, but improved access to diagnostics and further research is needed for clinical practice in low-resource settings.