From the Guidelines
Routine screening for Ureaplasma and Mycoplasma in urine is not recommended; testing should only be performed when patients are symptomatic with urogenital symptoms that suggest these infections. This approach is supported by the Infectious Diseases Society of America and the American Society for Microbiology, as outlined in their 2018 update 1. The rationale behind this recommendation is that Ureaplasma is commonly found as a colonizer in asymptomatic, sexually active individuals, and testing for it is not recommended due to its high prevalence of colonization 1.
When testing is indicated, nucleic acid amplification tests (NAATs) on first-void urine or urogenital swabs are preferred for detecting Mycoplasma genitalium, a recognized pathogen in nongonococcal urethritis and nonchlamydial nongonococcal urethritis in males and cervicitis and PID in females 1. Key symptoms that may prompt testing include urethritis, dysuria, abnormal discharge, or pelvic pain that persists despite negative results for more common pathogens.
Some key points to consider:
- Ureaplasma colonization is common in asymptomatic individuals, making routine screening unnecessary 1.
- Mycoplasma genitalium is a significant pathogen, but its detection requires validated molecular assays, as there is no FDA-cleared assay available 1.
- Treatment for Mycoplasma genitalium may involve azithromycin or moxifloxacin, depending on resistance patterns, while Ureaplasma treatment typically involves doxycycline 1.
- Widespread testing for these organisms could lead to unnecessary antibiotic use, contributing to antimicrobial resistance, a concern particularly for Mycoplasma genitalium 1.
From the Research
Ureaplasma and Mycoplasma Screening in Urine
- The decision to screen for Ureaplasma and Mycoplasma in urine depends on various factors, including the presence of symptoms and the potential risks and benefits of screening 2.
- Ureaplasma and Mycoplasma are common causes of non-gonococcal urethritis, with Ureaplasma urealyticum and Mycoplasma genitalium being the most prevalent species 3, 4.
- Screening for these organisms may be useful in certain situations, such as in patients with symptoms of urethritis or in those who are at high risk of infection 3, 5.
- However, routine screening of asymptomatic individuals may not be necessary, as the benefits of screening may not outweigh the potential harms, such as false-positive results and unnecessary treatment 2.
Diagnosis and Treatment
- The diagnosis of Ureaplasma and Mycoplasma infections is typically made using nucleic acid amplification tests (NAATs) or culture 3, 4.
- Treatment options for Ureaplasma and Mycoplasma infections include antibiotics such as azithromycin, doxycycline, and levofloxacin 3, 5, 6.
- The choice of antibiotic and duration of treatment depend on the specific organism, the severity of symptoms, and the presence of any underlying medical conditions 3, 5.
Considerations for Screening
- The decision to screen for Ureaplasma and Mycoplasma should be based on a careful consideration of the potential benefits and harms of screening, as well as the availability of effective treatment options 2.
- Screening may be more useful in certain high-risk populations, such as those with a history of sexually transmitted infections or those who are immunocompromised 3, 4.
- Further research is needed to determine the optimal screening strategies for Ureaplasma and Mycoplasma infections and to develop more effective treatment options 2, 4.