[Question #2345] Confusion about Ureaplasma

45 months ago
Hi,
I'm a heterosexual 40 year old male. I just saw a new primary doc and he did a STD panel as part of my physical. I came back clear for everything I know of, except I tested positive for ureaplasma. Until he called me with my results I'd never heard of it. I was further confused as I'm married, and prior to that I always used condoms (except for receiving fellatio or performing cunnilingus).  MD told me ureaplasma was "not an STI but is passed sexually", and he wants to treat me with Doxycycline for a week. I had mentioned to him that I have an ongoing issue with mild BPH, which sometimes causes a feeling of irritation at the tip of my penis after I urinate, but only sometimes and it's very mild. But I have never had discharge or pain during urination (symptoms that seem commonly associated with urethritis from ureaplasma infection). My urologist has never felt the need to give me antibiotics.

Long story short, after researching this topic I'm very confused - 
- Apparently 40-80% of women carry ureaplasma naturally, as well as some men? 
- If that's the case, do I even need to be worried about this? Or treated for it?
- If I get treated for ureaplasma  but my wife carries it naturally in her vagina, won't I just get reinfected anyway?
- Is this just something I carry normally as a sexually active adult (even a monogamous one), or have I been walking around with an STD for years? Or is it kind of the same thing in this case? 

More broadly (just for my education)-
- How exactly is ureaplasma passed? Some sources say just intercourse, other say oral sex, others say just oral to oral (kissing?) ie- How did I get this?
- Why do doctors test for this as part of an STD panel if it's not an STD/STI? 

I have to admit that I'm not keen on going home and explaining to my wife that I have an STI, especially if I don't.  Any help is appreciated.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thanks for your question.

Most STD experts would never include Ureaplasma testing as part of an STD testing laboratory panel, no matter how "comprehensive" it might be. Your doctor is right in one aspect:  Ureaplasma urealyticum is sexually transmitted but generally not considered an STD -- it's simply one of perhaps hundreds of bacteria (most not even identified yet) shared by sexual partners once they start having sex. At any point in time, roughly half of all sexually active people have UU in their genital tracts. It rarely causes symptoms and treatment is not needed for people without symptoms. So in that aspect, I disagree with your doctor's giving you doxycycline. If you were my patient, I wouldn't even offer it; and if it were me I wouldn't get treated. As for your other symptoms, they indeed are typical for mild prostatitis or BPH and I agree with your urologist that no antibiotic treatment was necessary. These problems are not caused by Ureaplasma or any other sexually transmitted cause.

So as those comments imply, your own research has been very good. Your questions are largely answered by your own research and my comments already, but to be explicit:  Yes, similar proportions of men have Ureaplasma in their genital tracts. You do not need to be worried or treated. And yes, you likely would be re-colonized if you were treated and your were not. And in any case, doxycycline might just transiently suppress the organism, which would reappear within a few weeks. You can look at this as entirely normal, definitely not "walking around with an STD".

I am unaware of any data that implicate oral sex in Ureaplasma colonization. It is generally considered a strictly genital organism. However, I cannot rule out potential carriage in the oral cavity or occasional transmission by oral sex. But I very much doubt kissing has any role at all in transmission. (My guess is that website claims about oral sex or kissing come from people who haven't had, or don't want to admit, intercourse with high risk partners, sex outside their marriages, etc. Such reports are notoriously unreliable for obvious reasons.)

Why is testing sometimes done? Some physicians just don't understand; and some labs just don't understand either. Testing is inexpensive in comparison to what labs can plausibly charge, so there's a marketing/profit component. The role of Ureaplasma as a significant STD pathogen has been an issue of debate for 40 years. The consensus is that although some strains occasionally cause symptoms in men, the large majority of the time it is harmless. But some physicians continue to believe (mistakenly, per most experts) that it's an STD in the usual sense. It isn't.

The only thing I'm unclear on is why your doctor did an STD panel at the outset? Have you been at risk, i.e. recent partnerships outside your marriage? If so, perhaps there are issues you need to discuss with your wife, regardless of the UU test result. However, that by itself doesn't require any discussion with her.

I hope this information has been helpful. Let me know if anything isn't clear.

HHH, MD

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45 months ago
Hello Dr. H,
Thanks for your reply.  That's good to hear. While it seemed to me that I was having a combination of BPH and "overthinking it" symptoms, it's good to have it explained clearly by an expert. I'm one of those people who was always extra afraid of STD's as a single guy, so I think the idea that I've been carrying one without knowing it for years just disturbed me. Thanks for clearing that up for me. 

You may have inadvertently answered another of my unasked questions, which is why I never tested positive for the presence of this bacteria previously. I was wondering if it was because -
A) I didn't have it (which seems all but impossible)
B) Most places don't test for it.
C) Instead of being a constant presence, the ureaplasma bacteria "comes and goes" within the body...but I don't know how that would be clinically possible accept that perhaps partners could pass it back and forth to one another with periods of "remission" or the body clearing it on it's own in between reintroduction through sexual contact. I don't know if that's how it works at all. Just curious.

I'm guessing now that it never showed because most places don't test for it.

The question about the STD panel is a good one.  My old primary doctor didn't do STD testing as part of an annual check-up. His nurse would ask if I wanted it, and I always said no as I didn't see the need for it. This new doctor says he does it for everyone, regardless of marital status. Perhaps he thinks it's safer, or perhaps it pads the bill. As I mentioned, I did tell him about my "occasional irritation" so maybe he thought I was skirting the STD issue? Or was genuinely looking for a different cause of the irritation. Honestly I don't know. 

Anyway, thanks for your time.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Thanks for the clarification on your doctor's decision to test you for STDs. It seems reasonable that he might indeed test all patients routine, that he was influenced by your prostate symptoms, or both. Why not ask him?

My guess would be that Ureaplasma wasn't included when you previously were tested, but the third possibility (C) could also be true. There has never been any reported research on consistency of positive tests over months or years.

Before you take doxycycline for this, you might consider printing out this thread as a framework to discuss it with your doctor.

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