Treatment of Ureaplasma urealyticum Detected on Vaginal Swab
The detection of U. urealyticum DNA alone on a vaginal swab does not warrant treatment in asymptomatic women, as this organism is commonly found as part of normal vaginal flora in 40-80% of sexually active women. 1
Key Clinical Decision Point: Treat Symptoms, Not Colonization
The critical distinction is between colonization (asymptomatic detection) and infection (symptomatic disease):
- Asymptomatic women with U. urealyticum detected on vaginal swab should NOT be treated 1
- Routine testing and treatment of asymptomatic women is not recommended and may cause more harm than good through unnecessary antibiotic exposure and resistance development 1
- U. urealyticum colonization does not alter vaginal cytology or physiological flora 2
When Treatment IS Indicated
Treatment should only be considered in the following specific clinical scenarios:
1. Symptomatic Cervicitis with Confirmed Inflammation
If the patient has mucopurulent cervicitis with objective signs (purulent endocervical discharge or easily induced cervical bleeding), first exclude Chlamydia trachomatis and Neisseria gonorrhoeae before attributing symptoms to U. urealyticum 3, 1
2. Partner of Symptomatic Male with NGU
If the patient's male partner has documented nongonococcal urethritis where U. urealyticum is implicated, partner treatment may be warranted 4, 5
Recommended Treatment Regimen (When Indicated)
First-line therapy:
Alternative regimens (if doxycycline contraindicated):
- Azithromycin 1 g orally as a single dose 4, 5, 6
- Erythromycin base 500 mg orally four times daily for 7 days 3, 4, 5
- Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days 3, 4
Post-Treatment Management
- Abstain from sexual intercourse for 7 days after initiating therapy or until completion of 7-day regimen 4, 5
- Partner evaluation and treatment is recommended if treatment was initiated; partners with last sexual contact within 60 days should be treated 4, 5, 6
- Test of cure is NOT routinely recommended unless symptoms persist or reinfection is suspected 5
Critical Pitfalls to Avoid
Do not treat asymptomatic colonization: The most common error is treating U. urealyticum simply because it was detected on a multiplex PCR panel 1. This leads to:
- Unnecessary antibiotic exposure
- Selection of antimicrobial resistance
- Substantial economic cost
- No improvement in clinical outcomes 1
Pregnancy considerations: While pregnancy may favor U. urealyticum growth, detection during pregnancy does not adversely affect pregnancy outcomes and routine treatment is not beneficial 2, 8. One trial of 1,071 pregnant women showed no statistically significant reduction in low birthweight with antibiotic treatment (RR 0.70,95% CI 0.46-1.07) 8
Always exclude traditional STIs first: Before attributing any symptoms to U. urealyticum, test for and exclude C. trachomatis, N. gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis 1