From the Guidelines
Yes, both partners should be treated for Ureaplasma infection, even if only one partner has symptoms or a positive test. The standard treatment is typically doxycycline 100mg twice daily for 7 days, or azithromycin 1g as a single dose followed by 500mg daily for 4 days in cases where doxycycline cannot be used, as recommended by the European Association of Urology guidelines on urological infections 1. Ureaplasma is considered a sexually transmitted infection that can be passed back and forth between partners, creating a cycle of reinfection if both partners aren't treated simultaneously. The bacteria can persist without causing symptoms in some individuals, particularly men, who may unknowingly reinfect their partners after treatment.
During treatment, couples should abstain from sexual activity or use condoms consistently until both have completed their full course of antibiotics to prevent reinfection, as suggested by the Centers for Disease Control and Prevention guidelines 1. If symptoms persist after treatment, follow-up testing may be necessary to confirm the infection has cleared, as some strains of Ureaplasma can develop antibiotic resistance. Key considerations include:
- Treatment of infected patients prevents transmission to sex partners
- Treatment of sex partners helps to prevent reinfection of the index patient and infection of other partners
- Abstinence from sexual activity or consistent use of condoms until both partners have completed treatment is crucial to prevent reinfection.
Given the potential for reinfection and the importance of preventing the spread of the infection, treating both partners simultaneously is the most effective approach to managing Ureaplasma infection, as supported by the most recent guidelines 1.
From the Research
Treatment of Ureaplasma Infection
- The treatment of Ureaplasma infection is typically done with antibiotics, and the choice of antibiotic may depend on the severity of the infection and the patient's medical history 2.
- In the case of Ureaplasma urealyticum, treatment with azithromycin or doxycycline may be effective 2.
- However, the European STI Guidelines Editorial Board recommends that routine testing and treatment of asymptomatic or symptomatic men and women for Ureaplasma urealyticum are not recommended, as asymptomatic carriage of these bacteria is common and the majority of individuals do not develop any disease 3.
Partner Treatment
- The question of whether both partners need to be treated for Ureaplasma infection is complex, and there is no clear consensus in the literature.
- One study suggests that both partners should be treated for urogenital infections, including Ureaplasma urealyticum, to prevent the spread of infection and promote reproductive health 4.
- However, another study recommends that only men with high Ureaplasma urealyticum load should be considered for treatment, and that routine screening of asymptomatic men and women or routine testing of symptomatic individuals for Ureaplasma urealyticum is not recommended 3.
Antibiotic Resistance
- The increasing resistance of Ureaplasma species to common antimicrobial agents is a concern, and treatment options are becoming limited 5, 6.
- A systematic review and meta-analysis found that the proportions of ciprofloxacin, ofloxacin, moxifloxacin, and levofloxacin resistance in Mycoplasma and Ureaplasma urogenital isolates were reported to be 59.8%, 31.2%, 7.3%, and 5.3%, respectively 5.
- Another study found that Ureaplasma species were highly resistant to erythromycin and tetracycline, and that speciation indicated that U. parvum was the predominant Ureaplasma species conferring antimicrobial resistance 6.