Treatment for Positive Ureaplasma with Negative Mycoplasma

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

First-Line Treatment Options

Doxycycline 100 mg orally twice daily for 7 days is the recommended first-line treatment for Ureaplasma infections, with excellent efficacy against Ureaplasma urealyticum 1, 3
Azithromycin 1 g orally in a single dose is an equally effective alternative first-line option, particularly beneficial when compliance with a multi-day regimen may be an issue 1, 4
Single-dose regimens like azithromycin have the advantage of improved compliance and direct observed therapy, which can be administered in the clinic 3

Comparative studies show doxycycline has excellent activity in preventing and treating Ureaplasma infections, making it the preferred first-line agent 5
Azithromycin has demonstrated clinical efficacy in eradicating Ureaplasma infections and improving symptoms in patients with chronic urinary symptoms 6
In experimental models, doxycycline showed superior activity against susceptible Ureaplasma strains compared to azithromycin and levofloxacin 5

If symptoms persist after initial treatment, objective signs of urethritis should be confirmed before initiating additional antimicrobial therapy 3, 1
For persistent infections after doxycycline failure, consider azithromycin 500 mg orally on day 1, followed by 250 mg daily for 4 days 1
For persistent infections after azithromycin failure, consider moxifloxacin 400 mg orally once daily for 7-14 days 1
Resistance to macrolides, tetracyclines, and fluoroquinolones has been reported, with varying susceptibility patterns among different Ureaplasma strains 7

Sexual partners should be referred for evaluation and treatment to prevent reinfection 3, 1
Treat partners with last sexual contact within 60 days of diagnosis 1
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

A test of cure is not routinely recommended after completing treatment with doxycycline or azithromycin unless symptoms persist or reinfection is suspected 1
If a test of cure is performed, it should be done no earlier than 3 weeks after completion of therapy 1
Consider a test of cure when therapeutic compliance is in question or when using erythromycin due to its lower efficacy 1

In immunocompromised patients, Ureaplasma infections may be more invasive and require careful monitoring during treatment 8
For pregnant patients with Ureaplasma infections, treatment with appropriate antibiotics has been associated with eradication of the organism from the amniotic cavity and improved pregnancy outcomes 9
The relationship between Ureaplasma and male infertility remains under investigation, with some evidence suggesting that treatment of asymptomatic infections may improve sperm parameters, though impact on conception rates is unclear 3