[Question #6100] M. Hominis, Ureaplasma Parvum, and other PCR testing

70 months ago

Hello! Thank you for answering my question here today.

I have read on this site that testing for these bacteria is usually unnecessary and that even if caught they don't have to be treated.

I had "PCR for STD" urine done a few months back ago which detected M. Hominis and Ureaplasma Parvum. I was given azithromycin 1gram (I think) for treatment, which I later learned doesn't even make the above bacteria/infections go away. Assuming that it did, after I was tested and treated I had unprotected sex with the same partners who may have given it to me in the first place. Is retesting and treatment necessary? Or should I have never taken the antibiotics in the first place?

This brings me to the further question of: Is testing with these large panels ever necessary? Or is the doctor simply wasting my money? The other infections/bacteria on the panel were the usual ones chlamydia, gonorrhea, with some ones I had never heard of including the above and Ureaplasma Urealyticum, M. Genitalium, Trichomonasis, etc.

Additionally, I am ashamed to admit that in the meantime, between that test and now, I have had my fair share of unprotected sex with CSWs in Thailand. Given this, is it reasonable to test for the above? Or what exactly should I be tested for in such cases and how long should I wait to be tested?

Thank you as always for your clear and well-thought answers.

H. Hunter Handsfield, MD

70 months ago

Welcome to the forum. Thanks for your confidence in our services. Thanks for looking at other questions in preparation for your own. You ask important questions, and I'm writing a sort of blog-like reply which I can use in response to similar queries in the future.

You correctly understand about Mycoplasma hominis and Ureaplasma parvum, which are entirely normal bacteria in the genital tract. Usually people do not "catch" them -- people just have them normally in the genital tract, probably from childhood. (Many of our normal body bacteria -- not only in the genital tract, but throughout the intestines and elsewhere -- orginate from our mothers' vaginal bacteria when we are born.) They can be sexually shared by partners, and thus sometimes they are "caught", but they are harmless. The same is true of U. urealyticum, which also is normal in healthy persons' genital tracts -- although on rare occasions, some strains of UU may cause urethritis in men; but no harm has ever been known in women. Positive results for any of these, in absence of symptoms, do not require antibiotic treatment.

The reasons these entirely normal bacteria are on STD testing panels is complex. Partly it's because some doctors or clinics have mistaken beliefs about how important they are and have requested such tests in the past, leading labs to include them on panels along with important pathogens, like Chlamydia trachomatis and Neisseria gonorrhoeae. Also, labs and test developers may mistakenly believe they are important. But I'm pretty sure it's often simple profit motive by labs and test manufacturers. It's a problem, creating a lot of patient anxiety and undoubtedly a lot of unnecessary antibiotic therapy (at someone else's profit).

Given your sexual history, it makes sense for you to have routine STD testing from time to time, maybe once a year. But in general, that need not go beyond urine or urethral swab testing for gonorrhea and chlamydia (valid any time more than 4-5 days after the last expsure) and blood tests for HIV and syphilis (6+ weeks after last exposure). If knowingly exposed to trichomonas, herpes, etc, or with symptoms compatible with STDs, testing for them might be warranted, but usually not needed for routine screening. That said, sometimes it may be less expensive to have a full panel, including unnecessary tests -- but if you use such panels, be prepared to ignore positive results for MH, UP, and UU.

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

HHH, MD

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70 months ago

Everything is clear as day, thank you.

Two last thoughts come up about this:

At a clinic I visited there is the option to test for Hepatitis A-C, and I think B is transmitted sexually and is not too uncommon, yet these are not recommended for routine screening. To my understanding symptoms aren't that obvious for these diseases -- so why do clinics skip out on testing for them?

Additionally, I saw an article on the internet talking about a study done which claims that Toxoplasmosis (a kind of brain parasite) is sexually transmitted. Have you heard about this before and is there any truth to it?

As this will likely be my last reply, thank you again for your time and I really appreciate your expertise.

H. Hunter Handsfield, MD

70 months ago

I believe that in western Europe and most industrlized countries -- which I assume applies to you, from your email address -- routine childhood immunizations include hepatitis B virus. If you were vaccinated, of course you are not susceptible and no need for testing. But even if not, the risk of HBV from any single heterosexual exposure is far too low for testing after any single sexual exposure except after sex with a known-infected partner. Depending on her age and national origin, it is likely your partner was vaccinated. Even without vaccination, in heterosexual men and women HBV can be viewed as sexually transmissible but not often sexually transmitted. People who have not been immunized and are especially sexually active should be tested at least once, but not after every sexual exposure. Sexual transmission of hepatitis A and C is even less frequent than for HBV.

As for toxoplasmosis, I suppose there may have been some reported cases of sexual transmission. The same can be said for tuberculosis, staph, strep, influenza, Ebola, and (with much media attention) Zika virus. But all these, even more than hepatitis B, are sexually transmissible but rarely sexually transmitted.

Thank you for your kind comments. I'm glad to have helped. However, each question includes up to two follow-up comments and replies. You have one more coming if anything else comes to mind.

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H. Hunter Handsfield, MD

70 months ago

Oops -- disregard my comment about your location and email address. I was thinking of another recent questioner. Sorry if any confusion.---

70 months ago

The chances are I've had the vaccination for that, then.

Does it last for life or is there some time in life that people should go back in to get it? Supposing I were a male around 30 years of age.

H. Hunter Handsfield, MD

70 months ago

I assume "that" means hepatitis B vaccine (there is no vaccine against toxoplasmosis). Indeed at age 30, it is likely you were vaccinated. If you cannot confirm it via your childhood immunization records (which your parents or your childhood doctor's office may have), a standard hepatitis B blood test can determine whether you were vaccinated: if positive of antibody to hepatitis B surface antigen (i.e., HBsAb) and no other elements included in the test, you were vaccinated.

That concludes this thread. I hope the discussion has been helpful.

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