[Question #9809] Test Results - Clarification
28 months ago
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Good Morning,
I recently thought it would make sense to do a STI screening not for any particular issue or event but simply because although I practice as best I can safe sex it seems that an annual screening is good practice.
All the results were fine - no issues at all. However in the screening they also tested for ‘Urea plasma parvum’ which was ‘detected’ but not ‘not detected’ when looked at in reference range. Im not entirely sure what this is and as far as I am aware this is not necessarily an STI and doesn’t necessarily require treatment? I’ve zero symptoms whatsoever.
So no sure if I need to do anything or not - I don’t think so, but thought I’d check?
Thanks
D
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H. Hunter Handsfield, MD
28 months ago
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Welcome to the forum. Thanks for your confidence in our services.
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First, congratulations on a rational approach to STI prevention. In absence of symptoms that suggest an STI, most sexually active persons do not need testing after individual exposures, but are wise to have routine testing periodically -- like once a year (or more often for some with especially frequent new partnerships).
The bottom line -- i.e. your main take-home from this test -- is that Ureaplasma parvum is an entirely normal component among the genital microbiome, i.e. the many bacteria that naturally reside in the genital tract. It is not known to cause any symptoms, disease, or health problem. In other words, the U parvum was detected in your test panel is a normal result. You need do nothing about it. For many or most labs, the default "normal" result is "not detected"; this can be the case even for harmless bacteria causing no health problem.
Now comes one of my occasional blog-like longer replies if you would like more information, perhaps useful in replying to future questions or for other readers who might browse the forum. Thanks for the opportunity.
The question is why so many labs include U. parvum in their STI test panels. The answer is partly just from habit, and the expectations of some (many?) physicians who order such tests. Undoubtedly marketing and profit also are influences: many physicians and patients think they're getting a good deal by inclusing of a whole bunch of sometimes sexually transmissible bacteria and viruses that in fact usually don't matter much or at all.
Until a few years ago, U. parvum was not recognized as a distinct species; it was classified as U. urealyticum. Since then, the two species are now distinguished from one another. However, even U. urealyticum is questionable for inclusion in such panels, because it also can be considered part of the normal genital microbiome. Unlike UP, UU does cause a minority of cases of nongonococcal urethritis (NGU) in men. However, this too usually causes no symptoms and, without symptoms, no treatment is needed. And UU has never been shown to cause symptoms or health problems of any kind in women.
Most "comprehensive" STI testing panels include several tests that, in the opinion of most STI and public health experts, should not be included at all. That includes both Ureaplasma species, Mycoplasma hominis and, for most patients, tests for hepatitis B and C and for the herpes simplex viruses (HSV1 and HSV2). These infections either are too rare to warrant routine testing or, especially for HSV, are poor tests that often give misleading results. The most rational tests for the large majority of dating persons are gonorrhea and chlamydia (by urine or swab from exposed anatomic sites) plus blood tests for HIV and syphilis. All the others are unnecessary and not recommended by most experts for most sexually active persons. In your future routine testing, you might reduce the test cost by selecting only these tests rather than a "comprehensive" STI panel.
All this can be confusing; let me know if anything isn't clear.
HHH, MD
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28 months ago
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Morning Dr Handsfield,
Thank you so much for such a comprehensive answer - it is extremely informative and I am so appreciative.
I was wondering why so many tests were included in the panel (albeit they did offer more concise testing options too) but at least now based on below I know what to do going forward. One other test confused me also which was for ‘gardnerella vaginalis’ which was detected. From reading your answer it probably shouldn’t have been tested for and the little I could figure out was that this too is a natural occurrence (and mainly in women?) and therefore nothing to be concerned about.
So once again thank you for your help and also to you and your colleagues for this resource as it is extremely useful and informative.
Best Regards,
D
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H. Hunter Handsfield, MD
28 months ago
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G. vaginalis is another normal component of the genital microbiome. It is associated with bacterial vaginosis in women (but doesn't cause it) and like U. parvum has never been associated with sytmptoms or disease in men. Indeed this is also something to ignore.
The American STD Association (www.astda.org) (I'm on the board of directors) has a position statement relevant to these issues (https://www.astda.org/pdf/Direct_to_Consumer_STI_Testing_Services.pdf). Although it primarily addresses testing by patients without a doctor's order, a large part of the problems it causes have to do with the multiplicity of tests often done, many of them with low clinical utility or even overtly misleading. The reasons such panels are offered are complex, as I alluded to above. As suggested above, in the future I suggest limiting your periodic STI testing to gonorrhea, chlamydia, HIV and syphilis.
Thanks for your kind words. I'm glad to be of help: that's why we're here!
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28 months ago
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Thank you so much for the quick response and the link which for my education I’ll read.
Wish you a great day (or evening I guess in the US!)
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H. Hunter Handsfield, MD
28 months ago
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Thanks again for the thanks. That concludes this thread; I'm glad we could be of help.---