ureaplasma

[Bo96]

I was recently diagnosed with ureaplasma and prescribed azithromycin @250mg in the zpaktabs-6 tablets.  I spoke to my doctor who consulted with other physicians and ANP's in her office, and I have been reading info on the internet about it (doc's advice), your site included.  There seems to be much controversy in the medical community about this bacteria.  It is not an STD but the primary way to get it is through sexual contact, although one site said it is "part of the natural body flora".  I noticed that even before penetration, I could feel an itch right after penis to clitoral contact by rubbing against one another.  Urination frequency also  became worse as we had more frequent sexual contact over a period of three months. As is noted on many sites, I was first tested for STD's (3 times, all came up negative) none had checked for ureaplasma. (I went to an STD clinic and two urgent care clincis.)  My questions are these:
1.  If my partner has no symptoms, should he receive treatment or even be tested for this?
2. Will the bacteria remain in my body after the course of antibiotics is done, even though the symptoms may be gone?
3.  Will I be reinfected if he is not treated?
I believe I had this before my current sexual partner but am not sure.  I had two prior sexual partners before him in the last year, used condoms with both and did not have oral sex. I was married for 7 years before that and had no symptoms.  My current partner and I began using a condom then stopped after several months when STD tests returned negative for both of us.
Thanks.

[Edward W Hook, MD]

The role of ureaplasma is a complex one.  As you have already heard, it turns out that many people have ureaplasma present in their genital tracts as part of their normal bodily bacteria.  There are no data to convincingly suggest that if a person is found to have ureaplasma that they need to be treated for it.  Thus, your initial presumption that this needs treatment is something that I and other STD experts would disagree with.  Furthermore, as related to your initial comment, I would also like to point out that there are no STDs which cause symptoms immediately at the time of sex or, for that matter, within the first 24 hours following exposure.  Now, for your specific questions:

1.  I would not recommend it because I do not believe that ureaplasma needs to be treated in normal people.  
2.  Yes.  I would bet that your ureaplasma will return. In fact there are a number of medical conditions in which no bacteria can be shown to be present but antibiotics help to relieve symptoms.  This may be your situation as well.  (p.s. related to no. 1 above, using this reasoning, you could argue that your partner should be treated, not for ureaplasma but because he should be treated for the same symptoms you were).  
3.  I do not thing re-infection is the issue. I do not think you will ever be without ureaplasma. It is a normal part of your body's bacteria.

Sorry this is so complicated.  I hope my comments help.  EWH

[Bo96]

Dear Dr. Hook,
Yes, your responses helped.  I know that epidemiology is often a puzzle and I am learning that ureaplasma is just that as well.  A few additional questions would be:
1. What makes me not a normal person who happens to have ureaplasma?  I'm not sure if this helps you answer this question but I have IBS and many skin allergies.  A year ago I found out I am allergic to latex. At 45 years old, that was a shock having no prior history.  In March, I also felt terrible joint pain (arms, legs, hips) and extreme fatigue in April up until my diagnosis. I also had the worst lower abdominal pain, not IBS, with the next two periods I had.
2. How can I avoid transmitting this to someone else?  
3.  I know it sounded crazy that I felt immediate responses after body to body contact but in the week between any sexual contact the symptoms lessened, although they did not disappear.  Can condoms prevent that? I think genital to genital, skin to skin contact was significant as that is where I felt most of the itching (vulva,clitoris even inner thigh area). I started a progestin regimen in late January as my periods from August of '07 -December '07 started to last up to 22 days (not heavy but just never ending spotting or flow- all of which I have read can be caused by this bacteria).  
Of course, I am talking to my doctor and she is wonderfully honest about what is known about this phenomena. I feel like we are really working as a team but I'm ready to become celibate so that I don't get this again, or pass it on to someone else.
Thank you for your help.

[Edward W Hook, MD]

1.  Neither IBS nor allergies make you abnormal from the perspective of ureaplasma. The only peole in whom ureaplasma is a major pathogen are peole with no antibodies at all (the kind that have to live their lives in isolation).  If anything, you have excess antibodies as part of your allergies.
2.  As I tried to indicate before, transmission of normal bacteria is not an issue.  Condoms are a barrier but one last time, this is not something that casues disease when passed from person to person.
3.  Again, I do not doubt that you experienced symptoms immediately after contact.  That said, microbiologic STDs just do not work that way.  

In summary, if your are considering celebacy because of your ureaplasma concerns, I sincerely believe this is an over reaction.  EWH

[Bo96]

Dear Dr. Hook,
You're right. It's not bad enough to consider celibacy.  I was kind of joking about that.  The symptoms were pretty bad, though, and it was frustrating not knowing what was wrong.  Thanks very much for your help.

[Edward W Hook, MD]

I understand the frustration you are having. I do not deny that they are a problem either. It is just that I doubt that they are related to our positive culture for ureaplasma.  Sometimes these things involve a certain amount of trial and error to deal with them.  It sounds as though you have a good health care provider, I would encourage you to continue to work with her.  Good luck.  EWH