When is Ureaplasma (a type of bacteria) testing ordered?

When to Order Ureaplasma Testing

Routine testing for Ureaplasma is not recommended in asymptomatic individuals due to high colonization rates and lack of evidence that detection and treatment does more good than harm. 1, 2

Appropriate Clinical Scenarios for Ureaplasma Testing

Ureaplasma testing should be limited to specific clinical scenarios:

1. Persistent or recurrent urethritis:

   • After treatment failure for other STIs
   • When other common causes of non-gonococcal urethritis (NGU) have been ruled out 1

2. Chronic prostatitis:

   • In men with symptoms of chronic prostatitis where other causes have been excluded 3

3. Before urological procedures:

   • When procedures will breach the mucosa 4

4. Special populations:

   • Patients with humoral immunodeficiencies who may be at higher risk for complications 1

Testing Methods and Specimen Collection

• NAAT (Nucleic Acid Amplification Test) is the preferred testing method 1
• Specimen types:
  • First-void urine samples are appropriate for NAAT testing
  • Urethral swabs show higher specificity and positive predictive value compared to urine specimens 1
  • For prostatitis evaluation: expressed prostatic secretions and post-massage urine 3

Important Considerations

• Avoid multiplex PCR panels that include Ureaplasma alongside traditional STIs, as these may lead to overdiagnosis and overtreatment 2
• Quantitative species-specific molecular tests should be used when testing is performed, as only high bacterial loads of U. urealyticum may be clinically significant 2
• Rule out other pathogens first:
  • N. gonorrhoeae
  • C. trachomatis
  • M. genitalium
  • T. vaginalis (where relevant) 2
• In women with symptoms, bacterial vaginosis should always be tested for and treated if detected 2

Cautions and Limitations

• Asymptomatic carriage is common (40-80% of cases) and most individuals do not develop disease 2
• Unnecessary testing and treatment may contribute to antimicrobial resistance 2
• U. parvum is rarely pathogenic and testing is generally not indicated 2
• M. hominis testing is also not routinely recommended 2

Treatment When Ureaplasma is Detected in Appropriate Clinical Scenarios

When Ureaplasma is detected in a clinically relevant scenario:

• First-line: Doxycycline 100 mg orally twice daily for 7 days 1
• Alternative: Azithromycin 1.0-1.5 g orally as a single dose 1
• For treatment failures: Consider moxifloxacin 400 mg daily for 7-14 days 1

Remember that partner notification and treatment are essential to prevent reinfection, and patients should abstain from sexual intercourse until 7 days after initiating therapy or resolution of symptoms 1.