Months ago I was diagnosed with a chlamydial infection, this was symptomatic and treated with 1 G of Azithromycin (did not eradicate it) then 7 days of doxycycline. I have  had vaginal irritation that comes and goes since the eradication of the infection and is very sensitive. I had the infection for 5 months. I have a lot of health anxiety related to this chlamydial infection and to infertility. I don't know if my symptoms are caused by anxiety. But what are the symtpoms of M. Genitalium or Ureaplasma? I have not been tested for these and my doctor does not think this is indicated. I don't have any weird discharge but I do have pelvic pain that comes and goes and doesn't feel like menstrual cramps. Should I push for testing of these organisms or should I trust that the antibiotics would have treated those as well as the chlamydia?

All the main sexually transmitted bacteria that infect the cervix (chlamydia, gonorrhea, M. genitalium, plus possibly other [unknown] ones) cause identical symptoms:  vaginal discharge is the most common, plus lesser frequency of painful urination, vaginal bleeding (usually scant, sometimes noticed primarily after sex), and low abdominal pain if PID (pelvic inflammatory disease, i.e. tubal infection) develops as a complication. None of these are known to cause vaginal irritation or sensitivity. Yeast infection always is a consideration for such symptoms, and yeast is common after antibiotic therapy, and often difficult to diagnose.

With possibly rare exceptions, Ureaplasma is not a pathogen or abnormal; it's present at any time in roughly 50% of sexually active persons; and anyway, Ureaplasma, like chlamydia, is always susceptible to doxycycline. Expert STD clinics and most providers experienced in STDs never test for it. M genitalium testing is only gradually becoming standardized and not yet routine in most settings. That said, I cannot exclude the possibility that it could explain your symptoms, and although some MG infections respond to doxycycline and/or azithromycin, some strains are resistant; confirmed infections usually are treated with moxifloxacin (Avelox). So you might raise the issue of testing once again with your doctor, and/or discuss a trial of moxifloxacin. Or try an anti-yeast treatment, for the reasons noted above.

But don't get your hopes up about any of this.  Most patients in your situation do not have M genitalium, yeast, or other clear cause of such nonspecific symptoms, and repeated courses of antibiotics make no difference in symptoms. Above I alluded to the possibility of other, unknown causes of lower genital tract infection in women. Most cases of cervicitis, if not caused by chlamydia, have neither M genitalium, gonorrhea, or any other known pathogen. It isn't clear whether such "idiopathic" (Latin for unknown cause) cervicitis is an STD -- but probably not -- or whether it is due to any infection at all; some cases may be some sort of immunologic reaction.

You've previously been advised that you're at or beyond the limits of what a forum like this can do, and that you're not likely to get anywhere by asking repeated questions about it. I do hope the present information helps, but let's truly make this your last thread on these symptoms and your concerns about them. If your own doctor doesn't seem up to speed on the various issue raised here and in our previous responses, you could seek out a gynecologist who subspecializes in infectious diseases. Such specialists are available in most urban areas or academic medical centers.

Best wishes and happy new year--  HHH, MD

Urine WBC usually are not present in cervical or vaginal infections, especially if care is taken in proper specimen collection. Even when STDs involve the female urethra, WBC may or may not be present. In general, urine WBC are a nonspecfiic finding -- i.e. not indicating a particular diagnosis and often found in enitrely healthy women. Neither presence nor absence of WBC makes much difference except in association with symptoms and other findings on exam or lab testing.

That completes the two follow-up commens and replies included with each question, and so ends this thread. As implied above, I'm also going to repeat a statement from at least one and maybe two of your previous threads. This time it will be enforced. If you have continuing questions, I would suggest you re-read all the replies in your several threads -- the answers likely are there -- and otherwise continue to work with your own doctor(s), perhaps especially a gyn/ID expert.

Best wishes.