[Question #2466] Mycoplasma Hominis and Trichomonias

43 months ago

2 months ago I was diagnosed with Trichmonias.  I completed the medicine in I believe a week or somewhat over a week, but I was still having symptoms such cramps and mild itching and burning that all would come and go. I decided to go back to the gyno and she told me that I may have has another infection that came along with Trich. Once she did the swab, she put me on Azithromycin that I took in one dose. I got the results back from that swab 3 days later and was told that I had a M.Hominis infection. 

I have never heard of this before. The nurse explained that it can be considered a STI being that it is able to pass from both partners, but when doing research I discovered that healthy women and men carries this in their genital tracts  and that it can cause infection when there is too much of the hominis bacteria.  I also found out that the Trich bug makes it easier for hominis to overgrow... Most of it is complicated and I am asking for some clarification from a trusted Doctor.  How is Trich and Hominis related? Could the trich or the antibiotics could have caused this or the person that infected me with trich? 

Another concern that I have is that I keep constantly thinking about having another STI even after being tested for Chlamydia, Gonorrhea, and  HIV.   I was swabbed for Chlamydia and Gonorrhea, and did the at home oral swab HIV kit.  All of these tests were negative. I took the HIV a little after 5 weeks. How accurate is the at home oral swab test at this time? Should I retest again ? 

I also did not take the hep c or hep b testing nor syphilis. Is it possible that I have any of these?  
After taking the antibiotics for trich and hominis, I have no symptoms and feel fine, 

I am devasted and have been so depressed for almost 2 months after knowing I had trich. Is it possibl that trich can be dormant and come back? 

I am not sure why studies claim that trich is so common and I never even heard of it until then. Why aren't we taught about this! I am so depress
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome back to the forum. Thanks for your continuing confidence in our servcies. I will be answering your question this time.

Mycoplasma hominis is an entirely normal bacteria, present in almost everyone's genital tract at least some of the time. It is shared by sex partners, and in that sex can be considered sexually transmitted. However, it is harmless. STD clinics and true STD experts never test for M. hominis; and when a test is positive, it does not need treatment. M. hominis therefoere is not a likely cause of your contiuing symptoms. Some clinics or doctors test for it, but it really isn't necessary. Whether positive or negative should make no difference in patients' diagnosis or treatment.

As for how you caught trichomonas, there's nothing mysterious there. It's an STD; in fact, by some estimates the most common of all STDs. Probably you were infected during the sexual exposure you asked about on the forum  acouple of months ago. (It appears to be a good lession in the possibility of STD from ejaculation near but not in the vagina, as Dr. Hook described to you. Also, trich testing is usually not done in men, so it's common for men to carry it even when they believe themselves to be free of STDs. 

in the past few years there has been laboratory reserch suggesting that Trichomonas vaginalis and Mycoplasma hominis can interact with one another:  In lab experiments, MH seems to make TV grow more vigorously. I'm wondering whether your nurse is aware of that research and has taken its conclusion too far. This interaction has NOT been shown to have any effect in patients' symptoms due to either bacteria and probably does not make trichomonas harder to treat. 

As for your other tests, all were highly reliable; you can be sure you don't have chlamydia or gonorrhea. However, the oral fluids HIV test is only fair at 5 weeks: for 100% assurance about HIV, have a lab based test, not a home test, (preferably a "4th generation" or "antigen-antibody" test) at least 6 weeks or more after your last sexual exposure. Also you don't mention a syphilis blood test. You should also have that, any time 6+ weeks after the last exposure. You definitely can expect negative results for both syphilis and HIV.

How was your trichomonas treated?  If you received only a single dose of metronidazole (Flagyl), that treatment is about 90% relialble. For complete reassurance, ask your nurse or doctor about getting treated for 5 days. That will take care of it for sure, and also will prevent the infection from going dormant and reappearing at a later time.

As for why trich has had less publicity and is less well known than other STDs is a complex issue:  even we experts don't fully understand it. But part of the reason is that complications are rare. Aside from an unpleasant vaginal dsicharge, trich rarely cuases serious problems. This is very different than gonorrhea, chlamydia, or syphilis, all of which commonly can become very serious or even life threatening. Also, until recent years, accurate testing was not readily available, and some doctors offices still do old fashioned tests that miss many infections. If and when women are tested for trich, they should insist on the nucleic acid amplification test, or NAAT (also called the DNA test), which is very accurate.

The final issue is your emotional reaction to trichomonas. I'm not sure where that comes from -- you're a better judge than I am -- perhaps just the mystery of it? If so, I hope the information above has helped. But I also have to wonder whether you're still being emotionally impacted by a sexual decision you seem to regret. If such feelings are part of the picture and don't clear up promptly, professional counseling might be a good idea. I suggest it from compassion, not criticism.

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

43 months ago
Hello Dr. Handsfield  

I am so happy that you answered in a prompt manner! I have read a lot of your research and responses about STD testing and exposures on the web!. 

The trich infection was treated with metro in the course of 7 days. I believe I had to take 2 pills by mouth for 7 days. After I took those, I was still having symptoms on and off so I went to the gyno and she swabbed me for everything possible. The results came back negative for trich and other infections except for m. hominis. She  then prescribed another course of Metro that I had to take all at once and Azithromycin that was also to be taken all at once. After that, the symptoms left.  So if it wasn't M.homins causing the symptoms could it have been the  first round of metro pills taking it's course to kill the trich? because the second swab showed I did not have trich.   

I also read where M.hominis can cause infertility and I am so afraid that the trich and M.hominis infected my Fallopian tubes . Trich has been causing me a great deal of depression because I had unsafe sex one time and I acquired a STI. I feel very dirty. I know it is a curable STI but I am so afraid that men will not want to date me anymore because of it. It is very devastating.
I am also so afraid to test for HIV again... I am afraid of needles and the gyno does a blood test and also an oral swab test. I am also scared I have syphilis and do not know that I am infected. 
I have also been afraid of a Hep c infection because 3 years ago I developed a body rash, lower back pain and orange urine that later was put off as a UTI, but I researched that it could have been hep c 

You are right! The infection came from the guy friend I had a one night stand with! He passed it to me and his girlfriend! They both were tested for everything when I informed him and her that I had trich!. They were negative for everything except for trich! 
Why is trich so easy to acquire?? than chlamydia or gonorrhea and HIV?  

I am sorry I am asking a lot of questions all at once. I am very emotional and have been bottled in for 2 months! I keep thinking that I have HIV or Syphilis and will die from it  or that I will get it in the future. 

43 months ago
Hi Dr Handsfield, I am wondering about the follow up question
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Apologies for missing your follow-up question. In the not too distant future, the forum will have new software that should improve notification or otherwise make the posting of follow-up comments more obvious to the moderators than they are now.

It's difficult to conclude any particular cause for your symptoms based on how they responded to these antibiotics. I wouldn't necessarily attribute them to either trichomonas or M. hominis, or their improvement to one or the other repeat treatments. There's just so much that isn't known about bacterial flora in the genital tract. I also am not aware of credible scientific evidence of M. hominis as a cause of female infertility. Don't confuse research showing statistical associations that don't necessarily reflect causality. (As an example of how misleading this could be, for several years there were studies linking HSV2 to cervical cancer, the role of HPV was known and HPV testing was readily available. The association of infertility with HSV disappeared overnight when the HPV links became obvious. By the same token, any number of as yet unidentified factors could be more common in women with M. hominis and actually cause various health problems, without implicating MH itself.)

As for men not dating you, this depends entirely on what you tell them, right? You have no obligation to discuss any of these with future partners. (It would be different if you had something permanent, like herpes -- but even that is less an impediment than many people assume it might be.) Your sexual medical history -- and as best I can tell, your sexual lifestyle -- are entirely typical of the large majority of women.

There are no data to suggest trichomnonas is any more easy to acquire than gonorrhea or chlamydia. But all three of these are far more easily transmitted than HIV.

You misunderstand your risks for infection with the hepatitis C virus (HCV). It's not your fault:  many apparently authoritative sources talk about HCV as sexually transmitted and hep C as an STD. They are all wrong. The ONLY proved sexual transmission scenario for HCV is among gay men who participate in potentially traumatic (i.e. likely bloody) rectal sexual practices. Even the long term heterosexual partners (e.g. 20 year spouses) of persons infected with HCV have no higher frequency of the infection than anyone in the general population, after you take into account blood exposures like both members of the couple using IV drugs. You definitely are not at elevated risk of HCV simply by being sexually active. And any elevated risk of hepatitis B (HBV) is also very low in women and heterosexual men.

Finally, your fear of HIV testing:  Sorry, I have absolutely no patience with this. It isn't the test that gives somone HIV or any other infection. If you are infected, you are obligated to know, in responsibility both to yourself (for life extending health care) and for your partners. You cannot ethically avoid HIV testing if you are at risk. Also, research shows that when people avoid testing for fear of the result, stress and anxiety always decline after testing, even if positive. Same deal with other health screening tests, e.g. mammography:  reduced stress even when the lump turns out to be cancer. In other words, fear of the result is generally more stressful than getting the "wrong" result. When in doubt or fearful, it always clears the air to know for sure. Be clear:  I am not suggesting you are at high risk for HIV (you are not) nor that you might be infected (almost certainly you are not). But as a non-virgin, you are theoretically at least at small risk and should be tested for HIV. Just suck it up and do it.

Apologies again for the delayed reply! But I hope it is helpful.

43 months ago
Thanks Dr. I found out that i have a UTI and is currently on medicine.  During my initial post Dr.  Hook told me not to worry about herpes or genital warts, but I can not help but to worry so I will be going to get tested for Herpes HIV and syphilis tomorrow. Am I risk for Herpes? He was the 2nd guy I had unprotected sex with? 
I currently have itchy thighs and just felt this tingliing sensation on the lips of my vagina. 
I've been reading where this can stay dormant for years. I had sex 2 months ago and  thought maybe i would have shown bumps now.  I have lower cramps in ab region not sure if it's uti or herpes symptoms. Can you please explain herpes for me? I never tested for it and the clinic wouldn't test unless I was having symptoms.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Your concern about herpes simply is not realistic. I know Terri said it's always possible, which is true:  it's a common STD and even persons with only two lifetime partners certainly can be infected. But this would be very rare. And even if you were to test positive, it would not explain any of your symptoms. Many online and other resources do not clarify that some symptoms are more likely than others; that many listed symptoms have many other causes; and that it's the pattern of symptoms that make herpes likely, not occurrence of any one of them. Herpes lesions may tingle or itch, or such symptoms may occur for a day or two before onset of a new outbreak (but not the first episode). But genital herpes simply does not cause ongoing "itchy thighs" or genitalal "tingling". And abdominal cramps are not symptoms of either herpes (or UTI). If you were to test positive for HSV, it would mean you have an asymptomatic HSV infection plus some other cause for your various symptoms.

Looking over your three threads on the forum, my overall assessment is that you may have some psychological conflicts or anxieties about sex in general, about these two partners in particular, and about STDs as a consequence. I would attribute your symptoms to genitally focused anxiety. Stress and anxiety may or may not cause symptoms directly, but for sure they can magnify trivial symptoms or normal body sensations that otherwise would be ignored or perhaps not even noticed. I think that's what's going on here. If these sensations and/or your STD fears continue, I would suggest professional counseling rather than further testing. I recommend this from compassion, not criticism. You also should go back and re-read all the replies you've had in all three of your threads; all three moderators have given you a lot of reasoned, science based reassurance.

Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about these exposures, testing, and your fears about STDs will be deleted without reply and without refund of the posting fee. Like my advice about counseling, this policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding.

Best wishes.