[Question #7447] Mycoplasma/HIV question for Dr. HHH

4 months ago
Dr. HHH,

As unlikely as it may seem, I tested positive for Mycoplasma Genitalium three months after mutual masturbation and 10 seconds of frottage with another man.  If you go on the Reddit forum, you will see people have caught MG from the most unlikely circumstances, including protected sex.

Compared to others, it seems my immune system has had an outsized reaction (possibly autoimmune?)  to this infection, with cold, numbness and tingling in my hands and feet, a rash/cuts on the penis, sleeping troubles, change in body odor,  very dry mouth and night sweats (2 months ago). And of course there has been pain and pressure in my penis.

I know this is going to be an uphill road ahead as many patients have  spent months or years, as well as thousands of dollarsof antibiotics  and pouring thousands of dollars,  into researching treatments. My main concern at this point, though, is the HIV  connection. 

I am wondering if my reaction is due to HIV coinfection? I saw a study that indicates a link between MG and acquisition of HIV.


I tested negative after 14 weeks with a 4th generation antibody-antigen test. Is it possible that HIV is hiding in the MG cells and are undetected? Has this been studied? If I am unable to treat the MG, could it cause HIV? Please, I am only interested in responses based on the latest MG research, not “40 years experience” as this is a new infection with unknown consequences.



Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago

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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4 months ago
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. 
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago

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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4 months ago
To clarify my treatment, I took 10 days of doxycycline on a presumptive NGU treatment from my doctor. Then I took one day break because my doctor refused to prescribe me anymore antibiotics. Now on Day 12, I have picked up the doxy again and plan to continue for another four days and then switch over the five days of azithromycin. Does that seem like a sufficient doxy pretreat or should I start from scratch after the one-day lapse from doxy?

I have been careful to use protection when having sex with my girlfriend, but on Thanksgiving, five days into doxy treatment, I performed oral sex on her. I have to imagine she already has the infection, as I had unprotected sex with her in the month after the incident and then once again in late October (After 10 doctors told me it was all in my head!) But what concerns me is I didn't think oral sex could transmit MG but now I am learning that many people get it this way. My question is if I not only introduced MG to my girlfriend through oral but if I gave her a doxy-resistant strain by doing so after five days of doxy. I didn't notice her low-grade conjunctivitis until after Thanksgiving.

So far she said she has not had any symptoms, but I guess we will know in the month that follows Thanksgiving. I am hoping she has an asymptomatic case, at least. If she is asymptomatic, do you still recommend treatment? You said many asymptomatic cases clear on their own? Huh?

Speaking of which, I am a little confused about some of the MG advice I have seen on this forum, mostly from Dr. HHH, who claims that MG is no big deal and will probably go away on its own. What evidence do we have to support that claim? Go to Reddit and see the many people suffering for years, trying to come up with different combinations of minocycline, pristanamyn, herbs, biofilm disrupters, etc... Then go to the Floxies page and read about all of the people who developed nerve damage, tendonitis and other diseases years after taking moxifloxacin.

Do you know where my girlfriend can get antibiotic resistance testing? They didn't offer it at the lab my sample was flown to (ARUP in Utah). 

There are articles about how mycoplasm can mutate cells and cause an autoimmune response, even aside from reactive arthritis. Do you know this to be true? Please address the question on its face without chastising me about my internet research. If I had listened to the 10 doctors I saw, not including online doctors, I would have never gotten tested.
4 months ago
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.
4 months ago
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?
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
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.

MG is unlikely to be transmitted by superficial kissing but, if present in the throat, it is theoretically possible the infection could be transmitted to a partner.  Same story for performing oral sex if MG is present in the throat although as a biological process cunnilingus is an very inefficient means of STI transmission.  If you have concerns about your GF, she should be tested (I presume she knows of your positive test).  

Regarding your sources of information, that’s your call, just as it is my right to choose to not agree with internet anecdotes.  As for the fluoroquinolone antibiotics, that the increase risk for tendon and related soft tissue damage in well known and widely accepted.  All treatment however is a balance between potential harms due to the treatment vs potential benefits.  This is part of the reason I have suggested you see a rheumatologist to explore your sense that you have a MG-related inflammatory process.

I have no comment on how MG might mutate or lead to reactive arthritis.  The studies you mention are not in the medical,literature I read, nor have they been mentioned in any of the numerous scientific meetings I have attended.

That’s it for,this thread.  I hope my comments have been helpful.  I will reiterate however that further repetitive questions may not be answered, nor the posting fee provided.  Take care.  EW

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