How do you treat a patient who tested positive for Ureaplasma after their partner tested positive?

Treatment of Ureaplasma-Positive Partner

Yes, treat the partner with doxycycline 100 mg orally twice daily for 7 days, regardless of symptoms, to prevent reinfection and transmission. 1, 2, 3

Partner Management Protocol

Sexual partners require evaluation and treatment when the index patient tests positive for Ureaplasma. The treatment window depends on symptom status: 4

• Symptomatic index patients: Treat partners with last sexual contact within 30 days of symptom onset 2, 3
• Asymptomatic index patients: Treat partners with last sexual contact within 60 days of diagnosis 4, 2, 3
• Last partner rule: Treat the most recent sexual partner even if contact occurred outside these timeframes 4

Recommended Treatment Regimens

First-Line Treatment

Doxycycline 100 mg orally twice daily for 7 days is the most effective first-line treatment for Ureaplasma infections. 4, 1, 2, 3 This regimen has the longest track record of efficacy and remains the most reliable agent against Ureaplasma species. 1

Alternative First-Line Option

Azithromycin 1 g orally as a single dose is an effective alternative, particularly when compliance with a 7-day regimen may be problematic. 4, 1, 2, 3 Single-dose regimens offer the advantage of directly observed therapy and improved compliance. 4

Additional Alternative Regimens

If doxycycline and azithromycin cannot be used: 4, 2

• Erythromycin base 500 mg orally four times daily for 7 days 4, 1, 2
• Levofloxacin 500 mg orally once daily for 7 days 4, 1, 2
• Ofloxacin 300 mg orally twice daily for 7 days 4, 1, 2

Post-Treatment Requirements

Both the index patient and partner must abstain from sexual intercourse for 7 days after initiating single-dose therapy or until completion of a 7-day regimen, provided symptoms have resolved. 4, 2, 3 This abstinence period is critical to prevent reinfection and treatment failure. 2

Critical Diagnostic Context

While partners should be treated, it's important to understand the nuanced nature of Ureaplasma:

• Ureaplasma exists in a "gray zone": It frequently colonizes healthy individuals without causing symptoms and is not classified as a traditional STD like gonorrhea or chlamydia. 3
• Treatment is indicated when: The index patient has documented urethritis with objective signs (>5 WBCs per oil immersion field on Gram stain, positive leukocyte esterase, or >10 WBCs per high-power field on first-void urine) or symptoms (mucopurulent discharge, dysuria, urethral pruritis). 3
• Species matters: Only U. urealyticum (not U. parvum) has strong pathogenic evidence and association with male infertility. 3

Follow-Up Recommendations

Partners should return for evaluation if symptoms develop or persist after completing therapy. 4, 2 However, routine test-of-cure is not necessary after treatment with doxycycline or azithromycin unless symptoms persist or reinfection is suspected. 4

Common Pitfalls to Avoid

• Do not delay partner treatment: Waiting for partner symptoms to develop increases reinfection risk for the index patient. 4
• Do not assume asymptomatic colonization is harmless: Even asymptomatic partners can transmit infection and should be treated. 3
• Do not treat without ensuring sexual abstinence: Treatment failure commonly occurs when patients resume intercourse before both partners complete therapy. 4, 2
• Do not routinely screen asymptomatic individuals: There is no evidence that treating genital tract infections without symptoms improves outcomes in the absence of an infected partner. 3

Special Considerations

HIV-infected partners should receive the same treatment regimens as HIV-negative individuals. 4, 2 Ureaplasma urethritis may facilitate HIV transmission, making partner treatment particularly important in this population. 4