Ureaplasma Test of Cure Recommendations
A test of cure is not recommended for Ureaplasma urealyticum infections after completing treatment with doxycycline or azithromycin unless symptoms persist or reinfection is suspected. 1, 2
Treatment Regimens for Ureaplasma
Before discussing test of cure, it's important to understand the recommended treatment regimens:
First-Line Treatment Options:
- Doxycycline 100 mg orally twice daily for 7 days 2, 3
- Azithromycin 1 g orally in a single dose (particularly when compliance with a 7-day regimen may be an issue) 1, 2
Alternative Treatment Options:
- Erythromycin base 500 mg orally four times a day for 7 days 1, 2
- Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days 1, 2
- Ofloxacin 300 mg orally twice a day for 7 days 1, 2
- Levofloxacin 500 mg orally once daily for 7 days 1, 3
Test of Cure Recommendations
Standard Follow-up:
- Routine test of cure is not recommended after completing treatment with doxycycline or azithromycin 1
- Patients should only be retested if symptoms persist or reinfection is suspected 1, 2
Special Circumstances for Test of Cure:
- Consider a test of cure 3 weeks after completion of treatment with erythromycin due to its lower efficacy 1
- Test of cure should be considered when therapeutic compliance is in question 1
Timing of Test of Cure (When Needed):
- If a test of cure is performed, it should be done no earlier than 3 weeks after completion of therapy 1
- Testing before 3 weeks may yield false-negative results due to small numbers of organisms or false-positive results due to detection of dead organisms 1
Management of Persistent Infections
- If symptoms persist or recur after treatment, objective signs of infection should be present before initiating additional antimicrobial therapy 1, 3
- For persistent or recurrent infection, consider the following:
- Re-treatment with the initial regimen if the patient was non-compliant or re-exposed to an untreated partner 1, 3
- After first-line doxycycline failure, consider azithromycin 500 mg orally on day 1, followed by 250 mg daily for 4 days 3
- After first-line azithromycin failure, consider moxifloxacin 400 mg orally once daily for 7-14 days 3
Partner Management
- Sexual partners should be referred for evaluation and treatment 1, 2, 3
- Treat partners with last sexual contact within 60 days of diagnosis 2, 3
- Both patients and partners should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen 1, 2
Important Caveats
- Persistent detection of Ureaplasma after treatment with doxycycline, azithromycin, and even moxifloxacin is common but may not be associated with persistent symptoms 4
- Antibiotic-resistant strains of Ureaplasma have been detected, with approximately 10% of strains showing resistance to tetracyclines 5
- Some strains that are resistant to tetracycline may also be resistant to erythromycin 5
- Routine screening for Ureaplasma in asymptomatic individuals is not recommended due to high colonization rates and limited evidence of clinical significance 6