Hi, my name is Tori and I am a doctor of physical therapy who specializes in pelvic dysfunction
which means I treat things that can go wrong around the pelvis. This includes painful sex
and bladder dysfunction, which is how I was first introduced to mycoplasma.
I’ve had two female patient cases now where the true cause of my patient’s pelvic symptoms
was mycoplasma, and I had someone reach out to me via my website and share a personal
story about mycoplasma and requested that I make a video about it because there really
aren’t a lot of good resources available for someone trying to learn about the bacteria
and figure out if their symptoms are being caused by it!
I’m honored to be doing request videos, and really excited to share what I’ve learned
with you. Check out the description below for timestamps if you want to skip around!
So, mycoplasma are a kind of bacteria. There are over 200 types of mycoplasma that can
live in our bodies and, for the most part, these micro-organisms are harmless.
There seem to be a few types, however, that can lead to an infection if they overgrow.
Those types are mycoplasma genitalium, mycoplasma hominis, and ureaplasma urealyticum.
In the same way that a yeast infection is the overgrowth of an otherwise harmless microorganism
that lives naturally in our bodies, these certain kinds of mycoplasma can overgrow and
cause infections, too.
These infections mimic urinary tract infections, vaginal infections—like yeast and bacterial
vaginosis, sexually transmitted infections, painful bladder syndrome, and interstitial
cystitis.
It’s important to pause here and mention that these bacteria and their potential to
cause harm is decently studied in men, but not studied well at all in women. I’ll be
talking through the female lens for most of this video, but if you are a man with these
symptoms you should definitely tell a physician and seek testing.
So, common symptoms that I’ve read about and also heard first hand include: urethritis,
which is inflammation of the urethra that can cause pain or burning during urination,
itching, and unusual or foul-smelling discharge either from the head of the penis in men,
or seemingly from the vagina in women (even though it’s coming from the woman’s urethra).
Learn more about internal female anatomy by watching this video, which will also be linked
in the description below (point up and down).
Increased bladder urgency and frequency, a resting sense of bladder or pelvic discomfort,
lower abdominal pain, and even vaginal swelling and bleeding, especially during or after sex.
There are also links to pelvic inflammatory disease, which is an infection of the female
reproductive organs, and pylonephritis, which is inflammation of the kidney, which can be
really painful.
But here’s the catch, if you test for a UTI, STI, BV, or yeast infection, then the
test results will come back negative. So we’ve got humans, like my two patients and the person
who requested this video, who go untreated with these bladder and/or pelvic pain symptoms
for months, even years—which can lead to the incorrect diagnosis of something like
painful bladder syndrome or interstitial cystitis.
The reason these particular bacteria are tricky to test for is multifold — first of all,
they are very small bacteria, actually the smallest living free bacteria that we’ve
discovered so far, which means it’s very hard to see certain types of mycoplasma under
a microscope.
Further, these bacteria do not have cell walls, instead they have cell membranes! The reason
this detail is important is because they cannot be treated with common antibiotics, because
a lot of antibiotics use cell wall inhibitors to kill bacteria.
If the bacteria doesn’t have a cell wall, a cell-wall inhibitor isn’t going to touch
them, let alone hurt them! Sometimes women with these clusters of symptoms are given
antibiotics anyway, and if the antibiotic is a cell wall inhibitor, then nothing will
happen save maybe a little bit of relief because there are anti-inflammatory properties in
most antibiotics.
Additionally, some of these bacteria are slow growing, and cannot be demonstrated on a standard
urine culture—like the one you do when you’re testing for a UTI. Instead, your physician
needs to collect either a urine sample or a vaginal swab, and specifically ask that
your urine or swab be tested for these bacteria. The way to test for all of them is through
something called polymerase chain reaction analysis, or PCR analysis, which essentially
looks for the DNA of these bacteria. If the bacteria are present either in the urine sample
or swab, this test will produce a positive result.
Another complicating factor is well said in this 2017 systematic review
“Mycoplasma species relevant to the urogenital tract include mycoplasma hominis, mycoplasma
genitalia and ureaplasma urealyticum. Their occurrence in the context of urogynaecological
disease has been demonstrated in urethritis (inflammation of the urethra), cystitis (inflammation
of the bladder) and upper renal tract infections (kidney infections—all of which we discussed
earlier). Their role in hyperactive bladder and interstitial cystitis/painful bladder
syndrome is controversial. All the above-mentioned microorganisms can occur as commensals or
as potential pathogens. In most cases their role in any particular pathology cannot be
proven, only presumed.”
Let’s break down that last little bit—all of the above mentioned microorganisms can
occur as commensals—commensal is a word given to a relationship where one organism,
like certain bacteria that live in our bodies, benefit from another organism (us) without
hurting or helping it. So, for example, there are bacteria that live in our mouths that
benefit from living there, but do nothing good or bad for us. So far, it seems that
mycoplasma falls into the same category—it is present in the genitourinary system of
some women and some men who have absolutely no symptoms.
So, essentially, it’s up to your physician to deduce if the mycoplasma living in your
system are commensal and mean you no harm, or if they are potential pathogens—aka causing
you harm.
Finally, these bacteria can be resistant to antibiotics, and from what I’ve read it
is recommended that, before you are given antibiotics, your bacteria are testing for
antibiotic resistance. If you’re curious about the treatment regimens, here is a screen
shot from that same 2017 systematic review outlining treatment options:
While you look over the treatment options, I do want to say another quote from the study
out loud to you: “Treatment of the patientʼs partner with the same antibiotic shown to
be effective in the index patient is generally recommended. Condom use or abstinence from
sexual intercourse is recommended until symptoms have resolved.”
The last point I want to touch on is whether or not mycoplasma is considered a sexually
transmitted infection. It is spread from sexual contact, or genital or genital touching. And
we know that it is found more often in women’s Genito-urethral
systems than men’s, although it is found in both women and men who have no symptoms.
Mycoplasma is also found in both healthy people, and people who have diseases that might compromise
their immune systems. The real catch is that we have proof of sexually inactive women with
mycoplasma living in their genital tracts.
So, needless to say, we don’t have all the answers and are still learning about these
bacteria. Technically, mycoplasma can’t be called a sexually transmitted infection
yet because
we don’t know the long term effects of the bacteria. Whereas other STIs, like gonorrhea
and chlamydia, will damage reproductive organs if left untreated.
Whew, I didn’t touch on mycoplasma pneumoniae, which is a type of mycoplasma that can cause
lung infections, or the potential relationship between mycoplasma and miscarriages and premature
birth because I wanted to keep this video timely for you. I’d be more than happy to
make a different video about that, or a video all about the bacteria that live in our vagina!
Please like this video, share this video, and feel free to comment any questions, ideas,
or suggestions for future content below—I really do try to read and respond to all of
my comments! Finally, be sure to subscribe for more content surrounding pelvic health,
and thank you so, so much for watching, I can’t tell you how much I appreciate it!
I’ll see you in the next one, bye!