[Question #11600] Mycoplasma Hominis Positive / Prostatitis symptoms / Advise Needed

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13 months ago

I was exposed to an infection 4 years ago, experiencing severe burning while urinating. After a Rocephin injection and Azithromycin, with no improvement, I developed severe knee pain and took many antibiotics.

Since then, I've had prostatitis symptoms: mild burning while urinating and perineum pain. Initial STD tests showed Ureaplasma urealyticum and Gardnerella vaginalis, later showing Mycoplasma hominis. A 10-day doxycycline course didn’t help.

I got married a virgin lady early this year. My STD tests were negative. After a few months, my wife had a one-day burning sensation, and ten days later, I had severe burning while urinating. STD PCR screening for my wife was positive for Gardnerella vaginalis. We both took Flagyl 1000 mg daily for 7 days. A follow-up test for her was negative.

I developed severe back pain and was diagnosed with ankylosing spondylitis 3 months ago, likely evolving from reactive arthritis. I'm on my third month of biological treatment with no improvement.

I've abstained from sex since then, fearing symptoms might harm my wife. A recent prostate fluid culture test showed Mycoplasma hominis. I took Azithromycin 500 mg for 5 days and Tarivid 200 mg twice daily for 7 days.

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13 months ago
forgot to mention the antibiotics that i took since this started :
  1.  Ceftriaxone 2000 mg one shot with Azithromycin 500 mg once a day for 3 days.
  2.  Doxycycline 100 mg twice a day for 4 days.
  3.  Ciprofloxacin 500 mg twice a day for two weeks.
  4.  Lincomycin injection for two days.
  5.  Flagyl 250 mg three times a day for 7 days.
  6.  Ceftriaxone 1000 mg for 3 days.
  7.  Clindamycin 400 mg four times a day for 2 weeks with Augmentin 1g twice a day for two weeks.
  8.  Azithromycin 1000 mg in one dose.
I really need advice on whether I can proceed with having sex normally with her ? Any other treatment needed for both of us? 
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Edward W. Hook M.D.
13 months ago
Welcome to our Forum. Thank you for your question and your description of your situation.  The organism found in your wife, Gardnerella vaginalis and Ureaplasma urealyticum, as well as Mycoplasma hominis are both bacteria which have been PROVEN to be normally present in the genitourinary tract and to NOT cause STI.  Unfortunately, there is a lot of misunderstanding about this and sadly, because they can, and not because the results are helpful to patients (they are not) laboratories test for them and doctors then try to treat them.  None of these infections require treatment and I would not be surprised that, if you test again in the future (which I would recommend against) tests were again positive because it is normal to find these bacteria in the genital tract. 

There is certainly no reason that you list for you to abstain from unprotected sex with your wife.

A note on prostatitis- prostatitis is almost never an STI and in a number of cases is not due to infection.  It tends to be a chronic problem which benefits from the continuing care of a prologist whom you feel comfortable with.  

I hope these comments are helpful.  EWH
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13 months ago

Thanks doctor, for your reply!

I have a few follow-up questions:

  1. I understand that these bacteria are normal in the genital area, but when I researched online, it says that an overgrowth can definitely cause infection. How true is this?

  2. If I do have an overgrowth, do I need treatment, and can I pass it to my wife through intercourse?

  3. Based on your experience, what genital bacteria can cause Ankylosing Spondylitis as a complication? I had reactive arthritis five days after an infection that lasted for a couple of years before it morphed into AS. Is Chlamydia the only one, or could it be something else?

Finally, I will follow your advice about having unprotected sex with my wife. Do you think I need further testing before that?

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Edward W. Hook M.D.
13 months ago
Straight to your follow-ups:

  1. I understand that these bacteria are normal in the genital area, but when I researched online, it says that an overgrowth can definitely cause infection. How true is this?  .  Concentrations of Mycoplasma hominis is the genital tract fluctuate greatly.  Years ago, before it was better understood, some felt that high concentrations of M. hominis needed treatment but this is incorrect. Mycoplasma hominis does not require treatment  

  2. If I do have an overgrowth, do I need treatment, and can I pass it to my wife through intercourse?   It would not be surprising at all if you and your wife shared the same genital tract bacterial including M. hominis however there is no need for treatment.  In fact, treatment might make thie organisms no longer detectable but they are likely to recur because they are normal.  

  3. Based on your experience, what genital bacteria can cause Ankylosing Spondylitis as a complication? I had reactive arthritis five days after an infection that lasted for a couple of years before it morphed into AS. Is Chlamydia the only one, or could it be something else?  Ankylosing spondylitis is different from reactive arthritis.  Ankylosing spondylitis is not the result of an infection but is due to the body fighting itself, probably because of a genetic predisposition.  Reactive arthritis can follow infections including Chlamydia as well as Campylobacter, a GI pathogen.  It would be most unusual for reactive arthritis to occur just 5 days after an infection was acquired.  Both ankylosing spondylitis and reactive arthritis are best managed by a rheumatologist.  If you have not seen one, I would suggest that you do.

Finally, I will follow your advice about having unprotected sex with my wife. Do you think I need further testing before that? I see no need for testing prior to having unprotected intercourse with your wife from what you say.


I hope this information is helpful.  EWH

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13 months ago
Hello Dr. Hook,

I am already on a third month of biological treatment (Simponi),  Just one question related to reactive arthritis (ReA) . 

Does this mean the infection is still present and causing an immune-mediated response, leading to chronic ReA? since I am still having symptoms of ReA since 4 years and AS since last year, While my HLA-B27 test is negative.

Additionally, according to many rheumatologists, chronic ReA is considered a form of AS (Ankylosing Spondylitis). What do you think, Dr. Hook, about the possibility that this immune-mediated response is due to the infection being hidden in calcifications of the prostate? Chlamydia could be the candidate bacteria here, since all of this happens after Sexual exposer.

Thanks.


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Edward W. Hook M.D.
13 months ago
Current theories on reactive arthritis is that the infection triggers an immune response which then attacks your body even in the absence of ongoing therapy.  The syndrome can persist following successful treatment of the inciting infection or other trigger.  

I will defer any comment on the relationship between ankylosing spondylitis and reactive arthritis to the rheumatologist.  I do not have a feeling for this as my practice is focused n management of acute infections.  

As you know, we provide up to 3 responses to each client's questions.  With this 3rd response the thread is complete and will be closed shortly.  Take care.  I hope the information I have provided has been some help.  As I already said, working with a well informed rheumatologist is likely to be the best way forward from here.  EWH
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