Does the male partner need treatment for Ureaplasma (a type of bacteria) if his wife tested positive for Ureaplasma infection?

Treatment of Male Partner for Ureaplasma Infection

Yes, the male partner should be treated when his female partner tests positive for Ureaplasma urealyticum, even if he is asymptomatic. This approach prevents reinfection and potential complications in both partners.

Rationale for Treatment

Ureaplasma urealyticum is a sexually transmitted organism that:

• Causes 20-40% of nongonococcal urethritis (NGU) cases in men 1
• Can be present asymptomatically in both men and women
• Can be transmitted between sexual partners
• May lead to complications if left untreated

Treatment Recommendations

First-line Treatment:

• Doxycycline 100 mg orally twice daily for 7 days 1, 2

Alternative Regimens (if doxycycline cannot be tolerated):

• Erythromycin base 500 mg orally 4 times a day for 7 days, or
• Erythromycin ethylsuccinate 800 mg orally 4 times a day for 7 days 1

For Patients Unable to Tolerate High-Dose Erythromycin:

• Erythromycin base 250 mg orally 4 times a day for 14 days, or
• Erythromycin ethylsuccinate 400 mg orally 4 times a day for 14 days 1

Management Considerations

Testing Before Treatment

• While testing the male partner is ideal, empiric treatment is often more practical and cost-effective
• CDC guidelines support treating partners of infected individuals even without testing 1

Partner Management

• Treatment of sex partners is imperative due to the risk of reinfection 1
• Male partners of women with Ureaplasma infection are often asymptomatic but still infectious 1
• Treating both partners simultaneously helps prevent the "ping-pong" effect of reinfection

Follow-Up

• No routine follow-up is needed if symptoms resolve
• If symptoms persist or recur after treatment completion:
  1. Consider retreatment with the initial regimen if non-compliance or re-exposure occurred
  2. If compliance was good and no re-exposure occurred, consider extended treatment with an alternative regimen for 14 days 1

Clinical Pitfalls to Avoid

1. Ignoring asymptomatic partners: Even without symptoms, the male partner can harbor infection and reinfect the female partner after her treatment 1

2. Inadequate treatment duration: Some studies suggest that a full 7-14 day course is necessary for complete eradication 3, 4

3. Failing to treat both partners simultaneously: This can lead to reinfection cycles between partners

4. Over-testing in asymptomatic individuals: While treatment of partners is recommended, routine screening of asymptomatic individuals for Ureaplasma is not generally recommended 5

5. Suboptimal treatment selection: Tetracyclines (like doxycycline) have better efficacy against Ureaplasma than erythromycin 6

By treating both partners simultaneously with appropriate antibiotics, you can effectively eliminate the infection and prevent complications and reinfection.