From the Guidelines
Ureaplasma (including species Urealyticum and Parvum) is considered a sexually transmitted infection (STI) and its management involves antibiotic treatment. The most recent guidelines from the European Association of Urology 1 suggest that Ureaplasma urealyticum, but not U. parvum, is an aetiological agent in non-gonococcal urethritis (NGU). Management typically involves antibiotic treatment with doxycycline 100mg twice daily for 7 days as the first-line therapy, or alternative treatments such as azithromycin 1g as a single dose or 500mg on day 1 followed by 250mg daily for 4 more days. Key points to consider in management include:
- For pregnant women, azithromycin is preferred due to doxycycline's contraindication in pregnancy.
- Fluoroquinolones like moxifloxacin 400mg daily for 7-14 days may be used for resistant cases.
- Sexual partners should be treated simultaneously to prevent reinfection, and patients should abstain from sexual activity until both they and their partners complete treatment.
- Testing for cure is recommended 4 weeks after treatment completion. It's worth noting that Ureaplasma requires specific treatment because these organisms lack cell walls, making them naturally resistant to beta-lactam antibiotics like penicillins and cephalosporins, and instead respond to antibiotics that target protein synthesis or DNA replication, such as tetracyclines, macrolides, and fluoroquinolones, as per the guidelines 1.
From the FDA Drug Label
1.2 Sexually Transmitted Infections Doxycycline hyclate tablets and capsules are indicated for treatment of the following sexually transmitted infections: Nongonococcal urethritis caused by Ureaplasma urealyticum.
Ureaplasma (Urealyticum, Parvum) is considered a sexually transmitted infection (STI).
- The management of Ureaplasma urealyticum includes treatment with doxycycline, as indicated in the drug label 2.
- Doxycycline hyclate tablets and capsules are indicated for treatment of nongonococcal urethritis caused by Ureaplasma urealyticum.
From the Research
Ureaplasma as a Sexually Transmitted Infection (STI)
- Ureaplasma urealyticum is transmitted through sexual contact, suggesting it can be considered a sexually transmitted infection (STI) 3.
- The presence of Ureaplasma urealyticum is higher in persons with immunosuppressive disease or treatment, indicating a potential increased risk of infection in these populations 3.
- Ureaplasma parvum has also been detected in individuals with non-gonococcal urethritis, although its role as a causative agent is less clear compared to Ureaplasma urealyticum 4.
Management of Ureaplasma Infections
- Treatment outcomes for Ureaplasma species can vary, with some studies suggesting that azithromycin and doxycycline may have similar efficacy in treating Ureaplasma urealyticum 4, 5.
- However, persistent detection of Ureaplasma species after treatment with these antibiotics is common, and may not be associated with persistent symptoms of urethritis 4.
- Fluoroquinolones, such as ciprofloxacin and ofloxacin, may also be effective against Ureaplasma species, although resistance rates are increasing over time 6.
- The choice of antibiotic treatment may depend on the specific species of Ureaplasma present, as well as the patient's individual circumstances and medical history 7, 6.
Antibiotic Resistance and Treatment Options
- Ureaplasma species have been shown to be susceptible to certain antibiotics, including doxycycline, tetracycline, and pristinamycin 7.
- However, the increasing prevalence of antibiotic resistance among Ureaplasma species may limit treatment options and make treatment more challenging 6.
- Newer fluoroquinolones, such as levofloxacin, may be effective against Ureaplasma species and could be considered as a first-line treatment option 6.