[Question #5937] mycoplasma genitalium

19 months ago
Hello! Here is my history:
I engaged in unprotected vaginal sex about 3 months ago. After some days I discovered urethritis due to discharge coming out my penis.
When I went to the doctor he gave me ceftriaxone+azithromycin and told me this was the standard treatment for urethritis, which should cover almost all bacterias.  The symptoms stopped for a few days but then came back. We then tried doxycycline and metronidazole, which did not work as well. He then suspected of Mycoplasma genitalium which was confirmed with urine (PCR I think) test. We treated with moxifloxacin for 12 days. The symptoms disappeared and I repeated the urine test 10 days after the end of treatment. It came back negative.
I was very happy until I went to show the result to the doctor and he said it was good we discovered genitalium relatively soon because some cases, if not treated right, can become chronical (as I understood something like herpes, that stays latent and then can come back any time). Even though he sad he was pretty confident this would not be my case now I'm freaking out because I have a girlfriend now and as soon as the exam came back negative we started having unprotected sex.
So here are my doubts:
1- Is that true that this genitalium can become chronical? Or this is an exaggeration on his part?
2- If it is true is there any way I know that is not my case? If it is my case am I not be able to never have unprotected sex again?
2- My negative urine result 10 days after the end of the treatment is not definitive? For practical purposes am I cured?
3- did I put my girlfriend on risk having sex after this negative result? Should I be worried about it? Can I continue having unprotected sex with her?
4- Any other thoughts on what should I do next? Can I consider the case closed? Do I need to test again?
Looking forward to your reply.
Sincerely, Thanks.
  
Edward W. Hook M.D.
Edward W. Hook M.D.
19 months ago
Welcome to our Forum and thanks for your question.  Before I address your specific questions, let me tell you that the treatments your doctor gave you, as well as the sequence in which they were given were exactly what we would do in my clinic and indicate that you have a well informed doctor who is aware of the latest developments in care of persons with STIs.  Many other health care providers would not do nearly as well.  

Mycoplasma genitalium is a relatively recently described STI and much is still being learned about it.  Your doctor did great in your management.  Thus, in answer to your specific questions:

1- Is that true that this genitalium can become chronical? Or this is an exaggeration on his part?
Mycoplasma genitalium can be difficult to treat and some MG does not respond well to azithromycin or doxycycline,.  Moxifloxacin is the recommended therapy and is highly effective.  Once treated effectively, as you were, MG does not become chronic and does not relapse in the way that herpes does.  

2- If it is true is there any way I know that is not my case? If it is my case am I not be able to never have unprotected sex again?
Please see my comment above.  I would not worry about having unprotected sex in the future - you test shows you were cured.

2- My negative urine result 10 days after the end of the treatment is not definitive? For practical purposes am I cured?
This result is reliable. you are cured. no further testing is needed

3- did I put my girlfriend on risk having sex after this negative result? Should I be worried about it? Can I continue having unprotected sex with her?
no, your negative test means that you were not infectious for your GF.  You can continue to have sex with her.

4- Any other thoughts on what should I do next? Can I consider the case closed? Do I need to test again?
I recommend that you consider the case closed.  no need for further testing.

I hope this information is helpful to you.  Take care. EWH
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18 months ago
Thanks for the answer!
I’m asking this because even though after 10 days of the end of treatment my result was negative for the mycoplasma genitalium (was positive before) and also negative for all other possibles causes my doctor told me (gonorrhea, Chlamidia, trichomonas, ureaplasmas and mycoplasmas)
I still some days (about 1 every around 4 days) see a little secretion (less than a common drop.. like a very little drop not enough big to come out naturally, only if I squeeze/milk the penis) when I Squeeze my penis (which i’ve Been doing every morning).
So,

1- Is this common in your practice experience?
Does patients still some times see this even exames are negative?
2-Maybe I have a bit know bacteria?
3-Taking that into account would you still recommend forget about this and live on or make further investigation?
4-Should I wait this vary little secretion desapear before consider myself clear and have normal unprotected sex?
Many thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
Thanks for your follow-up and additional information.  A small amount of clear fluid discharge is normal for many men and may only be obvious with close examination or squeezing the penis.  Please stop squeezing your penis.  This practice will irritate your penis and increase the amount of normal discharge present.  Thus, in answer to your questions:

1- Is this common in your practice experience?
Does patients still some times see this even exames are negative?
Yes, this is normal and should not trouble you.  Please stop squeezing yourself.

2-Maybe I have a bit know bacteria?
Your tests are negative.  Please believe them.

3-Taking that into account would you still recommend forget about this and live on or make further investigation?
I see no need for further testing of any sort.

4-Should I wait this vary little secretion desapear before consider myself clear and have normal unprotected sex?
I recommend that you consider yourself cured.  I see no reason to avoid unprotected sex with your regular sex partner.

I hope this information is helpful to you.  EWH

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18 months ago
Many thanks for the feedback! Last question to close the thread:
Even with your suggestion that I should be considered cured, just for peace of mind and final closure, I did a last STD PCR panel which mycoplasma genitalium and evereything else came  back negative except for this time Ureaplasma Urealyticum appeared positive.
During my research I found this should be considered normal. That women naturally have this bacteria. So if this is comum why is part of a STD panel? So kindly appreciate if you could answer these least questions.
- Should I treat this?
- Does I have any moral obligation to tell previous women I had sex that I have this?
- is this anyhow a threat for future girlfriends I will have unprotected sex?
- if I leave untreated does it goes away by its own?
I should have followed your advise and stop overtesting my self. 
Many Thanks again!
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
You are correct, men and women both are normally colonized with ureaplasma and its presence should not concern you.  Years ago there was a concern that ureaplasma might be a pathogen but careful studies have proven this to not be the case.  Despite that, some STD panels still test for it.  I wish they did not.

There is no need for treatment of your ureaplasma. 

No, there is no obligation to tell sex partners that you have tested positive for ureaplasma.  it is normal

Ureaplasma is not a threat for further sex partners.  

Ureaplasma can come and go.  

I hope you will now put your concerns aside.  You had Mycoplasma genitalium. You were treated and you were proven to have been successfully treated.  Time to stop worrying an move on.

As you note, as this is my 3rd response, this thread will now be closed.  Take care. EWH
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