[Question #13307] MGen and Ureplasma

15 days ago

Hello Doctors,

Thank you again for the service you provide. This is a sort of follow up to my previous question. I just wanted some clarity on mgen and ureplasma. Dr. Handsfield has stated that research is ongoing regarding mgen transmission. As such, there appears to be a lot of inaccurate information regarding transmission, what it is, and how it affects the body. That said, I'll jump right into my questions:

On some threads, you have indicated mgen is not spread via oral sex, and on others you state rarely it is spread via oral sex. Some sources state oral sex transmission is not possible, and others state it's possible, but rare. Does the current research indicate if mgen is spread through the recieving oral sex? Specifically, should I be concerned after receiving unprotected oral sex (a man's mouth on my penis) from a gay man?

On this forum you have stated mgen is mostly harmless. Is this true in men and women? The Internet seems to state mgen can cause fertility and other issues in women. Are you able to provide information on how it affects both sexes, if at all? I have a small concern I may unknowingly spread it to my female partners in the rare chance I am infected and asymptomatic.

Finally, the Internet seems to state mgen is often asymptomatic, and the only way to know is if you test for it. If screening is only recommended under certain conditions, how would one know they have it, and why isn't it recommended for regular screening?

Finally, ureplasma is something I've never heard of, and I'd like to confirm my understanding is correct. Ureplasma is normal, healthy bacteria found in the reproductive tract, and only requires treatment if there is an overgrowth that causes symptoms. As such, it isn't really considered a traditional sti, and is not screened for because it is normal to have this bacteria, is that correct? Is this also the case with the mgen bacteria?

H. Hunter Handsfield, MD

15 days ago

I'm sorry you felt the need to return. You're seriously overreacting to a near zero risk situation that, according to the best available scientific understanding, had no chance of infecting you with either Ureaplasma or Mycoplasma genitalium. Almost certainly you are being misled by spending unnecessary and unwise time on non professional online sources. Ureaplasma almost never causes symptoms or any serious health problem; there are good reasons that CDC and its equivalent organizations worldwide (European Union, Canada, Australia, WHO) ALL advise against routine testing for it in any sexually active persons. M. genitalium is more important and clearly causes nongonococcal urethritis in men, and may cause some cases of pelvic inflammatory disease (PID, fallopian tube infection) in women. Most infections probably cause no symptoms at all. Personally, I would not ever care if I were known to be carrying either one of them.

Oral sex: I am unaware of any scientific reports of oral to genital transmission of either organism. If it occurs at all, it is exceedingly rare. I am confident you were at zero risk.

M. gen issues: see above. No expert resource recommends routine testing in sexually active persons without symptoms.

Your understanding of Ureaplasma is mostly correct, except that it isn't known that "overgrowth" is a problem or that it ever causes symptoms of importance. It is entirely normal to have it; at any point in time, it can be detected in the genital tracts of ~50% of sexually active persons. M. gen is less common but also is not believed to require treatment in absence of symptoms.

I really think you are way over concerned. These bacteria should not be on your mind at all in view of the sexual exposure that triggered your worries about them.

HHH, MD

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15 days ago

Thank you, Dr. Handsfield. You are correct that it appears I have been misled by unverified, unmoderated Internet sources.

I will stop worrying about either an mgen or ureplasma infection. It is now clear to me that I am at no risk of infection for either. Thank you for providing reassurance and clarity among the many sources of misinformation.

I'm a curious person and can't help seek out information to better understand for my own personal benefit.

That said, am I understanding correctly that in the case of ureplasma and mgen, no symptoms=no problem? That is, if someone is asymptomatic, there is no risk to their reproductive health, regardless of biological sex? Would it be accurate to say medical professionals are more concerned about treating the symptoms, rather than the bacteria itself?

Assuming the main symptoms include PID, cervicitis in women and urethritis in men, how is it diagnosed if those conditions present asymptomaticlly? That is, if my urethra is inflamed, but I have no symptoms, would the inflammation eventually clear itself? Or would I need to rely on a regular checkup to catch such a condition? Have I once again been misinformed and the inflammation of the reproductive tract in men and women will usually show symptoms, especially if it's problematic and requires medical attention?

To reiterate, this is simply for my own curiousity. Because of your expertise, I have accepted that there is no chance I am infected with either.

Again, many thanks for this forum and the service you and your colleagues provide.

H. Hunter Handsfield, MD

15 days ago

"That said, am I understanding correctly...?" Yes, these are all accurate statements.

By definition, PID is not asymptomatic and neither is urethritis in men. Stated another way, if you have no urethral symptoms, you should not be at all worried about possible urethritis.

Thanks for the thanks. I'm glad to have helped.

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14 days ago

Thank you for the clarification. It is greatly appreciated.

I do have one final question: is the urge to urinate with some abdominal pressure/discomfort caused by an STI/NGU? There seems to be conflicting information about this online.

I suspect anxiety is the cause, but as mentioned, there is conflicting information online so I'd much rather have an expert answer than get lost down yet another rabbit hole.

Thanks again.

14 days ago

Sorry, to clarify, in addition to feeling the urge to urinate frequently it also occasionally feels like I do not completely empty my bladder when I do urinate.

Again, I understand this is likely the result anxiety and not an STI/NGU, but as there is conflicting information online I'd love if an expert, such as yourself, could weigh in and provide clarification.

Many thanks again for your expertise.

H. Hunter Handsfield, MD

14 days ago

" is the urge to urinate with some abdominal pressure/discomfort caused by an STI/NGU?" No, not according to the best available research. As it happens, my forum colleague Dr. Hook was the senior investigator on the best study on this topic. Such symptoms typically originate in the bladder, not the urethra; they also usually are not the result of any infection but other factors that stimulate bladder muscles. (Investigating any medical issue, you will find a lot less "conflicting information online" if you stick with professionally run or moderated sites. Especially avoid sites run by an for people with the problem or at risk for it -- like Reddit, for example.)

As for anxiety as a cause of such symptoms, the answer is yes; that's very common. That you raise this possibility yourself also is significant: when someone suspects their own symptoms have a psychological or emotional origin, usually they are right.

That concludes this thread. I hope the two discussions have resolved your concerns; there should be no need for additional questions about your recent exposure and symptoms. Best wishes and stay safe,

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14 days ago

Many thanks doctor. I assumed it was indeed anxiety since I am not experiencing any other symptoms such as burning, discharge, etc. I will take your advice, try to relax, and put this to bed.

Thanks again. Your expertise is greatly appreciated.

H. Hunter Handsfield, MD

13 days ago

Thanks for the thanks. I'm glad to have helped.---