[Question #1136] M. Gen. and followup to questions 1003, 1017

52 months ago

I had posted in the forum last month because I was concerned about a possible STI infection.  I was having symptoms that I believed to be yeast-infection related or due to a copper IUD.  I have since been to see two different OBs as well as my primary care doctor... my symptoms persist.  I have to believe that they are somehow related to the unprotected encounter I had on 6-28 because that is when they began (a UTI immediately after, and development of the symptoms over the next few weeks).My symptoms are:  white vaginal discharge, a raw feeling on my labia, itching, burning, and frequent watery discharge.  I have also developed cramping that is unrelated to my period.  I tested positive for bacterial vaginosis on 8-3 and took two courses of metronidazole which did clear the BV... however, the other symptoms persisted.  Multiple tests for wet mount (yeast, trich, BV), gonorrhea, and chlamydia have come back negative, although urine testing has shown the presence of leukocytes.  For the cramping, I had a pelvic ultrasound which was inconclusive and showed some potential cystic areas and a thickening of my endometrium.  I was prescribed doxyclycline and Levaquin by one OB to clear up the leukocytes... she wasn't sure why they were showing up and the UTI culture was negative.  The doxy helped but symptoms returned after I finished it. After extensive research, I am concerned that I have contracted M. Gen.  I have told two different OBs about my concerns and they have dismissed them.  One of the doctors thinks I have interstitial cystitis and the other thinks I have nothing wrong, although I have had trouble with both getting clear, firm test results back.  I am at a loss as to where to turn here in Charlotte, NC.  I contacted the local Planned Parenthood and they seemed clueless about MGen as well as very busy and unable to help.  Money and insurance are not an issue, I just want this issue resolved. I have told my partner about my indiscretion and we are working to repair our marriage.  I am afraid to be sexually active with him, and I am in a significant amount of discomfort on a daily basis. 

My question is:  do you believe my concerns about MGen are legitimate?  Where can I turn to find someone who might be able to make this diagnosis?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
Welcome back to the forum.

As you probably know from your own research, Mycoplasma genitalium is relatively newly discovered as an STD pathogen, and new information is evolving. It is conceivable that it could cause some of your symptoms, but probably unlikely. Certainly the large majority of women with symptoms like yours don't have M gen or any other STD.

Several knowledgeable resources are available in your area. The UNC (Chapel Hill) has one of the most sophisticated STD research groups in the world, including expertise in M genitalium. The NC State health department is a leader in STD prevention and research. And Wake Forest University (and the local health department STD clinic, which has strong links with WFU) also has world class STD research experts. There also are online testing services that offer testing for M genitalium. It wouldn't hurt for you to be tested.

But don't get your hopes up:  I doubt you have M genitalium, and you should expect any tests for it to be negative. Even if positive, I wouldn't necessarily conclude that it is the cause of your symptoms.

All this is too complex to expect definitive answers from this or any online forum. This requires in-person clinical evaluation (and perhaps testing), whether from one of the resources just mentioned or elsewhere.

Good luck--  HHH, MD

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52 months ago
Thank you Dr. Handsfield.  Any recommendations on a particular site for online testing?  My initial search shows most of them are based in Europe.  I agree, my symptoms are complex and I understand you cannot make a good diagnosis through an online forum.  I have a followup appointment this morning and if I can't get anywhere with my local doctors, I will check into those resources you mentioned.  I appreciate it.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
Most or all online STD testing services really are just brokers; they don't have their own labs, but contract with various commercial laboratories. That's why you might find it difficult to find M. genitalium testing; since no such test has FDA approval, only a few labs offer it, and without FDA approval, some of those results may not be trustworthy anyway. Some individual laboratories such as academic medical centers or a few health departments have developed their own tests and tested them rigorously and can provide reliable results. I believe but cannot confirm that UNC might have done that; I don't know about Wake Forest. Anyway, for these reasons, when M. genitalium is suspected, the most common approach is to treat with an antibiotic that is reliably effective against it, such as moxifloxacin (Avelox®), with no attempt at diagnostic confirmation.

Be clear that I'm not necessarily recommending moxifloxacin for you. As noted above, I doubt you have M genitalium or any other STD. But you could discuss ith with your doctor.

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52 months ago
Yes. I read about Avelox on the CDC website and I have mentioned it to both of my doctors. Neither wants to prescribe it. I'm very frustrated because I'm having to undergo a lot of what may be unnecessary treatment such as a vulvar biopsy when if that antibiotic would work and clear things up it would be so much easier. If I do have MGen will it show up ANYWHERE? Like as a bacteria in my urine culture? I'm so frustrated.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
AS far as known, M genitalium doesn't infect any genital or urinary site except the cervix. For sure it cannot cause any condition that might be diagnosed by vulvar biopsy, so whether or not you need that diagnostic procedure is entirely independent of M gen.

It is clear you are obsessed by this. I have to suspect that your symptoms are largely psychological in origin if not entirely so, and apparently your two ObGs agree and I have to wonder whether the main problem here is your anxiety about a sexual decision you regret. I would encourage you to try to separate such emotions from the infectious implications of it; they aren't hte same. Further, I would advise you to stop any and all internet searching about it. I think you're selectively seeing information that inflames your fears.

In any case, that completes this thread. I hope the discussion has been helfpul. Best wishes.

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