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欧洲幽门螺杆菌治疗共识 5

H. Pylori infection of urethra / urinary tract?

The various unpleasant manifestations of Helicobacter can be described here. Remember however that the great majority of persons with Hp have no symptoms that they are aware of and consider themselves normal.

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H. Pylori infection of urethra / urinary tract?

Post by ciproflox » Thu Feb 22, 2018 1:10 pm

I am a young male who suddenly developed urethritis following oral sex with an H. Pylori positive partner. My symptoms are red/irritated urethral meatus and surrounding few mm, and occasional pain on urination. I have had no exposure to other STDs, nor has my partner. My symptoms seem identical to those experienced by many other young men, all of whom began experiencing them shortly after oral sex, and all of whom afterward test negative for all standard STDs.

There has been speculation that H. Pylori may be transmitted by oral-to-urethra contact, and may colonize the urethral mucosa:

"Helicobacter pylori: a sexually transmitted bacterium?"

"Is there a role for Helicobacter pylori infection in urological diseases?"

...and there are many anecdotal stories of men who's symptoms resolved with Clarithromycin (alone or in combination) after failure of standard prostatitis antibiotic courses.

Assuming the urethritis I am experiencing is due to H. Pylori, what would be the best course of action to attack it in this non-standard location. I have already come off a 4 week course of Levofloxacin monotherapy without much improvement after an initial relief of symptoms, and an immediate followup of 2 weeks of Azithromycin seems to have gone the same way (....a version of reverse-sequential therapy?)

The PPI would be unnecessary for urethral infection due to pH ~6. of urine and prostate. I'm wondering if 10-14 days of Clarithromycin monotherapy might still work for me, given that the Azithromycin exposure is very recent (and my only exposure ever to macrolides) What other special considerations might there be for treating this type of infection?

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Re: H. Pylori infection of urethra / urinary tract?

Post by jeni6060 » Thu Feb 22, 2018 2:42 pm

thanks of nice information...

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Re: H. Pylori infection of urethra / urinary tract?

Post by ciproflox » Sat Feb 24, 2018 12:15 pm

Hello....I have begun Amoxicillan 1gm 2x per day...after 2 weeks of Azithromycin 250mg 1x per day.....after 5 weeks of Levofloxacin 500mg 1x per day for this stubborn urethritis suspected to be H. Pylori. Had clear initial improvement with both the Levofloxacin and the Azithromicin, but then mild relapse of symptoms after 1-2 weeks in each case. I assume I have generated resistance, even though the urine concentrations of both drugs should be well above MIC....(prostate concentrations would be more marginal)

What is the best way to deal with the 2 weeks Azithromycin exposure? If I were to begin Clarithromycin in the face of assumed Azithromycin-generated macrolide resistance, would it be better to do a week of Amoxicillan first, and then add on Clarithromycin later. Is there any time-window I need to operate in? Thanks!

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Re: H. Pylori infection of urethra / urinary tract?

Post by Helico_expert » Sun Feb 25, 2018 10:42 pm

first of all, you need to find out if you are still infected with H. pylori by doing a urea breath test. You should be able to do a urea breath test in any clinic, but you'll need to stop all medication for at least 3 weeks to avoid false negative outcome.

if you are indeed positive of H. pylori by UBT, then you are most probably carrying a resistant strain. Since you had azithromycin previously and it didnt work, I would assume that clarithromycin would fail too.

Should you need another treatment, I would suggest metronidazole, bismuth, Amoxicillin and rabeprazole.

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Re: H. Pylori infection of urethra / urinary tract?

Post by ciproflox » Mon Feb 26, 2018 3:19 am

Thanks for the response....I do not have H. Pylori in my stomach. I am not taking PPI
I am suspecting it is in my urinary tract due to receiving oral sex from an infected person.
Please read my original posting above......

Diagnosing it from the the urinary tract will be difficult.
My urine pH is from 6.0-6.8, I am trying to get it higher so that Amoxicillin is more effective.
Urethral tissue pH should be a little higher.

I have seen some improvement with Amoxicillin in the past 3 days.
For the stomach have heard of Amoxicillin-only treatments with Vonoprazan which gets the stomach pH closer to 6.0
I am wondering if I can expect better results from Amoxicillin in the urinary tract at pH 6.0
I am supposing 3 - 4 times daily dosing of 750 mg Amox is good for killing an H pylori colony on the urethra.
What would you recommend as a dosing schedule?

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Re: H. Pylori infection of urethra / urinary tract?

Post by Helico_expert » Mon Feb 26, 2018 10:10 am


I think that's why I am a bit confused. Sorry for that.

There are many reasons that you can only find H. pylori in the stomach and not any other organs.
Reason 1. It is because it is a very slow growing organism and cannot compete with other microbes in other organs.
Reason 2. To date, it is only known to be able to attach itself on the stomach wall, and not any other organ surface.
Reason 3. H. pylori is known to tolerate acid by producing ammonia. The bladder or urinary track is most likely having too much ammonia for H. pylori to survive.

E. coli is normally the culprit for urinary tract infection and Amoxicillin is usually very effective on it. Nevertheless, I think you should get proper examination from doctors. It's not advisable to self-diagnose and take antibiotics.

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Re: H. Pylori infection of urethra / urinary tract?

Post by jamespandy » Mon May 14, 2018 8:35 pm

Thanks for the details buddy. Glad to get this post here. :)

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Re: H. Pylori infection of urethra / urinary tract?

Post by Strandsidemol » Sat Jun 23, 2018 9:08 pm

I also have my suspicions of H Pylori being a causative factor in bladder/urethral problems. Long story short - I have had cystitis with occasional acute utis since I was aged 3.
(Father was H Pylori positive around the time Prof B Marshall found that it was the cause of stomach ulcers, dad was cured by his first phase treatment.)
I fell quite ill in Jan 2015 with a myriad of different symptoms, the worst being bladder/urethra. This was nothing like my usual cystitis or uti. Was labelled with Interstitial Cystitis an excrutiating suffering year later. Refused all barbaric treatments due to no known cause/cure.
After 3 years of continuous research and studying and in light of Prof Barry Marshall (Australia) taking on "IC" as a trial, my assumptions are within reason.
I must point out most people suffering with bladder/urethral pain often have overlapping symptoms and are diagnosed with a multitude of other "autoimmune diseases"
I would be highly suspicious of ever evolving H Pylori bug being sexually transferred and feel it is very likely. Whether or not it likes the infected environment is to be confirmed. That's not to say this clever bug couldn't adapt to it's 'new home' that is questionable. If we take the bladder for example, it is widely known that it is not the sterile environment we once thought. Also it's likely if asymptomatic individuals already have in gut, the disruption could be set off in the microbiome after a further infection.
I'm sure one day we will find out and trust that Prof B Marshall would be the man to do it.
Any suggestions though in the meantime would be very welcome.
I'm 90% better from change of diet, was on Chinese herbs for 18 months, refuse antibiotic therapy die to my gut already being in a terrible mess.
Take Black seed oil, propolis, pollen at the moment 2 months in, doing good but up and down. My bladder/urethra still a little irritated, gut issues, joint issues, sharp nerve pain, fatigue are worst symptoms now.

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Re: H. Pylori infection of urethra / urinary tract?

Post by Helico_expert » Sun Jun 24, 2018 12:07 am

Thank you for sharing your story.

H. pylori only colonise the stomach. However, there are many other species of Helicobacter which colonise the lower guts. These intestinal Helicobacter species have not been reported to cause any trouble in healthy individual yet. But does any of them colonise in the bladder? So far, it has not been discovered. Our laboratory surveyed over 100 healthy individual's bladder microbiota and Helicobacter is not shown in the list yet. Of course, our participants are currently limited to Australian only and the prevalence of H. pylori among Australian is very low. Since we did not check if our participants are carrier of H. pylori, I assume that many of them (perhaps all of them) are free of H. pylori.

the Interstitial cystitis is somehow similar gastritis. I am not expert in IC, but I know that so far the cause of IC is still unknown. Most scientists and doctors believe that the bladder is sterile, just like they believe the stomach is sterile 30 years ago. We know that IC is caused by chronic inflammation of the bladder but we do not know the cause yet. If you have not been to our IC-BPS website, here is the link

Anyway, back to the Helicobacter topic. If you are infected with H. pylori, the only way to get rid of it is by antibiotics. Let me know if you need help in understanding the H. pylori treatment.

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