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Ureaplasma infection & reinfection
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Ureaplasma infection & reinfection

Having suffered pelvic pain, pain in vagina and back passage, vaginal disharge, urinary frequency and some pain when urinating for some time, and with all swabs taken by my GP and local GU clinic coming back "all clear", I had a private PCR assay carried out on a urine sample (full sexual health screening).  This showed that ureaplasma urealyticum was present.  Even though she didn't know much about this and the medical jury is still out on its significance (I know some clinicians consider it an incidental finding as it is present is 75% of sexually active adults and in some people who've never had sex, while other doctors say it can cause symptoms and should be treated) my GP finally prescribed azythromyicin - I couldn't take doxyclycline (DOC) as it gave me headaches.  

A re-test has now shown that ureaplasma is not present, so obviously the antibiotics worked.  However, I am still suffereing from the symptoms described above.   My questions  therefore are:

1.  - Could the symptoms now  be due to pelvic inflammation and/or adhesions caused by the ureaplasma?

2.  - If so, what is the best treatment?

3.  - Does my partnr need treatment?  I am concerned that he may reinfect me.  He has no symptoms and I did read on another thread that people without symptoms (even if they have ureaplasma present) do not need treatment.  He has not been tested.  

4.  -I also read in my research on the subject of ureaplasma that taking an antibiotic after sex can help prevent re-infection.  Would this be a good strategy to adopt?  Despite the fact they give me headaches, I think I could cope with one doxycycline once or twice a week.

Thank you, and I look forward to your reply.
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Interesting that you had a test for Ureaplasma; most STD experts recommend against such testing, since Ureaplasma is generally considered a normal bacteria in the genital tract and most experts are not certain it ever causes disease.  We never test for it in my STD clinic.  However, this is a somewhat controversial area.  In any case, since your test became negative after treatment, I see no reason for continued concern about it.  (However, you can expect it to reappear someday, if repeat testing ever is done.  Most men also carry Ureaplasma in their urethras, so if and when you resume sex in the future, you'll probably have it again.)  To the specific questions:

1) Ureaplasma has never been proved to cause any symptoms in women.  I doubt it had anything to do with the symptoms you describe.

2) The recommended treatments are the ones you have had (or that were recommended):  the class of antibiotics called macrolides, which includes azithromycin (as well as erythromycin and clarithromycin); and the tetracyclines (doxycycline and others).

3) If your doctor is convinced that your symptoms were due to something sexually acquired or that ureaplasma was the cause, it would make sense to treat your partner before you have sex again.  He could take a single dose of azithromycin and that would be that.  I tend to doubt it is necessary, but follow your doctor's advice about it.

4) The antibiotic-after-sex advice does not apply to Ureaplasma, only to non-STD urinary tract infections, usually caused by E. coli and related bacteria.  In some women, UTIs are triggered by sex, even though UTI isn't an STD.  

Your use of the term "GP" for general practitioner suggests you might be in the UK (we call them family practioners/FP in North America).  If so, consider a visit to your local genitourinary medicine (GUM) clinic.  The UK's GUM clinics generally are among the best resources in the world for expert care in management of STDs and other genital tract infections.

Best wishes-- HHH, MD
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Thank you so much for this very useful advice and information.

I should have said previously that I was diagnosed with vulvodynia last year, so is it possible that current symptoms could be linked in some way to that condition?

Yes - I am in the UK and have been to my local National Health Service (NHS) GUM clinic.  Initial results on the day showed "some bacteria present", but no treatment was given there and then as the doctor said that they "don't hand out antibiotics like sweeties anymore"!   Final results which came through about 10 days later gave the "all clear".  When I telephoned to find out why these two lots of results seemed to conflict, I was simply told that as far as the clinic was concerned I didn't have an STI and therefore should go back to my GP.

As far as I am aware the NHS here in the UK doesn't test for ureaplasma in its GUM clinics.  It was only through a private PCR urine assay that I discovered the presence of ureaplasma.
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The "some bacteria present" result was from looking under a microscope at genital secretions or maybe urine; that's the only test that can give results while the patient is still in the clinic.  It means nothing more than that, i.e. that bacteria are there, as is expected.  Most bacteria in the vagina, cervix, etc are normal.  The later results undoubtedly were from laboratory testing, which looks only for abnormal bacteria like gonorrhea and chlamydia, not normal ones like ureaplasma.  Therefore, the two results are not in conflict at all.  And the later result also suggests that it was correct judgment not to give you an antibiotic at the initial visit.

One possibility you don't mention is bacterial vaginosis (BV).  You might call the GUM clinic and ask if they suspected BV -- generally not an STD, but can cause similar symptoms.  It's a judgment call as to whether or not to treat BV with antibiotics, depending on the severity and other factors.  But don't get your hopes up.  Most of your symptoms don't suggest BV as the cause.

GUM clinics don't test for Ureaplasma for the same reason that US STD clinics don't do it and that I don't recommend it:  whether positive or negative, the test makes no difference because generally Ureaplasma doesn't cause disease.  At any point in time, half of all women and sexually active men have ureaplasma in their genital tracts.  Since the GUM clinic is convinced you don't have an STD, you should rely on on that conclusion.  You and your GP should look to other causes for your symptoms.
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