Treatment of Ureaplasma urealyticum Infections

Doxycycline 100 mg orally twice daily for 7 days is the first-line treatment for Ureaplasma urealyticum infections. 1, 2, 3

First-Line Treatment Options

Doxycycline 100 mg orally twice daily for 7 days is the recommended primary treatment according to the European Association of Urology guidelines and FDA drug labeling 1, 2, 3
This regimen has been shown to effectively eradicate the infection and alleviate symptoms in most cases 3

Azithromycin 1.0-1.5 g orally as a single dose is an effective alternative, particularly when compliance with a multi-day regimen may be an issue 1, 2, 4
A systematic review and meta-analysis showed that azithromycin has comparable efficacy to doxycycline in treating Ureaplasma urealyticum 4
For patients who cannot tolerate doxycycline or azithromycin, the following alternatives can be considered:
- Erythromycin base 500 mg orally four times a day for 7 days 1, 2
- Levofloxacin 500 mg orally once daily for 7 days 1, 2
- Ofloxacin 200 mg orally twice daily for 7 days 1, 2

For persistent urethritis after first-line doxycycline treatment:
- Azithromycin 500 mg orally on day 1, followed by 250 mg orally for 4 days 1
For persistent infection after azithromycin treatment:
- Moxifloxacin 400 mg orally once daily for 7-14 days, especially for macrolide-resistant infections 1, 2
Before initiating alternative therapy, confirm objective signs of persistent infection rather than relying solely on symptoms 1, 2

Sexual partners should be treated while maintaining patient confidentiality 1
Partners with last sexual contact within 30 days of symptom onset for symptomatic patients or within 60 days of diagnosis for asymptomatic patients should be evaluated and treated 1, 2
Patients should abstain from sexual intercourse until both they and their partners complete treatment and are symptom-free 1

Ureaplasma urealyticum can cause non-gonococcal urethritis in men and may be associated with chronic urinary symptoms in women 5
In a study of women with chronic urinary symptoms, 48% had positive cultures for Ureaplasma urealyticum, and antibiotic treatment significantly improved symptoms and reduced urinary frequency 5
Treatment should be initiated only after confirming the presence of Ureaplasma through appropriate testing to avoid unnecessary antibiotic use 2

Treating based on symptoms alone without laboratory confirmation of Ureaplasma infection 2
Failing to address possible reinfection from untreated sexual partners 1, 2
Overlooking the possibility of co-infections with other sexually transmitted pathogens 1
Continuing treatment beyond recommended duration without clear evidence of persistent infection 1

For pregnant women with confirmed Ureaplasma infection, azithromycin may be preferred as it has been studied in pregnancy and shown to eradicate intraamniotic Ureaplasma infection in animal models 6, 7
However, a recent study suggests that standard antibiotic regimens including azithromycin may not always be effective against vaginal Ureaplasma in cases of premature rupture of membranes 8