From the Guidelines
Chronic urethritis caused by Ureaplasma urealyticum is primarily the result of persistent infection due to inadequate or incomplete treatment, often because of antibiotic resistance or poor medication adherence, as well as reinfection from untreated sexual partners, immunosuppression, and anatomical abnormalities. The causes of chronic Ureaplasma urealyticum urethritis can be multifactorial, including:
- Inadequate or incomplete treatment of an initial infection, which can lead to the development of antibiotic-resistant strains 1
- Reinfection from untreated sexual partners, highlighting the importance of partner treatment and screening 1
- Immunosuppression, which can impair the body's ability to clear the infection 1
- Anatomical abnormalities that create reservoirs for bacterial persistence, making it difficult to eradicate the infection completely
The European Association of Urology guidelines suggest that treatment for Ureaplasma urealyticum typically involves doxycycline 100mg twice daily for 7 days, with azithromycin 1.0–1.5 g as a single dose being an alternative regimen 1. It's also important to note that Ureaplasma urealyticum produces urease enzymes that break down urea into ammonia, creating an alkaline environment that irritates the urethral mucosa and triggers inflammation, leading to chronic symptoms of urethritis including discharge, dysuria, and urethral discomfort.
Given the potential for antibiotic resistance, it's crucial to follow the most recent guidelines and consider the use of alternative regimens such as moxifloxacin for resistant strains, as recommended by the European Association of Urology guidelines 1. The primary goal in managing chronic Ureaplasma urealyticum urethritis is to effectively treat the infection, prevent reinfection, and alleviate symptoms to improve quality of life.
From the FDA Drug Label
Nongonococcal urethritis caused by Ureaplasma urealyticum. The cause of chronic Ureaplasma urealyticum urethritis is infection with Ureaplasma urealyticum 2.
- Key points:
- Ureaplasma urealyticum is a bacterium that can cause urethritis.
- Doxycycline is indicated for the treatment of nongonococcal urethritis caused by Ureaplasma urealyticum.
From the Research
Causes of Chronic Ureaplasma urealyticum Urethritis
- Chronic Ureaplasma urealyticum urethritis can be caused by the bacterium Ureaplasma urealyticum, which is often overlooked or improperly treated 3
- The infection may account for a large proportion of unexplained chronic voiding symptoms 3
- Ureaplasma urealyticum can cause urethritis in healthy individuals and invasive infections in immunocompromised patients 4, 5
- The absence of a bacterial cell wall in Ureaplasma urealyticum makes it resistant to commonly prescribed antibiotics and prevents it from being cultured using routine bacteriologic media 5
- Delayed or missed diagnosis can occur due to the difficulty in detecting Ureaplasma urealyticum, and the use of broad-range bacterial polymerase chain reaction (PCR) amplification may be required to make the diagnosis 5
Risk Factors
- Immunocompromised patients, such as those with hypogammaglobulinemia, are at a higher risk of developing invasive Ureaplasma urealyticum infections 4, 5
- Patients with chronic prostatitis or urethral syndrome may be more likely to have Ureaplasma urealyticum infections 6, 7