STDs Expert Forum
Mycoplasma???
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Mycoplasma???

I am a healthy 35 yr old American male on assignment in China.  I had a sexual encounter 1-1/2 weeks ago with a female and used a condom.  This was my first sexual activity in maybe two years.  I've never tested positive for STDs in the past.

Only two days after the encounter I noticed that the tip of my penis was irritated and burned mildly only after urination.  I also noticed a small white "glob" coming out of my penis that morning.  I went to the international clinic and was tested last Friday, June 27th, with a swab to my urethra and blood test.  The doctor just called me to inform me that I tested positive for Mycoplasma, but negative for Chlamydia, Gonorrhea, and Syphilis.

I've since noticed that my urine is sometimes cloudy and if I pee into a glass there seem to be small particles floating around.  Also, I don't know whether it's because I'm paranoid now, but I feel like my groin area and lower abdomen are a little bit swollen.

What is Mycoplasma?  I've never heard of it before and when I google it the results are very confusing.  I used a condom, so how is it possible that I contracted it?  Can it be passed on by touching eachother's privates and then our own?

The fact that I've caught this has me really worried that something went wrong with the condom.  Is only one week after the activity too soon to detect other diseases such as Chlamydia, Gonorrhea, and Syphilis, etc?  If something went wrong and I've caught this disease, then what's to say that I haven't been exposed to something much worse?

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It would be helpful to know more about the positive test.  Specifically, which Mycoplasma?  

But I will come back to that.  The first and perhaps more important issue is whether you had any STD at all.  Your symptoms suggest nongonococcal urethritis (NGU) -- and looking at urine for floating particles (actually called "threads" of mucus, because you might notice they are elongated) is one way to judge whether urethritis might be present.  On the other hand, it is unlikely you acquired NGU via a condom-protected exposure.  But if your sexual encounter incluced fellatio, that also is a possible source of NGU.  Also, 2 days is too soon; NGU generally takes 7-14 days before symptoms start.  The early onset suggests gonorrhea or perhaps a virus, like adenovirus (which can be caught by oral sex).  Herpes due to HSV-1 (the usual oral strain) also is possible if you received oral sex, but is unlikely without overt herpes blister/sores of the penis.  (Gonorrhea tests are highly reliable, so that's really not a concern.)

Now to mycoplasmas.  There are several bacteria in the mycoplasma group, and their roles in causing NGU have been the subject of uncertainty for a long time.  In the past several years, M. genitalium has been found to be the cause of 10-20% of NGU cases.  However, tests for M genitalium are not widely available except for research.  However, if the provider who diagnosed you used an especially sophisticated lab, perhaps you had a positive PCR test for M genitalium.  In that case, I would take it seriously -- despite my uncertainties above about the condom and oral sex, it likely is the cause of your problem.

No other mycoplasma regularly causes NGU.  There is debate about a bacteria called Ureaplasma urealyticum -- which is in the mycoplasma group, despite the different name.  However, UU is present in half of all sexually active men, and a positve test is believed by most experts to be meaningless.  (For this reason, most STD experts and STD clinics never even test for it.)  Finally, there is Mycoplasma hominis.  If the lab tested for that, you can forget it.  MH never causes disease in men; it carried normally in both men's and women's genital tracts.  Like UU, few STD experts ever test for it.

Does any of this matter?  Maybe not.  All NGU should be treated, and probably you were prescribed an antibiotic.  If so, and if your symptoms clear up, that's all that matters.  However, if you have M genitalium and your symptoms don't clear up, you might need additional treatment.  For example, either doxycycline or azithromycin are normally used against NGU, but azithro is more reliable against MG than doxy is.

To your closing question:  You can rely on the negative test results for chlamydia and gonorrhea; a week after exposure is plenty.  It takes up to 6 weeks for syphilis blood tests to become positive, but there is no way your symptoms are due to syphilis, and the treatments for NGU would cure it before the infection ever takes hold.

As is now obvious, you have touched on a complex subject -- which undoubtedly is why you have had trouble finding clear information about Mycoplasma in your online searching. But the good news is that all the infections we have discussed are minor problems, with few or no long term health problems once treated. If your symptoms clear up on antibiotics, then I wouldn't worry further about it.  The mystery might not be solved, but in the long run, no harm will come.  But if you remain concerned or uncertain, call or return to the clinic to clarify 1) whether or not they diagnosed NGU (or perhaps prostatitis?); and 20 what sort of mycoplasma was found.

I hope this helps.  Best wishes--  HHH, MD
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Thanks very much Doctor.  I am returning to the clinic on Friday to get some more details and will revert with the answers to your questions.

I am still puzzled/concerned though since I did use a condom even when given oral sex.  Is there any way I could have contracted any of the above through her fluids on her/my hands and then touching my genintals?
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239123_tn?1267651214
I agree it is puzzling and that it is unlikely you acquired any STD, given the apparently correct condom use.  Hand-genital contact isn't a likely source, but conceivably could have occurred.  One possibility is urethral irritation due to a physical or chemical irritation, such as inflammation from lubricant (especially if it contained a spermicide, like nonoxynol-9).  That would also fit with the onset after only 2 days.  
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Avatar_n_tn
Hello Doctor,

I just returned from the clinic and confirmed I was tested positive for Ureaplasma Urealyticum.  I took another urinalysis and everything showed up normal.  The Doctor gave me 2g of Azithromycin and now I am on Minocycline, 100mg twice a day, for the next week.

I was mistaken when I said was tested for Syphilis, as you said, it was too soon for that.  Regardless, it sounds like from what you've said, this treatment would kill that off anyhow.

The Doctor said that should do the trick and if I was still worried that I could be tested again four weeks after the treatment was finished.

I grilled him a little more about how I might have caught this.  He said it is possible it could be transferred through contact with say a contaminated towel or hand.  Does that sound right to you?

Anyhow, thanks very much for your advice.  Not to sound like a bigot, but it's comforting to get advice from an American Doctor when you are in a place like this.
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239123_tn?1267651214
A positive test for Ureaplasma is meaningless.  It is a normal bacteria in the urethra.  Test 100 men, with or without suspected STD, and 50 will have positive results.
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