Treatment for Ureaplasma urealyticum Infection

Doxycycline 100 mg orally twice daily for 7 days is the first-line treatment for Ureaplasma urealyticum infection. 1, 2, 3, 4

First-Line Treatment

Doxycycline 100 mg orally twice daily for 7 days is recommended by both the CDC and European Association of Urology as the primary treatment regimen 1, 2, 3
This regimen is effective for urethritis, cervicitis, and other genital tract infections caused by Ureaplasma 2, 4
Administer with adequate fluids to reduce risk of esophageal irritation; may be given with food or milk if gastric irritation occurs 4

Azithromycin 1 g orally as a single dose is an effective alternative, particularly when compliance with a 7-day regimen is questionable 1, 2, 3
This single-dose regimen showed comparable clinical cure rates to doxycycline in clinical trials (81% vs 77%) 5
However, note that azithromycin has lower microbiological cure rates for Ureaplasma specifically (45% vs 47% for doxycycline) 5

For patients who cannot tolerate doxycycline or azithromycin:

Avoid fluoroquinolones empirically in patients from urology departments or those who used fluoroquinolones in the last 6 months due to high resistance rates 2

Only treat Ureaplasma urealyticum when there are symptoms of urethritis (urethral discharge, dysuria, urethral pruritus) or documented urethritis (≥5 PMNs/HPF on urethral smear) 2
Do not treat asymptomatic bacteriuria unless the patient is undergoing traumatic urinary tract procedures 2
The pathogenic role of Ureaplasma species is debated; recent data suggests U. urealyticum (but not U. parvum) is an etiological agent in nongonococcal urethritis 2

Consider extending treatment to 14 days in men when prostatitis cannot be excluded 2

Refer all sex partners for evaluation and treatment 1, 2, 3
Treat partners with last sexual contact within 30 days of symptom onset for symptomatic patients or within 60 days of diagnosis for asymptomatic patients 1, 2
Both patients and partners must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen, provided symptoms have resolved 1, 3

Test of cure is NOT recommended after completing treatment with doxycycline or azithromycin unless symptoms persist or reinfection is suspected 3
If test of cure is performed, do it no earlier than 3 weeks after completion of therapy 3
Consider test of cure 3 weeks after erythromycin treatment due to its lower efficacy 3

Confirm objective signs of urethritis before initiating further antimicrobial therapy for persistent symptoms 2, 3
Re-treat with the initial regimen if the patient was non-compliant or re-exposed to an untreated partner 2, 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 for macrolide-resistant infections 2, 3

Do not treat based on symptoms alone without confirming the presence of Ureaplasma through appropriate testing 2
Failing to address possible reinfection from untreated partners is a common cause of treatment failure 2
Do not use fluoroquinolones in patients with recent fluoroquinolone exposure due to resistance 2
Ureaplasma may account for a large proportion of unexplained chronic voiding symptoms in women; culture and treatment should be considered before pursuing more costly and invasive tests 6