[Question #6587] Mycoplasma Genitalium and Ureaplasma

15 months ago
Hi doctors,Having a lot of confusion, maybe you can help  point me in the right direction.

Brief history:
26 Female. I've only been sexually active for the last 1.5 years  with a total of 2 partners.

- Partner 1 and I were fully exclusive. We both tested negative for standard STIs during and after the relationship. I had no issues except for a single case of BV when we first started having sex. I treated the BV and had no more issues with it.

- Partner #2 and I both tested negative for standard STIs before having sex. We only had sex a total of 3 times; the first 2 times were protected, & 3rd time was unprotected. After the first 2 instances of protected sexual intercourse I noticed some vaginal itching of & a single hard raised bump inside my vagina all within a few days of us having protected sexual intercourse two times total. The bump and itching went away on their own in about 3-4 days. Shortly after this, we had unproteced sex and the following few days I noticed the vaginal itching again (no bump this time). I got anxious and went to a PCP. I again tested negative for the standard STIs and also tested negative for BV and Yeast. My PCP ended up prescribing antifungal oral tablet because she saw yeast upon visual inspection (the lab test for yeast came back negative though).

- Fast forward 2 months and I've had no more sexual encounters at all. I notice some vaginal discharge somewhat resembling yeast. It was thick and creamy discharge (sorry for the detail there). I went to a gynecologist and yet again tested negative for standard STIs, yeast and BV. I also got my first pap smear at this same appt (this being 8 months after becoming sexually active). Pap came back abnormal with LSGIL and HPV positive for 1 or more of the 13 high risk strains. Did colposcopy and biopsy and result said: "benign endocervical tissue negative for dysplasia, viral effect, and malignancy" (what??)
15 months ago
Went over my character count so going to continue here, As I said, colposcopy and biopsy result said: " Endocervix - benign endocervical tissue negative for dysplasia, viral effect, and malignancy" and part b of the results said "Cervix - squamous metaplasia and chronic cervicitis. Negative for dysplasia, viral effect, and malignancy. Non-correlation with recent abnormal ctyology" What does any of this even mean. My doctor never explained... do I have cervical dysplasia or not?

It's been 8 months since all of this has happened. I needed to switch gynos and I went back to have a follow-up pap smear about 6 months after the first abnormal result.  The result  yet again come back abnormal LSGIL. (no hpv test done this time).

Here is my issue/questions:
I'm continuing to test negative for STIs (not including HPV) but I still have weird symptoms like that white creamy yeast like vaginal discharge that has been present and getting worse since that 1 instance of unprotected sex with partner #2 just under a year ago. I dont know the cause of this I keep testing negative for yeast. Additionally, I've since gotten back together with partner 1 a few months ago. Please keep in mind that  I haven't been sexually active in almost a year since all of this started happening, and now that I'm active again I'm experiencing things I never experienced before such as painful sexual intercourse and mild spotting after sex (This doesn't always happen just on a few occasions so far). The issue has now progressed to mild and occasional lower abdominal pain during and after sex (again not all the time just on a few occasions). There is no vaginal odor at all, and the discharge is white and creamy or sometimes white and watery. This discharge is white and stains this sheets a white chalky color. It's so weird.

I'm very confused. Is this the Cervicitis that's causing all of this? Could it be the LSGIL/HPV? I personally think it could be Mycoplasma gen. or ureaplasma? Any insight? What do I even get tested for that this point. I'm worried I have some bug that could eventually lead to PID...  I have a new gyno now and he wants to do a repeat colpo and go from there
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Welcome to the forum. Thanks for your question.

First, you don't have dysplasia. That result combined with LSIL on your pap smear suggests your apparent cervical HPV infection probably is with a low risk type, i.e. unlikely to lead to cancer. Good news.

Cervicitis is a complex and poorly understood issue. Most cases of chronic, ongoing cervicitis are not caused by any known STD. Whether there are unknown bacteria or viruses that might explain some cases is a subject of active research, but at least some cases (most? nearly all?) may have an immunuologic origin, not due to any infection. Regardless of the cause, cervicitis certainly can cause vaginal discharge, and that's usually the best guess of the cause when no other cause can be found.

There's been a lot of media and online attention to Mycoplasma genitalium, but there are still major unknowns. The only proved health problem is nongonococcal urethritis (NGU) in men, with MG causing around 15-20% of cases. Data in women are conflicting:  some reports suggest it is associated with cervicitis and pelvic inflammatory disease (PID), but most studies so far don't confirm those results. Research continues. As for Ureaplasma urealyticum, a number of studies over the years have found no association with cervicitis. UU is a normal bacteria in the genital tract, at any point in time present in about half of all sexually active men and women.

Have you had any antibiotic treatment? If not, a trial of doxycycline might make sense. If already done and not effective, testing for M genitalium definitely is worth considering and, if positive, a trial of moxifloxacin. But don't get your hopes up. 

My advice is to follow through with your new gyn evaluation. You might consider printing out this thread as a framework for discussion.

Let me know if anything isn't clear or if you have anything more to add. In the meantime, I hope these comments are helpful.

HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
A couple of corrections. I initially missed your opening question page; all my comments were based on the follow-up window. Among other things, I missed that HPV testing showed a high risk type. However, that doesn't change the fact that LSIL ("low grade squamous intraepithelial lesion") by pap, plus no dysplasia on biopsy, indicate you don't have an aggressive HPV infection and that the liklihood of progression to pre-cancer or cancer is very low. I'm confident your new gyn will agree.

I also didn't focus on your pain during sex. Where exactly? Vaginal, vulvar, etc? Or internal pain in the pelvis? The latter suggests a possibility of fallopian tube infection (PID). On the other hand, you're apparently had negative tests for both gonorrhea and chlamydia, by far the main causes of PID. In any case, this also is an issue for you to address with your gynecologist.

Finally, I'm not clear on whether your current partner has symptoms of any kind (probably not or you would have said so) or whether he has had STD testing. If not, that would make sense.
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15 months ago
Thank you for the response!

Meeting with my gyn. this Monday.
btw, pain during sex is two fold. Initially, it started with burning sensation upon penile entry. I disregarded this because, at the time,  I recently started taking prozac and it causes a lower labido (so was assuming the pain was from lack of lubrication). Anyway, pain has now escalated (in about a 5 month time frame) to internal pain when S/O is inside.

Few questions -
1) If I don't have dysplasia does this mean the LSGIL was not HPV related? I thought LSIL was dysplasia. As a reminder - I had an abnormal LSGIL pap result followed by colposcopy / biopsy with the following results--> "Endocervix - benign endocervical tissue negative for dysplasia, viral effect, and malignancy" and part b of the results said "Cervix - squamous metaplasia and chronic cervicitis. Negative for dysplasia, viral effect, and malignancy. Non-correlation with recent abnormal ctyology" What is metaplasia?

2) I know this is a damn near impossible question for you to address, but how likely is it that I could have strain 16. I hear HPV never truly clears and can reactivate. Would hate to give someone this virus years down the line since it is the worst strain. 

3) Do you know the symptoms of M Gen. ? I'm having clumpy white discharge that has a creamy texture. Does yeast have a creamy texture? (Sorry don't mean to get too specific with the details but I need to figure out what this stuff is. It's quite a lot of discharge too. For example I dont usually notice it on a day to day (maybe once a week discharge) but when I engage in sexual activity my partner gets a lot of it on his genitals. This is when it is the most noticeable.

4) My boyfriend has had no symptoms with the exception of the occasional lower abdomen pain. at the right upper pelvic bone. He says it feels more like muscular pain but I don't know for sure. He is clean for standard STDs and always has been. No penile discharge. His urine smells a bit strong though. I don't know just grasping at straws here. What is your take on these symptoms the upper pelvic bone pain and the urine smell?

5) What are the overt symptoms of m gen. in women (proven or not) based on studies you have read?
15 months ago
Also forgot to ask one last thing -

How long does it take for HPV to cause LSGIL. (assuming my LSGIL results are indeed hpv related and not related to cervicitis). I had my pap approximately 4 months after sleeping with partner #2. I'm almost certain he gave me high risk HPV given his extensive sexual history and the fact that we had unprotected sex once.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Pain during sex:  Both kinds of pain deserve personal attention with exam by a gynecologist.

1) The terminolgy used for dysplasia and other cervical problems can be confusing, and I think you are mixing up the terms used in two different contexts. Dysplasia per se is only diagnosed by cervical biopsy. Biopsy terminolgy also incluces cervical intraepitheilal neoplasia (CIN), graded as CIN gardes 1-3, with 3 meaning severe dysplasia and carcinoma in situ (the earliest stage of cancer, before invation). LSIL and HSIL are terms used in interpreting pap smears. In general, low grade pap smear abnormalities (LSIL) correspond to CIN1, rarely CIN 2 or 3. HSIL often corresponds to CIN 2 or 3, but not always. With LSIL on pap AND no dysplasia on biopsy, probably you don't even have CIN1. There is no signficant risk of progression to cancer in the near future, probably not ever. These are issues to discuss with your gynecollgist.

2) Do you have HPV16? Probably not. But it wouldn't matter if you did. The large majority of HPV16 infections do not progress to serious dysplasia or cancer. Even if you have HPV16, apparently it is not causing a serious condition and probably never will.

3,5) All symtpoms of any and all cervical infections of any cause are the same. There are no differences between gonorrhea, chlamydia or (probably M. genitalium). Gonorrhea tends to cause more severe or noticeable discharge, pain, discomfort, spotting between periods, or pelvic pain than chlamydia and probably M gen. But there is huge overlap of symptoms between these and other (often unknown) causes of all these symptoms. That your discharge is "clumpy white" doesn't help judge the cause, except that "clumpy) sometimes means yeast. On top of all this, there is trichomonas (an STD) and bacterial vaginosis (sexually associated, but not an STD in the usual sense). It is not possible for any online resource, without direct exam, to judge the cause(s) in your case.

4) Strong smelling urine is rarely abnormal; urine odor and concentration (yellow color) depends almost entirely on diet and fluid intake. From what you say, your partner is asymptomatic. This supports the probability that your symptoms are not due to any STD.

Last question:  pap smear abnormalities, whether low- or high-grade, can occur as soon as a month or not until a few years after acquiring HPV. Same for CIN/dysplasia by biopsy. Your pap and biopsy abnormalties say nothing about how long you have had the underlying HPV infection.

The bottom line is the same advice I gave above:  Follow through with your planned second gyn evaluation. Discuss all these issues at that time. In the meantime, try not to worry. From all you have said, most likely nothing serious is going on.
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15 months ago
Thank you - I will refer to my doctor for these issues.

2 of your answers were a bit unclear so let me try and ask in a different way

- I understand that I most likely don't have CIN. What I would like to know is if I do or do not have LSIL? Can cervicitis cause LSIL?   Then again, if the nucleus of the cervical cells looked like that of LSIL so I'm assuming only HPV causes that. I'm assuming I have strain 16 then because of those who have LSIL on pap AND positive high risk HPV test, about 30% have strain 16. I'm basing this on epidemiological studies I've read online. I'm trying to determine if I should genotype test for strain 16 or not.

- Lastly, thank you for addressing my partner's urine oder symptom. Can you also address is secondary "symptom" - occasional pain in his upper right pelvic area. It comes and goes - been happening for last 2 months but we've been sexually active since July (8 months to date). He's saying that to him it feels more like muscular pain. I am not a male and don't understand the anatomy and if he is experiencing pelvic pain or not. Or if this is anything for him to worry about if he is. Any insight?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
If your pap report diagnosed LSIL, you had it. But that doesn't matter. Biopsy gives the definitive diagnosis; pap reports are only a clue. That is, biopsy results overrule pap results, so the LSIL report doesn't matter any more. (We're getting into the weeds on pap smear interpretation and I'm not an expert on it. I'm pretty sure I've got it right, but you should clarify with your new gynecologist.) But as I said above, it doesn't matter if your high risk HPV type was HPV 16. Even if it was, it's not causing a problem that is likely to lead to cancer; and probably will go away, either on its own or with treatment, depending on the gyn's advice. Anyway, why are you so laser focused on HPV16? It's no more risky for cancer than some other types.

No STD causes pelvic of abdominal pain in males. If he feels like it's muscular, probably it is. If it concerns him, of course he should see a doctor about it. But you can be sure it is entirely unrelated to your HPV, vaginal discharge, or other of your symptoms or concerns.

That completes the two follow-up question and replies included with each initial question and so ends this thread. I hope the discussion has been helpful. Best wishes to you.
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