What is Ureaplasma (a type of bacteria) infection?

From the Guidelines

Ureaplasma is a type of bacteria that can cause urinary tract and genital infections, and its role in causing urethritis is debated, with recent data suggesting that U. urealyticum, but not U. parvum, is an aetiological agent in non-gonococcal urethritis (NGU) 1.

Key Points

• Ureaplasma infections can be asymptomatic but may cause urethritis, cervicitis, pelvic inflammatory disease, and complications in pregnancy.
• The bacteria lacks a cell wall, making it naturally resistant to antibiotics that target cell wall synthesis like penicillins and cephalosporins.
• Treatment typically involves antibiotics, with doxycycline 100mg twice daily for 7 days being the first-line therapy for most Ureaplasma infections, as suggested by the European Association of Urology guidelines 1.
• Alternative treatments include azithromycin 1g as a single dose or 500mg on day 1 followed by 250mg daily for 4 more days.
• For pregnant women, azithromycin is preferred as doxycycline is contraindicated.
• For persistent infections, moxifloxacin 400mg daily for 7-14 days may be used.
• Sexual partners should be treated simultaneously to prevent reinfection.
• Testing is typically done via PCR of urine, vaginal, or urethral samples.
• After treatment, patients should abstain from sexual activity until both they and their partners complete therapy to prevent reinfection.

Symptoms and Diagnosis

• Symptoms of urethritis include mucopurulent or purulent discharge, dysuria, and urethral pruritus, although many urethral infections are asymptomatic 1.
• Diagnosis is typically done via nucleic acid amplification tests, and treatment should be guided by the results of these tests.
• It is crucial to evaluate and treat all at-risk sexual partners while upholding patient confidentiality 1.

Treatment and Management

• Empiric treatment should commence on diagnosis in cases of severe urethritis, while mild cases may delay treatment until guided by the results of the nucleic acid amplification tests 1.
• The European Association of Urology guidelines suggest that doxycycline 100mg twice daily for 7 days is the first-line therapy for most Ureaplasma infections, with alternative treatments including azithromycin and moxifloxacin 1.
• Treatment duration and choice of antibiotic should be tailored to the individual patient and guided by local resistance patterns and specific host factors.

From the FDA Drug Label

Ureaplasma urealyticum Ureaplasma urealyticum

Ureaplasma infection is caused by the bacteria Ureaplasma urealyticum, which is a type of microorganism that can infect the urinary tract and other parts of the body.

• Key points about Ureaplasma infection:
  • It is a type of bacterial infection
  • It is caused by Ureaplasma urealyticum
  • It can infect the urinary tract and other parts of the body
  • The bacteria can be treated with certain antibiotics, such as erythromycin, azithromycin, and doxycycline 2, 3, 4

From the Research

Definition and Prevalence of Ureaplasma Infection

• Ureaplasma infection is caused by the bacteria Ureaplasma, which can colonize the genital tract of sexually mature women, with a colonization rate of up to 80% 5.
• The infection can invade the amniotic cavity during pregnancy and cause complications, such as preterm birth and preterm rupture of the membranes 5, 6.

Symptoms and Diagnosis

• Ureaplasma infection can cause chronic urinary symptoms, such as frequent urination and pelvic pain, in women 7.
• The infection can be diagnosed through culture screening, such as the Mycofast Revolution assay, and speciated using multiplex polymerase chain reaction assay 5.

Treatment and Antibiotic Resistance

• Antibiotics, such as erythromycin and azithromycin, are commonly used to treat Ureaplasma infections, but resistance to these antibiotics is increasing 5, 7.
• Studies have shown that Ureaplasma species are highly resistant to erythromycin and tetracycline, with resistance rates of up to 80% and 73%, respectively 5.
• Alternative antibiotics, such as solithromycin, have been shown to be effective in eradicating Ureaplasma parvum from the amniotic fluid in an ovine model of intrauterine infection 8.

Pregnancy and Neonatal Outcomes

• Ureaplasma infection during pregnancy has been linked to adverse neonatal outcomes, such as preterm birth, low birth weight, and bronchopulmonary dysplasia 6, 9.
• Antenatal treatment with azithromycin has been shown to reduce the incidence of preterm premature rupture of membranes, but not necessarily improve neonatal outcomes 9.
• Maternal Ureaplasma colonization has been associated with an increased risk of moderate-severe bronchopulmonary dysplasia in preterm infants, despite antenatal treatment with azithromycin 9.