For decades, the field of gynecology has lagged in research and development. Due to misogyny, biases, and systematic cuts, women are often left at a loss with their gynecological pain, and using things that we “think” work for our issues. Just this last month, PCOS was renamed through a global consensus process in the medical community to Polyendocrine Metabolic Ovarian Syndrome (PMOS). Besides that, things like endometriosis seemingly have no cure, bacterial vaginosis is not fully understood, and our maternal mortality rate is the highest for any first-world nation, specifically, for Black women. Just like the stubborn bacterial overgrowth of Bacterial Vaginosis, there are other misunderstood bacteria on the scene that are rising rapidly, and many women are struggling with them — Ureaplasma and Mycoplasma.
For two years after taking an antibiotic for a harmless BV infection, I suffered from back-to-back yeast infections. I would take an antifungal, and it would go away, only for it to come back eight days later. I went long periods of time with anti-fungals and in and out of the OBGYN, pinning for answers. Over time, what I thought was a chronic yeast infection turned into actual burning every single day. Urinary burning, pain, retention, and frequency. I would go to the urgent care, thinking I had a UTI, only for every single test to come up negative. This went on for months until, finally, an OBGYN who listened to me said, “If this doesn’t work, I’m going to test you for one last thing.” The last test didn’t work, and I came in once more as we agreed. She told me she tested me for Ureaplasma and Mycoplasma. I had absolutely no idea what that was, but I came back with my first positive diagnosis for over a year —urea plasma urealyticum.
Ureaplasma and Mycoplasma are common bacteria found in both men’s and women’s microbiomes, but when they overgrow in women, they can cause urethral pain, urethritis, discharge, and burning. In some, it is not symptomatic, and it is not fully classified as an STI but it can be spread sexually. “The disagreement regarding the treatment of Ureaplasma and Mycoplasma often stems from their dual nature as both natural colonizers and potential pathogens,” said Dr. Adjoa Bucknor, an obstetrician-gynecologist. “These bacteria frequently live in the body as part of the normal flora and remain asymptomatic, particularly in sexually active individuals. Because of this high prevalence of asymptomatic colonization, some physicians find it difficult to definitively identify these organisms as the primary cause of a patient’s symptoms.”
Some clinicians view them as harmless colonizers that naturally exist in the human microbiome, while other clinicians argue that they may be responsible for chronic urinary, itching and pelvic pain. The biggest issue with Mycoplasma and Ureaplasma is not only getting an initial diagnosis, but killing the bacteria overgrowth overall. According to the National Library of Medicine, Mycoplasma and Ureaplasma lack cell walls, rendering beta-lactam antibiotics ineffective.This makes antibiotics like penicillin, absolutely useless.
Women like myself are often given multiple cycles of doxycycline and azithromycin, this is also attributing to the one of the most urgent health concerns, antibiotic resistance. “The reason some women require multiple rounds of antibiotics for Ureaplasma and Mycoplasma is attributed to a combination of bacterial colonization, emerging antibiotic resistance, and the lack of a unified treatment approach,” Dr. Bucknor said. “For Mycoplasma specifically, there is up to a 40% chance that the bacteria will be resistant to standard antibiotics. While combination therapy is often utilized to combat this, there is currently no universal treatment plan or standardized protocol for these regimens.”
Because women are suffering from something doctors, at this time, don’t have standardized protocol on, many like myself turned to TikTok, Reddit, and other social networking sites to talk to other women with this diagnosis. There is a bustling Ureaplasma community on Reddit with women sharing their own treatment plans that have worked for them, and an entire TikTok community sharing information about the pesky bacterial overgrowth for women desperate to get rid of it.
If you’ve spent months or years cycling through yeast infection treatments, negative UTI tests, unexplained burning, urinary urgency, or pelvic pain that no one can explain, don’t be afraid to advocate for yourself. Ask your OB-GYN what else could be causing your symptoms. Ask whether additional testing is appropriate. Ask what has been ruled out and what hasn’t. Ureaplasma and Mycoplasma may not be the answer for everyone, and the science surrounding these bacteria is still evolving. But for some women, asking one extra question could be the difference between another year of suffering and finally having a name and a plan for what’s happening to their body.
If there is one thing I hope black women take away from my experience, it’s that chronic pain deserves chronic curiosity, you know your body better than anyone else, so ask for more. Black women shouldn’t have to earn a diagnosis by suffering long enough. I spent two years believing my pain was something I simply had to live with. I hope the next woman who reads this doesn’t have to wait that long to ask, “Could it be Ureaplasma?”