[Question #13094] Mgen/Spotting/Biktarvy/

2 months ago

Hello again, doctors. I have a few more questions. This time it is in regard to Mgen. I possibly had unprotected vaginal intercourse 1x with a person of unknown STD/STI status approx 4 weeks ago - I was highly intoxicated and do not know remember whether sex occurred at all. I am currently on Day 28 of Biktarvy. I was also treated with antibiotics prophylactically for Chlamydia and Gonorhea (doxy 2x/day and ceftiaxone IM). A few days ago, I began spotting, 8 days after last day of period. A day or so later, I noticed warmth/ tingling at the vaginal opening, vestibule area. There is some discharge, but appears mostly clear and don't not have an odor. I do NOT have burning with urination. But do feel this warmth, after wiping and while sitting. Lastly, some twinges in my right lower pelvic area now and again.

I went back to doc who tested me for BV/Yeast/Trich (KOH & Wet mount) - 20 mins later I received negative results.

So my questions:

1.) Is this how Mgen typically presents in women 3-4 weeks post exposure - Light Spotting, some warmth/irritation/ somewhat burning, but NOT during urination, twinges in right lower pelvic region?

2.) I have read that Biktarvy can cause menstrual changes in women such as spotting, is this true?

3.)If this is Mgen - could this be from a past exposure from 15+ years ago and I've just been carrying it all this time or does this line up more with a recent exposure?

4.) Would you recommend testing for Mgen at this time? Aside from this possible exposure 4 weeks ago, I am in a monogamous relationship. I have not resumed sex with my regular partner, and do not plan to until I receive conclusive results for HIV, but wonder now, if I should get tested for Mgen as well? I wonder if I resume sex, I may infect my partner if this is New Mgen. I have never been tested in my life for Mgen.

Edward W. Hook M.D.

2 months ago

Welcome back to the Forum although I'm sorry you felt the need. I reviewed your recent interaction with Dr. Handsfield and agree with all that he said, including "Do your best to relax and stop worrying. I am confident any and all tests of any kind at any time in the future will remain negative. The events you experienced must have been quite traumatic for you to be having so much trouble moving forward. In addition, I sense that you have been exploring the internet regarding any and all STI risks. I would urge you to stop this. So much of what is said there is exaggerated, overstated, misleading and all too often, wrong. Unless there is more going on here than was mentioned, I would have cautioned you that there is no clear indication for taking PEP either. In response to your current questions:

1.) Is this how Mgen typically presents in women 3-4 weeks post exposure - Light Spotting, some warmth/irritation/ somewhat burning, but NOT during urination, twinges in right lower pelvic region?

The importance of M. genitalium as an STI is a topic of considerable debate. The only STI syndrome it has been proven to cause is treatment resistant NGU in men and even in those situations it is relatively uncommon. Routine testing for M. genitalium is not recommended by most experts.

2.) I have read that Biktarvy can cause menstrual changes in women such as spotting, is this true?

Menstrual irregularities have been reported with all anti-HIV medications, including Biktarvy. Spotting is a non-specific finding and has many causes including stress. If spotting is new and persists, I would suggest you discuss it with your GYN.

3.)If this is Mgen - could this be from a past exposure from 15+ years ago and I've just been carrying it all this time or does this line up more with a recent exposure?

Little is know about the natural history of M. genitalium. Available data from studies covering a far shorter period of time, suggest that many M. gent infections, like other STIs, indicate that the infection may become undetectable over time despite no treatment, suggesting that the body cures itself of many of such infections over time.

I see no medical or scientific reason for M. genitalium testing at this time.

I hope this information and perspective is helpful. EWH

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2 months ago

Thank you so much for your response.

The spotting that I mentioned has subsided. I am having an increased amount of discharge - at least it appears so, although, I don't often check like this regularly. The increased discharge is clear to off-white, does NOT have an abnormal odor. I've also been experiencing that warmth, or irritation I mentioned before. A sort of full feeling at the vaginal opening. I do notice it is intermittent, And does NOT burn during urination. However, there is some discomfort down there, a warmth, a slight burn feeling AFTERWARD, that lasts for some time after wiping. I have had two wet mounts at this point, the first one looked for BV, Trich, and Yeast which was negative. I had a repeat yesterday, where they looked for BV and Trich only. - this second exam was negative. I was also swabbed for Gonorhea and Chlamydia just to be sure - and they've come back negative.

So with all that being said, negative trich, bv, yeast, gonorhea and chlamydia - could my discomfort and change in discharge be related to the antibiotics I took 2 weeks ago (doxy, augmentin, and ceftriaxone). Can my flora just be out of whack, causing this increase in discharge and irritation/warmth/slight burning sensation?

2.) Mgen questions: You mention Mgen has only been proven to cause STI syndrome in men such as NGU, so as far as for women -

1.) Mgen generally does not present like this or whatever I am going through is likely not related to Mgen at all?

2.) Mgen has not been proven to cause such issues in women?

3.) As a woman with these symptoms, should I even have Mgen on my radar? (FYI sexual activity currently have 1 longterm sexual partner, and 1 possible/unknown unprotected vaginal exposure 4 weeks ago)

Sorry if I my questions are redundant, I am just trying to be clear.

Edward W. Hook M.D.

2 months ago

Certainly having taken antibiotics, you may not have needed could’ve made changes in the bacteria, normally present in your vagina and be related to the symptoms you seem to be experiencing. So could anxiety related hyper awareness

1. As I already indicated the symptoms you are experiencing are unlikely to be related to M. Genitalium.

2. Correct

3. As I also already indicated, in your situation, I would not be concerned about M. Genitalium.

One follow up remaining. EWH

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2 months ago

My final question is related to the ongoing discharge.

I understand that antibiotics can cause a change in discharge/a disruption of sorts. I am so very concerned though. Again, the discharge has no odor, and it is mostly clear in color, however it looks like there may be some bubbles in it. It does not look like the trich photos online - I am just wondering if what I am seeing is classified as frothy?

It is clear, a mix between watery and stringy, with some bubbles here and there that I notice when checking/wiping.

1.) Does this sound like it could be Trich?

I've had two wet mounts that have both come back Negative for trich. (First one 27 post potential exposure, and the second one 30 days post exposure)

2.)Can I believe these Wet Mount results to be conclusive at day 27&30 that I do not have Trich?

3.) Or would you recommend at NAAT test and then try and close this door for good?

Thank you so much, for your kindness and understanding, what I have been dealing with has been quite a traumatic experience and I'm just trying to get through it safely.

2 months ago

Wanted to add: are Trich NAAT tests and Trich RT-PCR equally accurate?

Edward W. Hook M.D.

2 months ago

Final Responses:

1.) Does this sound like it could be Trich?

A wet mount could certainly have missed trich. Nucleic acid amplification (NAAT) tests on the other hand are very reliable.

2.)Can I believe these Wet Mount results to be conclusive at day 27&30 that I do not have Trich?

If you are concerned, a NAAT test would provide a more accurate, definitive result

3.) Or would you recommend at NAAT test and then try and close this door for good?

Clearly you are quite worried about this. I would suggest a NAAT test. If negative, then it's time to close the door

The terms Trich NAAT and Trich-PCR are synonymous

This completes this thread. I hope the information I've provided has been helpful. I will leave the thread open, anticipating that you are going to get a NAAT for trich and will be willing to share the results. EWH

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2 months ago

Ty for leaving open, I am happy to share my results.

The test:

Uroswab (urine sample)

MDL 111 Trichomonas Vaginalis Real Time PCR (Reflex to Metronidazole Resistance)

My results:

Pathogens Not Detected

111 Trichomonas Vaginalis (Reflex to metronidazole resistance)

*This test was developed and its pertormance characteristics determined by the laboratory. It nas not been cleared or approved by the u.s

Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary.

A positive result is provided for bacteria, virus, parasites, and/or fungal species when PCR amplification (real-time PCR), sequence information (Pyrosequencing), and/or sequencing analysis occurs above cut-ott levels establisned by the laboratory. Pertinent reference intervals for the

tests reported above are available from the laboratory upon request.

This seems to mean I am negative for Trich, would you agree?

Is this considered conclusive, 4 weeks 5 days post possible exposure?

Ty so much.

Edward W. Hook M.D.

2 months ago

Yes, you can be confident that you don’t have Trich based on this test result.

Closing the thread now. Take care. EWH

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