Treatment of Ureaplasma Infection in Partners
For partners with Ureaplasma infection, doxycycline 100 mg orally twice daily for 7 days is the recommended first-line treatment. 1
First-Line Treatment Options
- Doxycycline 100 mg orally twice daily for 7 days is the first-line treatment recommended by the Centers for Disease Control and Prevention for Ureaplasma infections 1, 2
- Azithromycin 1 g orally in a single dose is an effective alternative first-line option, particularly when compliance with a 7-day regimen may be an issue 3, 4, 5
Alternative Treatment Options
For patients who cannot tolerate doxycycline or azithromycin:
- Erythromycin base 500 mg orally four times a day for 7 days 3, 1
- Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days 3, 1
- Levofloxacin 500 mg orally once daily for 7 days 3
- Ofloxacin 300 mg orally twice a day for 7 days 3
Management of Sex Partners
- All sexual partners of patients with Ureaplasma infection should be referred for evaluation and treatment 1
- Partners who had sexual contact within 30 days of symptom onset for symptomatic patients or within 60 days of diagnosis for asymptomatic patients should be treated 1
- Partners should receive the same treatment regimen as the index patient 6
Treatment Considerations
- Single-dose regimens like azithromycin have advantages for compliance and allow for directly observed treatment 3, 7
- Studies have shown similar effectiveness between single-dose azithromycin and 7-day doxycycline regimens for Ureaplasma infections 5, 7
- In vitro data confirms that Ureaplasma urealyticum is susceptible to azithromycin, though clinical significance requires further study 4
Post-Treatment Recommendations
- Both patients and partners should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen, provided symptoms have resolved 3, 1
- This abstinence period helps minimize the risk of reinfection 3
Treatment Failures
- For persistent infection despite appropriate treatment, consider testing for tetracycline-resistant Ureaplasma urealyticum 6
- Recent studies show concerning rates of persistent detection after standard treatments, with 25-31% failure rates after initial doxycycline or azithromycin treatment 8
- For persistent infection after initial treatment, consider switching to the alternative first-line agent (if azithromycin was used first, try doxycycline, or vice versa) 6
- For infections that persist after both doxycycline and azithromycin, moxifloxacin may be considered, though failure rates of approximately 30% have been reported even with this agent 8
Common Pitfalls to Avoid
- Failing to treat partners, which significantly increases the risk of reinfection 6
- Treating based on symptoms alone without confirming the presence of infection 6
- Overlooking Ureaplasma as a potential cause of chronic urinary symptoms, particularly in women 9
- Not ensuring adequate follow-up for patients with persistent symptoms 6, 1