Treatment of Ureaplasma Infection in Female Patients
Treat female patients with Ureaplasma infection using doxycycline 100 mg orally twice daily for 7 days as first-line therapy, reserving azithromycin 1 g as a single dose for situations where compliance with a 7-day regimen is questionable. 1, 2
First-Line Treatment
Doxycycline 100 mg orally twice daily for 7 days is the recommended first-line treatment for Ureaplasma urealyticum infections in women, supported by both CDC guidelines and FDA labeling. 3, 1, 2
This regimen has demonstrated superior efficacy in clinical trials, particularly in women with symptoms lasting 3 weeks or longer. 4
Administer with adequate fluids and consider giving with food or milk if gastric irritation occurs, though absorption is not significantly affected. 2
Alternative Treatment Options
Azithromycin 1 g orally as a single dose is the preferred alternative when compliance with a 7-day regimen may be problematic. 1, 5
For women with symptoms present for 3 weeks or longer, azithromycin 500 mg once daily for 6 days demonstrates significantly higher eradication rates (p < 0.001) compared to the single 1 g dose. 4
Erythromycin base 500 mg orally four times daily for 7 days or erythromycin ethylsuccinate 800 mg orally four times daily for 7 days are additional alternatives, though these require more frequent dosing. 3, 1
Fluoroquinolones (ofloxacin 300 mg twice daily for 7 days or levofloxacin 500 mg once daily for 7 days) can be considered as alternative options. 1
Critical Diagnostic Requirement
Only treat Ureaplasma when patients have documented urethritis symptoms or objective signs of inflammation—do not treat based on positive testing alone in asymptomatic women. 5
Required symptoms include: dysuria, mucopurulent discharge, urethral pruritis. 5
Required objective signs include: >5 WBCs per oil immersion field on Gram stain, positive leukocyte esterase, or >10 WBCs per high-power field on first-void urine. 5
Ureaplasma frequently colonizes healthy individuals without causing symptoms and should not be treated in asymptomatic women, even in infertility workups. 5
Management of Persistent or Recurrent Infection
If symptoms persist or recur after treatment, confirm objective signs of infection are present before initiating additional antimicrobial therapy. 1, 6
Re-treat with the initial doxycycline regimen if the patient was non-compliant or re-exposed to an untreated partner. 3, 1
After first-line doxycycline failure with confirmed persistent infection, consider azithromycin 500 mg orally on day 1, followed by 250 mg daily for 4 days. 1, 6
After first-line azithromycin failure, consider moxifloxacin 400 mg orally once daily for 7-14 days. 1, 6
For persistent symptoms despite treatment, erythromycin-based regimens extended to 14 days may address possible tetracycline-resistant U. urealyticum. 3
Partner Management
Sexual partners must be referred for evaluation and treatment—this is non-negotiable for preventing reinfection. 1, 6, 5
Treat all partners with last sexual contact within 60 days of diagnosis. 1, 5
Both patient and partners must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen. 1, 5
Test of Cure Recommendations
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 test of cure 3 weeks after erythromycin treatment due to its lower efficacy compared to doxycycline or azithromycin. 1
Common Pitfalls to Avoid
Do not routinely screen or treat asymptomatic women for Ureaplasma—there is no evidence that treating genital tract colonization without symptoms improves conception rates or pregnancy outcomes. 5
Do not confuse U. urealyticum with U. parvum—only U. urealyticum has established pathogenic significance, particularly regarding male infertility. 5
In women with chronic urinary symptoms, consider Ureaplasma as a potential cause before pursuing more invasive testing for interstitial cystitis, as up to 48% of such cases may be due to U. urealyticum infection. 7
Ensure adequate fluid intake with doxycycline to reduce risk of esophageal irritation and ulceration. 2