Question to general practitioner Maarten: STD contracted, probably suffering from mycoplasma hominis for 15 months.
Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand and writes about medical facts.
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Dear Martin,
General information:
- Age 62 years
Weight kg 105
Health complaint: Probably suffering from mycoplasma hominis for 15 months.
History: I have had 2 short-term relationships – January 2018 and later October 2018 – with 2 different Thai ladies and in both cases something went wrong with the contraceptives during intercourse (no anal).
Complaint: In January 2018 I noticed a light white discharge from the urethra; only in the morning and insignificant. After 3 weeks we went to the hospital (Ram chain) for examination. Here the blood was tested for HIV, Hepatitis (thought 2 types) and Syphilis. All negative. Without further investigation, a prognosis of gonorrhea was made. I was given a course of doxicycline. It seemed to work, but about 1 or 2 weeks after the cure again discharge. Without testing I was then given a course of azythromycin (1.000mg). However, I took it wrong; 2 days 1 pill of 500 mg instead of the whole dose at once. Obviously didn't work so after a few weeks back to the hospital.
I was made aware of my mistake and I was given a new course of azythromycin, which I did take well. Result the same as with the doxycicline; seemed to help, but after 1 or 2 weeks recurring complaint. This was all from January to March 2018.
After this, a smear was made very carefully for the first time. So careful that I wondered if enough material had been taken. As a result, I was given a course of torymicin. Just like previous treatments without results. Because all these treatments had no effect, I had another blood test done for HIV and the like. Result negative.
Then brought a urine sample for testing in June. Prior to the results of the test, I was given a course of erythromycin and metronidazole. A few days (2 or 3) later I got a call to stop the erythromycin. I had to come to the hospital and was told I had e-collie and therefore not an STI. Also antibiotics / medicines for this, but don't remember which one. These didn't work either, so far that the light discharge wasn't gone.
In mid-July 2018 I got irritation on my head followed by red bumps. Herpes zoster was immediately diagnosed in the hospital. I wondered how I got there again and had a blood test carried out for the 3rd time to be sure. For the herpes I was given vilerm, roxithromicin and pyridium and that was gone after 1 week.
By chance I ended up with another doctor in the same hospital in mid-July. A urine sample was also submitted there. Laboratory research of this sample showed that I have mycoplasma hominis. When I asked why this had not been observed earlier, it turned out that all previous samples had not been cultured. I was given ciprofloxacin for treatment. That was on August 10, 2018. At the end of August, the complaints had not disappeared. Tired of fighting, I stopped the tests and especially the antibiotics. Also because I actually had no physical complaints and had no idea how to proceed.
In October 2018, I had another short-term relationship in which the contraceptives went wrong. In December I had a period when I didn't feel well. Not really sick or fever, but sometimes a sick / slightly nauseous feeling. Stool is also different. Not exactly diarrhea, but different from normal. At the end of January 2019, I had an Alere 4th generation combo test done for HIV, Hepatitis, HCV and Syphilis at a small laboratory. I indicated that I have mycoplasma hominis, but according to the lab that had no effect on the test. Results all negative. I still have the sick feeling, but otherwise no physical complaints, no skin rash or fever and no weight loss. I do notice that my vision is deteriorating a bit.
My questions:
- Is it true that the mycoplasma hominis does not affect the Alere test? Is the result of this study also 3% reliable after 100 months?
- Can you tell me what mycoplasma hominis can cause in the long term if left untreated? There is very little information about this on the internet. Most stories are about infertility and urinary tract infections, but I have also occasionally found things like meningitis and heart defects. In addition, I have a number of prostheses in my body.
- Can you give me advice on how to treat mycoplasma hominis? I don't have much faith in Ram Hospital anymore, as you may understand. On the internet I read that macrolides do not work including erythromycin, azythromycin and clarithromycin. Levofloxacin and Moxifloxacin are often recommended. I have already experienced that it is difficult to discuss with Thai doctors, but I would like to try to give some direction.
I hope you can give me advice. Thanks in advance for this!
Regards,
J.
Dear J,
A long story.
Mycoplasma hominis is more or less a commensal. This bacteria can be found in about half of all people. It is therefore not surprising that it has also been found with you.
My thoughts rather turn to Mycoplasma genitalium. The normal treatment for this is azithromycin. 3 grams the first day and then another 1 gram for 4 days. Fluoroquinolones such as Levofloxacin and Moxifloxacin and the Tetracycline Doxycycline also work. Mind you, sometimes they don't work either. So it remains a guess when it comes to treatment. A combination would be a possibility in such a case. For example, the first to fifth day Azithromycin and from the second day two weeks of moxifloxacin. Even then, however, there is no guarantee of a cure.
Looks like the Thai doctors haven't done too badly in that regard. You have now tried almost everything and my advice is to visit an STD clinic, for example in Bangkok. https://www.pulse-clinic.com
New cultures will need to be used after you have been antibiotic free for at least 10 days.
Don't forget Chlamydia
Here's some more details: www.nhs.uk/news/medical-practice/new-guidelines-issued-sti-most-people-have-never-heard/
The fact that you are not feeling well and have intestinal problems could well be related to the antibiotics. There may of course also be another cause, for example the E-coli, normal intestinal bacteria by the way, which are overpowered by all the pills. the gut has taken over.
That's why a check-up never seems to go away. Let the ophthalmologist also take a look. Your eye problems may be related to herpes zoster (shingles).
I hope this is of some use to you.
Yours faithfully,
Dr. Maarten