[Question #11045] MGEN? Urealplasma?

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17 months ago
Good morning! I have found very few responses from women related to this topic, so I was hoping to present my case to you to get some advice. I'm a 39 heterosexual year old female who was in a 17 year marriage, monogomous, with no history of STD/STI or issues. After divorce, I met a great 49 year old hetersexual male who I've been seeing since late summer. We became intimate with condoms in early fall, and around October, made the very adult and responsible decision to get testing together. We both tested negative for HIV, Syphillis, Chlamydia, Gonorrhea, Hepatitis and Trich--your basic panel at any clinic. We started having unprotected sex. After an encounter in Nov, within about a week, I started noticing some general agitation/burning and thick white discharge. Knowing that I was with a new partner who was clean and very likely just disturbing my vaginal flora, I kept an eye for a few weeks. I finally got tired of it and was given diflucan. The next several weeks has led into four months with no answers. I have been tested for every type of yeast, BV, had another full STD panel just in case, ALL negative. 2 rounds of oral then metro gel where I felt complete relief for several days (no discharge/agitation), then symptoms returned. I've stumbled now across Mgen. Does this sound like a feasible answer? Would Mgen come and go like this, responding so well to metro? I am feeling so defeated and upset as I felt like I did all the right things after getting out of a tough marriage to now find this new STI I was not even aware of! What about urealplasma? It also has similar sounding symptoms.
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17 months ago
I also wanted to mention we have been using condoms ever since I've been experiencing the agitation as to try and not agitate things further, but what an incredible buzz kill this has been on our new found passion and sex life with each other!
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H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thank you for your confidence in our services. I think I can help.

My best judgment is that your initial assumptions may be correct -- that you're experiencing accommodation of your vagina and its microbiome (the general mix of normal bacteria) to your partner's microbiome and/or increased sexual frequency. The intitial symptoms, i.e. "agitation" (did you mean irritation?) with burning and thick discharge suggest yeast infection. But you don't say whether the fluconazole (Diflucan) improved those symptoms. As you may know, yeasts are normal in the vagina and cause symptoms whey the grow to increased numbers or otherwise become irritating -- which probably can result from microbiome disruption. However, yeast doesn't respond to metronidazole gel (Metrogel).

Can you describe your current symptoms in more detail? Or the symptoms immediately before the Metrogel and whether they have returned? Continued itching, irritation, etc? Increased or abnormal discharge? If so, what's the discharge like -- thin? thick? does it stain your underwear? Have you noticed increased vaginal odor, or odor triggered by sex? If so, what is the odor like? Have you been in a doctor's care for these issues? If so, what did s/he say about them?

Now to your core questions. First, there's a lot of misinformation online, primarily from nonprofessional sites, about ureaplasma and other genital mycoplasmas, including Mycoplasma genitalium. You might have seen alarming but probably irrelevant information about your symptoms. Ureaplasma urealyticum (or U. parvum) are normal bacteria in the genital tract. They're shared between sex partners, but so are all other bacteria in both their genital tracts. Although U. urealyticum explains a minority of nongonococcal urethritis (NGU) in males, it has never been associated with any symptoms or disease in women and its presence on testing does not require treatment. M. genitalium also is documented primarily as a cause of NGU in males, but there are mixed data on its contribution to genital symptoms in women. 

Finally, what can you say about your partner's sexual lifestyle up til now? Has he had other partners recently, or maybe still? STIs are quite uncommon at his age, and I would be surprised if he infected you with M. genitalium; and it wouldn't matter if he happens to have ureaplasma.

I'm fairly confident this will sort out as an unpleasant inconvenience and not a serious health issue for you. I'll be happy to comment further if you can fill in the details I've asked about. In the meantime, I hope these comments start to help.

HHH, MD
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17 months ago
AGITATION: Yes, mostly burning more so than itching, outside (vulva+Labia more than internal).
DIFLUCAN: At first, I honestly thought they did. In fact, I would bet I DID have a yeast infection in the beginning of this which resolved. 4 days later, symptoms returned.
SYMPTOMS:  The discharge is literally all over the place. Some days it is literally all water. My underwear is just soaked and damp all day and I have to change it. Other days it is a yellow/mucousy discharge. Other days it is a clear discharge with small, white clumps. I do not notice any odor really that I can describe as bad or fishy. It does seem different, but not bad if that makes sense. I have zero spotting, urinary issues, abdominal pain--sex is not painful at ALL, during or after. I am also not getting any spotting. I only had spotting after I tried some vaginal probiotics out of desperation, and it lasted literally 24 hours. DOC: I was given Metro oral first as my doc was still convinced I had BV despite the negative results and my discharge completely disappeared, though it did take the FULL course of the seven days for me to feel full relief. 2 1/2 weeks later, burning and thin discharge. I then used metro gel 0.75 for five days BID. Discharge immediately went away while the burning slowly went away. Today is a "wet" day, needing to change my underwear.
PARTNER: My partner was also married and has had very limited partners; 2 at most in the last four years since his divorce. Both long term, in their 40's, and like with me, he used condoms with them until testing was completed.



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17 months ago
I had a swab (NuSwab VG+) for the three most common yeasts, BV+Gard, Trich, Chlamydia, Gon which of course all came back negative. I have never been so sad to see a negative result in my life. And yes, the discharge when thick white or with the white clumps definitely stains my underwear.
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H. Hunter Handsfield, MD
17 months ago
Thanks for all this. I agree that BV is not likely. At this juncture, I would advise returning to your doctor for further evaluation -- perhaps that's already in the plan (?). Inclusion of "yellow/mucousy" discharge indeed suggests an infection of some sort. In view of negative test results so far, I would suggest you go ahead and check for Mycoplasma genitalium; many or most commercial labs now offer it. I also assume your NuSwab test was on a vaginal or cervical swab, not urine -- in any case, you might ask your doctor about repeating it. Another possibility could be a yeast resistant to fluconazole, such as Candida glabrata -- the cause of up to 10% of yeast infections. (My understanding is that NuSwab makes a test version that detects up to 6 types of Candida.)

Presumably you have discussed all this with your partner.  You're sure he doesn't have symptoms, like urethral discharge? In any case, it would be reasonable for him to also be tested for common urethral infections, perhaps also including M. genitalium if an initial test is negative for gonorrhea and chlamydia.

You use fairly sophisticated terminology -- do you have medical training?
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17 months ago
He's been aware of my symptoms and I've asked him of course if he's had any recent or current urethral symptoms given I've seen SO many reports of the mgen come from men due to symptoms. He has absolutely nothing going on, nor can he ever remember a time where he had discharge, discom or irritation of any kind
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17 months ago
So sorry, I accidentally submitted before answering everything, moving too quickly on my phone with these little buttons. I am in healthcare, just under a doctor level, but my career is in a different genre! I did actually order a full vaginal microbiome test thats to be delivered Saturday and sent back to the lab. It will include 700 bacteria and fungi, including mgen. I'd be happy to share the results with you if youd like to keep this open if you're just as interested in this conundrum as I am! I should get the PCR results for the STDs (including MGEN) in 1-4 days, so likely by this time next week. The full report will take ten days. 
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H. Hunter Handsfield, MD
17 months ago
Thanks for the additional info. No established clinical decisions (like treatment, follow-up, etc) are likely at the current stage of knowledge about microbiomes, vaginal or otherwise. I'm happy to look at the result and wil leave the thread open for that result. However, unless a particular pathogen is found (like M. genitalium or perhaps an atypical yeast), please don't expect any sophisticated advice. Maybe someday, but not yet. (I hope you didn't spend a bundle on it!)---
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17 months ago
Well Dr. H, my PCR from my vaginal swab so far has come back negative for everything AGAIN, this time including Mgen. My first workup was for 11 common things+STD testing for chlamydia, gon, trick and mgen. Negative across the board, and negative for all types of other mycoplasma/ureaplasma so I can't even go down the wormhole blaming those. I had of course convinced myself it was mgen; even had the CDC meds ready for my doc on Monday for scripts, but unless this is a false negative, which I also will not entertain give I have active symptoms and the company claims 95%+ accuracy. This was done through the evvy vaginal swab who has partnered with some major lab company to roll this out. You've been kind enough to keep this thread open and I appreciate you so much. If you have any other advice on testing or treatment for just about anything, the girl with the four months burning vagina will take just about anything you've got. Thank you again so, so much.
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H. Hunter Handsfield, MD
17 months ago
On one hand, this is good news -- i.e. no known pathogens present. On the other, I guess the bad news part is that the cause of your symptoms remains unclear.

We do not provide direct medical care, so I cannot give treatment advice (and if I could, I would not). Many physicians in this situation might try another course of broad spectrum antibiotic(s), which might be similar to the regimens recommended for M. genitalium. In any case, all I can do is suggest you keep working with your doctor; and/or consider referral to a gyn who sub specializes in infections diseases. Such experts are available in most major metropolitan areas and/or in association with major (e.g. academic) medical centers.

That concludes this thread. I hope the discussion has been at least somewhat helpful. Best wishes.
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