[Question #12733] What's the deal with Ureaplasma?
5 months ago
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Male - 1 day post unprotected vaginal sex in Nov: genital/abdominal discomfort, frequent urination, feeling like I didn't "get it all out" after urination, also felt like I had urethral discharge but saw nothing upon inspection. Tested positive for ureaplasma, negative for everything else. Took doxycycline. Symptoms went away but came back immediately after meds, just milder (wasn't sexually active at this time). Follow up test was negative, symptoms eventually went away.
In Jan, 1 day post unprotected vaginal sex w/ another woman: similar symptoms plus visible clear/viscous discharge. Tested positive for Ureaplasma, negative for everything else. Finished doxycycline. Symptoms better but still persist.
I know Ureaplasma occurs normally in the genital tract but can overpopulate, at which point can be passed sexually. After treatment and a negative follow up test, is it possible it overpopulates on its own without sexual contact or is this usually something that requires sexual contact to result in having an abnormally high amount?
Is this something I shouldn't worry about treating, passing to others, or informing sexual partners about? Think I've read that on this forum. But then reputable websites and even my doctor state this should still be addressed like an STD and treated.
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H. Hunter Handsfield, MD
5 months ago
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Welcome back to the forum. Thank you for your continued confidence in our services.
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It certainly is true that there is highly variable information about Ureaplasma online. But the truth is orrect that Ureaplasma species (U. parvum and U. urealyticum) are normal bacteria in the genital tract. UU sometimes is responsible for nongonococal urethritis (NGU), but uncommonly; and UP is believed to never cause symptoms. (Which type was found on your test?) There is no evidence that UU causes symptoms or health problems when it grows to greater numbers, which presumably is what you mean by "overpopulate". Perhaps some knowledgeable experts have speculated about such increases as explaining some cases of NGU, but I am unaware of any evidence for this theory. In any case, your symptoms were not typical for NGU and I would not have advised treatment with doxycycline. I'm glad your symptoms have cleared up, but the doxycycline probably wasn't the reason. If you test for ureaplasma again in the future, you can expect to someday test positive again, which usually recurs after treatment. However, I would not advise further testing for it anyway.
In any case, even if it were true that your symptoms were due to ureaplasma, you don't have it now; and nobody ever is obligated to inform partners of past infections. And as implied above, I would see no need to discuss this with partners even if you test positive again.
I hope these comments are helpful. Let me know if anything isn't clear.
By the way, looking back at your last thread 5 years ago, I'm curious if herpes was confirmed for your perianal lesions. If so, which HSV type? Any recurrence outbreaks since then?
HHH, MD
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5 months ago
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Sorry if I was unclear, I was having trouble being detailed and staying under the character limit in my original post and I think there's some incompatibility with different web browsers. I DO currently have symptoms (mostly clear/viscous discharge and frequent urination/incomplete bladder emptying). Back in November when I had ureaplasma the first time, that's when the symptoms eventually went away and follow up test was negative. And I'm unsure which type because the Labcorp test results have only ever said "Ureaplasma spp NAA".
I thought discharge was a common symptom of NGU? What would you have treated with, if not doxycycline? Also, why do you say I will probably test positive again, simply because this is just normal bacteria in the genital tract of most sexually active adults or because this truly just never goes away or something? FYI I did get tested again yesterday, awaiting results
And are you saying you are not confident my symptoms were related to Ureaplasma? I had sex with a woman in November, developed symptoms a day later, then tested positive for Ureaplasma, then negative after treatment. Then in January, had sex with a different woman, developed pretty much the same symptoms also a day later, and tested positive for Ureaplasma again. Would you say this could be merely coincidental?
Regarding the thread from 5 years ago, my apologies, I tried to follow up later on but the thread had already been closed. It was not HSV or any type of STI. At this point I cannot recall the explanation given by the provider, but it cleared up pretty quickly once I received an ointment.
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H. Hunter Handsfield, MD
5 months ago
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Clear discharge usually doesn't occur with NGU, and the urinary symptoms also don't fit. (As it happens, my colleague Dr. Hook was the senior investigator one one of the main studies showing that such urinary symptoms are rarely if ever caused by NGU.) Also, in your initial question you describe what seems to be rather slow resolution of symptoms, especially the second time; "eventually" suggests it took quite a bit time. In NGU, typically symptoms clear completely within a few days and do not recur or continue on and off the next few weeks.
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Had you been my patient, we would have examined a urethral discharge for white blood cells; if none seen, I would have treated you at all. If in doubt and you insisted, doxycycline would not be unreasonable, but your experience suggests it didn't work well and might have had nothing to do with the gradual improvement you experienced.
Testing positive the second time was not because you were reinfected. As I said above, it is common for people treated for ureaplasma to again test positive at a later time, even without new sexual exposure. Most likely antibiotics only suppress the organisms without actually eradicating it.
Yes, I am indeed "not confident [your] symptoms were related to Ureaplasma"; I am quite confident they were not. Also, NGU symptoms -- whether due to chlamydia, ureaplasma, or anything else, one days is much too soon for onset of symptoms, which generally begin 1-2 weeks after exposure. Your symptoms might somehow be triggered by sex, but not because of any infection.
Thanks for the follow-up for your distant past thread. I'm glad to hear it didn't pan out as herpes.
5 months ago
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Ok final question(s) because this ureaplasma stuff just utterly confuses me (compounded by the fact that every single provider I've talked to at my urgent care clinic has conflicting info/explanations on ureaplasma):
So once it's in my genital tract, it's just kind of always going to be there? Which leads me to ask, I know you say this bacteria is "normal", so is this something that was just always there naturally or was it passed to me from someone somewhere along the way (I've been tested for ureaplasma in the past during routine STI screens - was always negative until November).
Also, what are some possible health conditions my symptoms are stemming from? Or is that just entirely impossible to say and something I should see a urologist about?
And finally, perhaps this isn't your domain, but any tips on combatting ED would be highly appreciated. The reason I have these "scares" is because I don't always use protection. This is due to ED caused by finasteride/minoxodil/age (41). I do take tadalafil, but it doesn't always do the trick, especially if alcohol is involved.
Thanks to you and your colleagues for all your past and present help.
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H. Hunter Handsfield, MD
5 months ago
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There are few absolutes in medicine or human biology, and U. urealyticum (but not U. parvum) can sometime cause NGU -- but as discussed, not usually the symptoms you describe. That said, it is conceivable that UU in fact was the cause of your problems, but I've given the reasons why I am skeptical about it. I can't comment on the views of "every single provider" you spoke with; my comments are based on the near universal agreement about Ureaplasma among genuine STI experts, including CDC's and the European Union's guidelines, as well as my own expertise. See the links below.
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Ureaplasmas are transmitted sexually, but that doesn't mean they are harmful. The same is true for literally hundreds of bacteria that comprise the genital microbiome, all of which are shared by sex partners. (Most such bacteria cannot even be identified, only detected by tests that reveal bacterial DNA.) Your symptoms are more typical for prostatitis, chronic pelvic pain syndrome, or perhaps genitally focused anxiety. If they continue, urology evaluation would make sense.
As for ED, that indeed is outside my expertise. We're experts in STIs, not sexual functioning or other aspects of genital health.
That concludes this thread. I hope the discussion has been helpful.