What is the treatment for Ureaplasma (a type of Sexually Transmitted Disease (STD)) infection in women?

Treatment of Ureaplasma STD in Women

The recommended first-line treatment for Ureaplasma urealyticum infection in women is either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days. 1

First-Line Treatment Options

• Azithromycin: 1 g orally in a single dose 1

  • Advantages: Single-dose therapy improves compliance
  • Particularly useful for patients with questionable adherence to multi-day regimens 1

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

  • Equally effective as azithromycin but requires longer treatment course
  • Lower cost compared to azithromycin 1

Both regimens have demonstrated similar efficacy in eradicating Ureaplasma infection. Clinical trials comparing these treatments showed no statistically significant difference in effectiveness 3.

Alternative Treatment Options

If first-line treatments cannot be used, consider these alternatives:

• Erythromycin base: 500 mg orally four times daily for 7 days 1
• Erythromycin ethylsuccinate: 800 mg orally four times daily for 7 days 1
• Ofloxacin: 300 mg orally twice daily for 7 days 1

Note that erythromycin is less efficacious than azithromycin or doxycycline, and gastrointestinal side effects often reduce patient compliance 1.

Special Considerations

Pregnancy

• Doxycycline and ofloxacin are contraindicated in pregnancy 1
• For pregnant women, recommended options include:
  • Erythromycin base: 500 mg orally four times daily for 7 days 1
  • Amoxicillin: 500 mg orally three times daily for 7 days 1
  • Azithromycin: 1 g orally in a single dose may be considered, though data on safety in pregnancy were limited in earlier guidelines 1

HIV Infection

• Patients with Ureaplasma infection who are also HIV-positive should receive the same treatment regimen as HIV-negative patients 1

Management of Sex Partners

• All sexual partners within the previous 60 days should be referred for evaluation and treatment 1
• Partners should receive the same treatment as the index patient 1
• Both patients and partners should abstain from sexual intercourse until:
  • 7 days after completing a single-dose regimen, or
  • Until completion of a 7-day regimen 1

Follow-Up Recommendations

• Patients treated with azithromycin or doxycycline generally do not require retesting unless symptoms persist or reinfection is suspected 1
• If symptoms persist, patients should return for reevaluation 1
• For persistent symptoms, consider:
  • Reevaluation for possible reexposure 1
  • Assessment of partner treatment compliance 1
  • Evaluation for other potential causes of symptoms 1

Clinical Pearls and Pitfalls

• Ureaplasma urealyticum can cause chronic urinary symptoms in women and is often overlooked in diagnostic workups 4
• Studies have shown that approximately 48% of women with chronic urinary symptoms may have Ureaplasma infection 4
• For patients with symptoms lasting longer than 3 weeks, extended treatment with azithromycin (500 mg daily for 6 days) may be more effective than the single 1 g dose 5
• Single-dose therapy offers the advantage of directly observed treatment, which can improve overall effectiveness in populations with poor follow-up or adherence 1