[Question #10410] Mycoplasma Genitalium
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23 months ago
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I had a one night stand on night of 9/9 unprotected oral and vaginal.
I started to get symptoms the night of 9/13 of pain/burning sensation inside my urethra like it has inflammation and pain n discomfort in my testicles, pelvic area that I could not sleep that night because of the intense pain. No discharge or pain during urination. Other symptoms included urge, more frequency to pee. I would feel a lot of discomfort if I tried to hold my pee for too long.
I went to get tested for gonorrhea, chlamydia and trich on 9/14 and results came back negative.
I went to get tested for gonorrhea, chlamydia and trich on 9/14 and results came back negative.
I was given 500 mg of ceftriaxone and 1g of Azithromycin on 9/14 because of the symptoms and had 7 day Doxyclycin on hand.
Because I was already familiar with Mycoplasma and that was the most likely culprit to cause my urethritis with the Chlamydia and Gonorrhea coming back negative, I took the Mgen test on 9/15 and started on my 7 day Doxycyclin since if it's Mgen or any other bacteria it would work for it. After the Azi and Doxy, the pain has slowly reduced the past two days but all symptoms are still present just not at extreme levels. I'm awaiting results but my questions are:
Because I was already familiar with Mycoplasma and that was the most likely culprit to cause my urethritis with the Chlamydia and Gonorrhea coming back negative, I took the Mgen test on 9/15 and started on my 7 day Doxycyclin since if it's Mgen or any other bacteria it would work for it. After the Azi and Doxy, the pain has slowly reduced the past two days but all symptoms are still present just not at extreme levels. I'm awaiting results but my questions are:
1. This sounds like MGen correct?
2. Would me taking Azi and 1 pill of Doxy affect the Mgen test results?
3. And the lab test wasn't approved until late afternoon so I made it before it closed but I had peed little over n hour earlier and so I didnt prep to hold more pee in. Would this affect results too? it was catch method.
4. I would assume because I took the Azi first and then Doxy already, that it wouldn't make sense to go the treatment route of taking 2.5mg Azi at the end of Doxy treatment right? The better treatment anyways is to take 7 day 400 mg Moxy after my Doxy correct?
5. How soon after finishing antibiotics should I wait to retest to confirm negative?
Thank you.
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H. Hunter Handsfield, MD
23 months ago
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Welcome to the forum. Thanks for your confidence in our services.
It is apparent you have done some pretty good research and have some basic understandings about Mycoplasma genitalium. However, your knowledge also has some important flaws or misunderstandings. The time frame of your symptoms and treatmtens are much too fast to attribute your symptom to M. genitalium and I very much doubt that's the problem. According to all guidelines and increasinglly extensive clinical experience, M. gen is unlikely unless standard treatment of urethritis (usually NGU, sometimes gonorrhea) fails to resolve symptoms after 1-2 weeks, or if symptoms recur 2-4 weeks after initial treatment. With prominent urethral pain and painful urination without discharge, I would be most suspicious of viral urethritis, like that resulting from adenovirus or herpes -- and that possibility became even more likely after your negative tests for gonorrhea, chlamydia and trichomonas.
As those comments suggest, two days is too soon to conclude that persisting symptoms are due to M. genitalium; and another day or two since starting doxycycline is far too soon to conclude that it is the reason for the apparent improvement in your symptoms, I suggest stopping doxycycline -- there seems to have been time for only one or two doses -- and just sit tight for several more days as your symptoms continue to improve. It certainly is possible you indeed have M. gen, but most likely you do not and I expect your pending test result to be negative. If positive, you can always resume the doxycycline at that time.
To your numbered questions:
1. Not necessarily; see above.
2. There should be no effect of treatment this soon on these results. The test detects M gen DNA, which persists for several days even as antibiotics start to kill the bacteria. You can still trust the result if negative.
3. Time since urination probably makes little or no difference in test reliability, despite official advice to hold urine a while before collecting the sample.
4. The regimen you described is not the usual one recommended in the US. If your M gen test is positive, the next step is to request further testing for antibiotic susceptibility. If that isn't done or results unknown, the recommended management is a week of doxy followed by a week of moxifloxacin, with no azithromycin.
5. Retesting to confirm cure of M genitalium is not officially recommended and usually not done. But if you have a clinic or doctor who understands the situation and is willing to test, or if you're working directly with a laboratory on your own, you could have a follow-up test 2-3 weeks after your last dose of moxifloxacin. For the reasons obvious above, my suspicion is you'll never get to this point.
All that said, I'll be interested to learn the result of M gen testing if you would care to share it.
I hope these comments re helpful. Let me know if anything isn't clear.
HHH, MD
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23 months ago
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Thanks for the quick reply.
One correction for you. I have no discharge and NO PAIN during urination. Do you still think symptoms arent M gen and its viral?
One correction for you. I have no discharge and NO PAIN during urination. Do you still think symptoms arent M gen and its viral?
I have HSV1 in the genitals. Viral urethritis symptoms from HSV would only happen at first infection and initial outbreak right? It wouldn't just randomly occur 20 years later? Or is it possible because of another infection like M gen that it triggered HSV urethritis episode? Are there any tests for the other viral causes of urethritis or is it pretty much rule out the bacterial ones and wait out the symptoms?
I guess my thinking from my research is in some cases M Gen does not respond well with Azithromycin. So if i just continue the Doxy and the tests come back positive I can just flow right through into Moxy without a time delay. Or are you thinking the Azi on the front end would have an adverse affect on the Doxy and Moxy treatment? Or is it that viral urethritis symptoms clears on it's own while bacterial symptoms continue without treatment. So best to stop medications to also see what happens?
I guess my thinking from my research is in some cases M Gen does not respond well with Azithromycin. So if i just continue the Doxy and the tests come back positive I can just flow right through into Moxy without a time delay. Or are you thinking the Azi on the front end would have an adverse affect on the Doxy and Moxy treatment? Or is it that viral urethritis symptoms clears on it's own while bacterial symptoms continue without treatment. So best to stop medications to also see what happens?
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H. Hunter Handsfield, MD
23 months ago
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These symptoms are not typical of M genitalium.
Correct -- urethral herpes is primarily with newly acquired infection. Other urethral infections are not known to trigger urethral (or genital) herpes outbreaks. Adenovirus thus is a better bet; your symptoms certainly are typical for viral urethritis, not M gen or any other bacterial cause.
Roughly half of M gen strains are fully susceptible to azithromycin, the rest entirely resistant. So it's a 50:50 crapshoot. Your symptom improvement seems too soon to be the result of your antibiotics; they could improve that soon, but this sounds to me more like the typical spontaneous resolution of a viral infection.
We do not provide medical care and I'm not your doctor; I cannot make any specific recommendations about continuing or stopping treatment at this point. Had you not started, I would have advised you to hold off and have a proper medical evaluation. At this point, that still makes sense to me.
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