[Question #13595] UU question

1 months ago

I (man) had sex with a new woman twice. A week after the 2nd time, my main partner found she was pregnant. Day 10 from the last encounter with the new woman, I retested, adding uu. Neg for everything except positive for UU (no symptoms). Never tested for it before. Could I have had this for years? 10 years? Should my pregnant partner (unknown UU status, no symptoms yet) test? should I avoid sex with my partner?

1 months ago

Also, How often is uu symptomatic? Can you have uu a long time without symptoms and then get them? Like 10 years? how common is uu? I’ve seen you say 50% of sexually active people but I’ve seen estimates all over (usually lower). Should I try to forget about this test?

H. Hunter Handsfield, MD

1 months ago

Welcome to the forum and thanks for your question.

Your timing is immaculate -- a very nice coincidence. The Infectious Diseases Society of America (IDSA) has a national email listserv called the Epidemiology Intelligence Network (EIN) for ID specialists to ask for advice in managing problems they have encountered. Yesterday someone asked whether and how to treat two women with Ureaplasma urealyticum in whom the infection rapidly returned after repeated treatment with doxycycline. I sent in the following reply, which was posted on EIN this morning. My comments start to answer your questions:

Personally, I would not interpret the literature on genital U. urealyticum as especially “vague" [the original questioner's word]. At any time up to 50% of sexually active people have GU [genitourinary] colonization with UU and the evidence is strong that it is uncommonly a pathogen. ... the association with female infertility is inconclusive at best. There are good reasons that CDC and most comparable agencies worldwide recommend against testing asymptomatic persons, despite the near universal inclusion by labs of UU in “comprehensive” STI testing panels. UU causes a small minority of nongonococcal urethritis (NGU) in men, but little or no evidence supports significant morbidity in women. In general it should be considered a normal component of the GU flora — sexually shared by partners, but rarely pathogenic [i.e. causing disease]. Your experience with recurrent infection in your two patients is typical: most treated persons soon test positive again, either because of incomplete eradication or rapid reacquisition from sex partners.

All that said, the issue is somewhat controversial. Ureaplasma tends to be viewed as a pathogen more frequently in some countries (e.g. in parts of Europe) than in the US. However, I doubt UU is responsible for your patients’ rather nonspecific symptoms and would counsel your patients that nothing is wrong and no further treatment is needed. ...most STI specialists will agree with these perspectives, although I anticipate you’ll receive varied advice.

To your specific questions: "Could I have had this for years? 10 years?" Yes. "Should my pregnant partner...test?" Pregnant or not, there is no need. "Should I avoid sex with my partner?" No you should not. Since you've been having sex for years, you can be sure you are sharing most of the bacteria in your genital tracts, including U. urealyticum. Even if it were potentially harmful, it's way too late now to make any difference in her risk, which probably is zero anyway (for any important symptoms or important health problem).

"How often is UU symptomatic?" Maybe 5% of the time in men, but that's only a guess; probably lower in women. Delayed onset of symptoms? Irrelevant since symptoms rarely occur at all. If it happens, the frequency isn't known but probably this is rare if ever. "Should I try to forget about this test?" Yes indeed. You should never have had it in the first place.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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1 months ago

Thank you! Do you think it’s unlikely that I acquired the UU from my recent encounters with a new woman, given that I’ve had sex with ~10 people over my life? Do you have any sense of why your answers are different from some other sources I’ve seen, which suggest lower UU prevalence than 50% and that women do sometimes have symptoms?

H. Hunter Handsfield, MD

1 months ago

Good questions and this is a bit complex; I'm taking the opportunity for one of my occasional blog-like replies that might be useful to readers in general and to answer future similar questions. It goes a bit into the weeds, but stay with me.

Systematic research has found Ureaplasma urealyticum in the same frequencies in persons with and without various urogenital symptoms (urethritis in men, vaginal discharge or other genital symptoms, and others). But such symptoms are very common, and when UU is present in absence of proved causes like gonorrhea, chlamydia or M. genitalium, there is a natural tendency by both infected persons and their doctors to assume or believe UU the the cause. But the genital microbiome -- i.e. the mix of hundreds of bacterial present, most of which cannot be detected in standard testing -- is exceedingly complex and there simply is no way to know which if any of them are the true causes of various symptoms. Of if the symptoms are due not to infection at all.

In other words, the presence of UU simply does not prove it is the cause of such symptoms and in general treating UU in this situation does not clear the symptoms. And there no research at all to link UU with important or damaging health outcomes like pelvic inflammatory disease in women, infertility, or epididymitis in men (unlike gonorrhea, chlamydia, and M. genitalium). Here is a link to the latest statement on UU and testing for it from the European Union STI group. The abstract succinctly summarizes these issues: https://pubmed.ncbi.nlm.nih.gov/29924422/

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1 months ago

Thanks! Last question, I think. I see so many varying sources. How long do you think it would take someone exposed to a bacteria like UU to become contagious with it? A day? 5 days? More? I’ve seen from “immediately” to “weeks”. Happy thanksgiving!

H. Hunter Handsfield, MD

1 months ago

There are no data at all on this; anybody stating a particular interval is just guessing. My own guess almost immediately -- certainly within a few days of acquiring it.

It sounds like you're reviewing non-professional sources for your information. That's often a serious mistake for people concerned about a particular health problem, whether STI or other. Anyone can write whatever they want; you'll be less likely to find misinformation if you limit searching to professionally run or at least professionally moderated sources, like this one and those of academic or public health agencies. And avoid those set up by and for people with the problem you're concerned about -- like Reddit for example.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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