Dr. HHH,

Welcome back to the Forum.  I must say, I'm a bit surprised to hear that your test for MG was positive but at least you got tested appropriately (I presume).  As you know, Dr. Handsfield and I share the forum and who answers a question is a random event.  Today I happened to pick up your follow-up post.  As I also suspect you know, Dr. Handsfield and I have worked together for nearly 40 years and while our verbal styles differ, the facts which we base our responses, and our analyses of those facts have never differed from one another.  FYI, I met with the scientists who discovered M. genitalium when it occurred in the 1990s and have published on the disease.  I feel entirely comfortable in answering your questions. 

I trust you are being treated with doxycycline, followed by moxifloxacin, as recommended.

The fact that you are positive for M. genitalium does not mean that you acquired it through the encounter you have focused on. The infection is more often asymptomatic than symptomatic and when it is present the symptoms are genitourinary in nature, not those that you describe.  Ongoing research on MG reveals that the organism is highly prevalent in asymptomatic persons and in at least some patients, may persist without symptoms for relatively long periods (the studies done thus far have tested persons over a period of months- no one knows how long asymptomatic infection might persists.  In general, when present without symptoms, most STIs tend to clear without therapy over a period of months).  The report you mention regarding association of MG with HIV is similar to other reports which note that when persons get one STI, they are at risk for acquiring another (such as HIV); this has been the case since the earliest days of the HIV pandemic.  As a result of these sorts of studies, we routinely recommend testing for HIV in persons who have HIV.  That said, most persons who get HIV DO NOT have HIV and if they do, standard HIV testing procedures reliably detect it.  I (once again) urge you to believe your HIV test results.  EWH

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Yes that is the point I am trying to make. - that my body is having an autoimmune reaction, possibly reactive arthritis. My girlfriend and I both have low-grade conjunctivitis (is this temporary?) and I have been having pain in my left knee. This seems unusual as you mention, especially because my symptoms were more mild in the genitals (sensitivity/discomfort in the glans, pressure feeling in the urethra). The infection seems to have spread throughout my body, creating the neuropathy, weight loss, dry mouth, red and ashy genital discoloration and a rash over an extremely purple capillary in my penis. Perhaps my immune system has been damaged from fighting this off. I have heard of people losing/gaining weight, losing hair, developing dry skin after years with this infection. I am starting with doxy and Azithromycin, although I know it might not work. I don’t think this would affect my chances with moxy in the future would it? I would really like to avoid being crippled by moxy.  I took 10 days of moxy, my prescription ran out for a day and now I am planning to pick up another 4 days of doxy and then 5 days of Azithromycin. Does that sound OK if I skipped a day of doxy?  Antibiotic resistance testing was not available at my doctor’s office, but I will do that if the Azithromycin fails. Let me know what you think. 

You may or may not be having an autoimmune reaction.  To be honest, based on having been peripherally involved in the management of post-infectious reactive arthritis syndromes on several occasions, I will tell you that the symptom complex you describe does not match up with such problems.  When they occur, these every rare events may occur even after successful treatment and require management by a rheumatologist, not an infectious disease physician.  The first task however is to determine whether or not that is what is going on or there is some other, unrelated process going on.  Either way, the right place to seek evaluation is with a rheumatologist who can do the appropriate tests and provide a tailored therapeutic approach as needed.   

Regarding therapy, I am having trouble following the sequence of medications you have taken.  Taking azithromycin before starting moxifloxacin should not be a problem.  At present the favored treatment  for MG at the moment is 7 days of doxycycline, followed immediately by 7 days of moxifloxacin 400 mg daily for the next 7 days.  In instances in which initial therapy with azithromycin has failed to resolve symptoms, 7 days of moxifloxacin alone is typically effective although there are no comparative trials to state whether or not after azithromycin failure the 7 days of doxycycline meaningful improves the response to therapy. 

I presume as well that your girlfriend has been tested for MG.  She should be if she has not started treatment.

finally, I acknowledge that you are trouble by your symptoms.  As I've said before, they may or may not be related to the encounter you have described.  Irrespective however, my sense is that you are scouring the internet for information.  I must warn you that doings such on sites such as Reddit is all too often misleading.

I hope this information is helpful.  As you know, you have one more follow-up opportunity as part of this thread.  EWH

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I would still like to hear Dr. HHH's opinion on the relationship between HIV and Mycoplasma Genitalium, if that is possible. I know not to get my hopes up, though.

Sorry, one last question: If the bacteria on one's tongue/mouth is enough to give someone a genital infection, does that mean I should refrain from kissing my girlfriend as well?

In finishing up this thread, I will work through your questions as best I can.  After that, the thread will be closed.  Dr. Handsfield will not be weighing in on this thread but I can assure you, he agrees with the statements I have made above.  Further, while he and I agree that there remains much to be learned about MG, at present most persons with the infection are asymptomatic and that while we have solid, convincing evidence that MG can cause the NGU syndrome and that in some men, MG is a cause of NGU refractory to azithromycin or tetracycline therapy.  In addition, in several excellent studies, there are good data that MG infection does go away on its own,without therapy of any sort.  The links to other problems such as cervicits,  epididymitis, reactive arthritis are associations which have not been rigorously scientifically proven although research on these issues is ongoing.  If that sounds like we are being dismissive, that is incorrect but there need to be more rigorously conducted scientific study.---