Ureaplasma issues

[pedadolgynmd]

I respect the opinions of the STD experts but I have some, I believe, legitimate concerns about the potential of Ureaplasma urealyticum and Mycoplasma hominis to cause symptoms and disease.  I practice pediatric and adolescent GYN and reproductive endocrinology and appreciated about 9 years ago that patients were having various symptoms and signs which could not be explained by the usual microbiological testing (i.e., GC, Chlamydia and genital and anaerobic vaginal/cervical testing).  Such symptoms/findings included vaginal/cervical discharge, pelvic pain/tenderness, abnormal uterine bleeding (even having been well controlled on hormonal therapies such as OCPs or Depo Provera).  When I would evaluate semen samples from husbands for infertility, often many white blood cells would be present.  Years before, I had checked couples for Ureaplasma but became frustrated when, after treatment, some would persist with positive cultures, so I stopped checking.  I resumed checking in these patients with various symptoms, not just couples seeking pregnancy and found many patients were positive.  I understand that many people with Ureaplasma are asymptomatic, but many with gonorrhea and Chlamydia are, as well.  Most of these patients were symptomatic and no other tests were positive.  Some came to laparoscopy for pelvic pain and were biopsy-negative and visually negative for endometriosis but were positive for Ureaplasma.  Many symptomatic patients, who were negative for other organisms and positive only for Ureaplasma or Mycoplasma hominis were treated and many who had negative tests of cure had improved or resolved symptoms or findings.  Since about 20% of patients may carry either organism and have never had sexual body fluid contact, I have checked them, as well, if they have symptoms.  I have had many adolescents (or adults) who were sexually naive but positive for one or both organisms and symptomatic (e.g., dysmenorrhea, pelvic pain, PID, abnormal uterine bleeding) have symptoms resolve after treatment results in negative cultures.  Treatment can be problematic in that it usually requires 14 days of specific antibiotic therapy with agents such as doxycycline, levofloxacin, moxifloxacin; clindamycin for M. hominis.  Azithromycin has some activity in children and pregnant women but seems less effective than the other agents.  Tests of cure are important since about 60-75% of strains may be resistant to doxycycline.  It is interesting why the CDC recommends two weeks of doxycycline for PID or NGU.  Chlamydia can be cured with only 7 days; what are we treating with the extra 7 days?  About 80% of positive tests seem to be associated with prior body fluid sexual contact; about 20% without such contact.  We know that Ureaplasma can be passed from mother to fetus in the amniotic fluid and the indolent intracellular organism can be asymptomatic for a long time.  I don't think I have an agenda but I was concerned about many patients who have rather subtle disease, pelvic pain, abnormal bleeding, vaginal discharge who fail to correct after the typical diagnostic tests and treatment, only to clear when Ureaplasma or Mycoplasma hominis are diagnosed, treated, and confirmed negative.  Often there are negative objective findings, such as fever, elevated white count, sed rate, or c-reactive protein but they often have pain and tenderness.  The time to resolution seems longer, ironically, than treating GC or Chlamydia, perhaps because the antibiotics are not "cidal" as penicillin (or related drugs) would be to gonorrhea and the intracellular status may retard killing.

I would be interested in your thoughts.  I would encourage checking ureaplasma studies, at least in patients which symptoms above, especially if the usual diagnostic tests are negative.  Thanks for your consideration of this matter.

EWS
Birmingham, AL

[Dallasfan]

The questions you pose have been a topic of debate for some time. Unfortunately the research in this area has only touched the surface of the complete Ureaplasma and Mycoplasma story. In my research with Chlamydia, Ureaplasma has been found often as a "contaminate" in Chlamydial specimens and can be problematic  in research where pure stock cultures of Chlamydia are needed. ATCC is a source of Pure Chlamydia strains, but as we know there are some that have Ureaplasma mixed with them. Why is Ureaplasma and Mycoplasma found in healthy individuals is subject for futher research. Perhaps we will know some day. Unforunately research funding for this is hard to obtain. In light of the present finacial crisis we may even see a cutback on present STD research. Testing for Ureaplasma and Mycoplasma is not cheap and may be cost prohibitive in the clinics providing pro bono care. Thank you for your input and comments.