You get checked, everything is negative, and yet the complaints persist. That is exactly the situation where trichomonas and mycoplasma come into view: two lesser-known causes that are not always part of a standard STI test. Many people have never heard of them, while they can cause complaints.
Our stance: a negative standard test does not automatically mean everything is ruled out. With persistent complaints, a lesser-known cause can be the missing piece of the puzzle.
What are trichomonas and mycoplasma?
Trichomonas (trichomoniasis) is caused by a parasite and can cause complaints mainly in women, such as changed discharge and irritation. Mycoplasma genitalium is a bacterium that can cause complaints in both men and women that resemble chlamydia, but is not found with a chlamydia test. Both often run without symptoms. RIVM counts mycoplasma genitalium among the STIs where testing is mainly useful with complaints, not as routine.
| Cause | Possible complaints | When testing can make sense |
|---|---|---|
| Trichomonas | Changed discharge, itching, irritation (often in women) | With persistent lower complaints |
| Mycoplasma genitalium | Burning urination, discharge, resembles chlamydia | With complaints that persist after a negative standard test |
| Chlamydia (for comparison) | Often none, sometimes discharge or burning urination | Standard part of most tests |
The complaints overlap strongly with other STIs, so you cannot tell on feeling alone which cause is at play. If you are unsure about discharge, that article helps you place the signs.
Why they are often missed
An ordinary STI test usually focuses on chlamydia and gonorrhoea, and sometimes HIV and syphilis. Trichomonas and mycoplasma are not always included. So if you have complaints and your standard test is negative, it is no surprise that you wonder what else could be at play. Soa Aids Nederland advises caution about testing for mycoplasma without complaints, partly because unnecessary treatment can encourage resistance. With persistent complaints that is different, and then discussing it with a doctor is wise.
When does a targeted test make sense?
A targeted test for trichomonas or mycoplasma can make sense if you have complaints that persist after a standard test showed nothing, or if a partner has tested positive. So it is about targeted addition, not testing everything as standard. What the right choice is in your situation is best discussed with a doctor or guided by your complaints.
If you want to keep it discreet, you can take a trichomonas test or a mycoplasma genitalium test at home. If you were at broader risk, a combined test for chlamydia, gonorrhoea and trichomonas can be more efficient than separate tests.
And treatment?
Both trichomonas and mycoplasma genitalium are treatable, usually with antibiotics via a doctor. Thuisarts.nl stresses that you should not judge a treatment yourself, precisely because mycoplasma is sometimes less sensitive to certain antibiotics. So you always discuss a positive result with your GP, who can also advise on testing your partner. What to do after a positive result is in positive STI result: what now.
Differences between men and women
With trichomonas, women more often have noticeable complaints than men, such as changed discharge, itching or irritation. Men usually notice little or nothing, which means they can pass on the parasite unknowingly. That is exactly why testing both partners can help prevent an infection from bouncing back and forth. With mycoplasma genitalium the complaints are closer to those of chlamydia: burning urination and discharge in men, and in women sometimes lower complaints or complaints after sex. Because the signs overlap so much, you cannot tell on feeling alone which cause is at play; only a targeted test answers that here.
Why not just test for everything
It can be tempting to want to test for everything at the first doubt. Yet with mycoplasma that is not always wise. Soa Aids Nederland and RIVM point out that testing and treating without complaints can contribute to antibiotic resistance, while a mycoplasma infection without complaints often stays harmless on its own. Our view on this is level-headed: test in a targeted way, not out of fear. If you have complaints or a positive partner, a targeted test makes sense. If nothing bothers you and there is no reason, a standard STI check is usually enough, and you can reserve trichomonas and mycoplasma for when there is a real reason.
The message with these lesser-known STIs is not alarm but nuance: if your complaints persist despite a negative standard test, take them seriously. Every result we provide is assessed by a BIG-registered doctor, and you make treatment decisions together with your GP.
Sources
Autor
Discreettest
Dr. Naimi, lekarz wpisany do holenderskiego rejestru BIG, nadzoruje standardy medyczne naszych treści i ocen. Przeczytaj naszą politykę medyczną
