From the Research
Ureaplasma species are not typically considered primary causative agents of bacterial vaginosis (BV), though they may play a supporting role in the condition. BV is primarily characterized by an overgrowth of anaerobic bacteria like Gardnerella vaginalis and a reduction in protective Lactobacillus species. Ureaplasma (particularly U. urealyticum and U. parvum) are often present in the vaginal microbiome as commensal organisms but can become opportunistic pathogens when the vaginal environment is disrupted. These organisms may contribute to the polymicrobial nature of BV by producing ammonia through urease activity, which raises vaginal pH and creates conditions favorable for BV-associated bacteria. When Ureaplasma is suspected of contributing to symptoms, treatment typically involves antibiotics like doxycycline (100mg twice daily for 7 days) or azithromycin (1g single dose) 1. However, standard BV treatment with metronidazole (500mg twice daily for 7 days) or clindamycin (300mg twice daily for 7 days) does not effectively target Ureaplasma. Some key points to consider:
- Ureaplasma species can be associated with adverse pregnancy outcomes and diseases in the newborn 2.
- The detection of Ureaplasma species is challenging and is not covered by routine diagnostics 2.
- Current empiric antibiotic treatment in neonates suspected of infection is not directed against Ureaplasma species 2.
- Azithromycin has been shown to be effective in treating Ureaplasma urealyticum, with a comparable therapeutic effect to doxycycline 1. Testing specifically for Ureaplasma may be warranted in cases of recurrent BV or persistent symptoms despite standard treatment, as addressing this organism might help restore vaginal microbiome balance in some patients. It is essential to note that the role of Ureaplasma in BV is still not fully understood, and more research is needed to determine its exact contribution to the condition 3. In terms of treatment, azithromycin (1g single dose) is a recommended option for treating Ureaplasma urealyticum 1, and its efficacy has been supported by recent studies 1.