From the Guidelines
Ureaplasma infections should be treated with doxycycline 100mg twice daily for 7 days as the first-line therapy, according to the most recent guidelines from the European Association of Urology 1. This recommendation is based on the latest evidence from the European Association of Urology guidelines on urological infections, which suggests that doxycycline is an effective treatment for Ureaplasma infections.
- Alternative treatments include azithromycin 1g as a single dose or 500mg on day 1 followed by 250mg daily for 4 more days, as outlined in the guidelines 1.
- The role of Ureaplasma spp. in causing urethritis is debated, but recent data suggests that U. urealyticum, but not U. parvum, is an aetiological agent in non-gonococcal urethritis (NGU) 1.
- Symptoms of urethritis include mucopurulent or purulent discharge, dysuria, and urethral pruritus, although many urethral infections are asymptomatic 1.
- In cases of severe urethritis, empiric treatment should commence on diagnosis, while in mild cases, treatment should be delayed until guided by the results of nucleic acid amplification tests 1.
- It is crucial to evaluate and treat all at-risk sexual partners while upholding patient confidentiality 1.
- Ureaplasma can cause urethritis, cervicitis, pelvic inflammatory disease, and has been associated with pregnancy complications and infertility.
- Patients should complete the full course of antibiotics even if symptoms resolve early and should abstain from sexual activity until treatment is completed.
From the FDA Drug Label
Nongonococcal urethritis caused by Ureaplasma urealyticum. Other Microorganisms ... Ureaplasma urealyticum “Other” bacteria ... Ureaplasma urealyticum
Ureaplasma infections can be treated with doxycycline or azithromycin.
- Doxycycline is indicated for the treatment of nongonococcal urethritis caused by Ureaplasma urealyticum 2.
- Azithromycin has been shown to be active against Ureaplasma urealyticum in vitro, but its clinical significance is unknown 3.
From the Research
Ureaplasma Overview
- Ureaplasma species are the most prevalent genital Mycoplasma isolated from the urogenital tract of both men and women 4
- There are 14 known serotypes of Ureaplasma, divided into two biovars: Ureaplasma parvum and Ureaplasma urealyticum 4
Treatment and Antimicrobial Susceptibility
- Azithromycin and doxycycline are commonly used to treat Ureaplasma infections 5, 6, 7
- The efficacy of azithromycin in treating Ureaplasma urealyticum is comparable to that of doxycycline 7
- Resistance to macrolides, tetracyclines, and fluoroquinolones has been reported 4, 8
- Levofloxacin resistance was found in 6.4% and 5.2% of U. parvum and U. urealyticum isolates, respectively 8
Clinical Symptoms and Diagnosis
- Ureaplasma infections can cause acute urethral syndrome, genital tract infections, and infertility 5, 4
- Culture and polymerase chain reaction (PCR) are the mainstay of diagnosis 4
- Commercial assays are available with improved turnaround time 4
Virulence Factors and Complications
- Ureaplasma has several genes coding for surface proteins, including the Multiple Banded Antigen (MBA) 4
- Infection can produce cytokines in the amniotic fluid, initiating preterm labor 4
- Ureaplasma is also associated with adverse pregnancy outcomes and diseases in the newborn, such as chronic lung disease and retinopathy of prematurity 4