What treatment is recommended for a sexually active adult whose partner has tested positive for Ureaplasma and Mycoplasma?

Treatment for Partner Positive for Ureaplasma and Mycoplasma

You should be treated with doxycycline 100 mg orally twice daily for 7 days, which is the first-line treatment recommended by the CDC for partners of patients with Ureaplasma and Mycoplasma infections. 1, 2, 3

First-Line Treatment Regimen

• Doxycycline 100 mg orally twice daily for 7 days is the preferred treatment for sexually active adults whose partners test positive for Ureaplasma and Mycoplasma 4, 1, 2, 3
• This regimen achieves 91% susceptibility rates against Ureaplasma species and effectively treats both organisms simultaneously 2
• Doxycycline is bacteriostatic and works by inhibiting protein synthesis in these organisms 5

Alternative Treatment Options

If you cannot tolerate doxycycline, the following alternatives are recommended:

• 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

  • This achieves 71% susceptibility rates but offers the advantage of directly observed single-dose therapy 2
  • Single-dose therapy improves compliance compared to multi-day regimens 4

• Erythromycin base 500 mg orally four times daily for 7 days is another alternative for patients who cannot tolerate doxycycline or azithromycin 4, 1, 6

  • However, resistance to macrolides is increasingly common 3

• Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days can be substituted for erythromycin base 4

Critical Management Points

Sexual Abstinence Requirements

• You and your partner must abstain from sexual intercourse for 7 days after single-dose therapy (azithromycin) or until completion of the entire 7-day regimen (doxycycline or erythromycin) 4, 1, 2, 3
• This abstinence period is essential to prevent reinfection and ensure treatment success 1

Partner Notification Timeline

• Since your partner tested positive, you should be treated because your last sexual contact was presumably within 60 days of their diagnosis 4, 1, 2
• For symptomatic patients, partners with sexual contact within 30 days of symptom onset require treatment 4, 1, 3
• For asymptomatic patients (like your partner may be), partners with contact within 60 days of diagnosis require treatment 4, 1, 3

Important Clinical Considerations

Testing vs. Empiric Treatment

• You should receive empiric treatment without waiting for your own test results, as you are a sexual contact of a confirmed positive case 4
• The CDC guidelines emphasize that partners should be treated presumptively to prevent reinfection of the index patient and transmission to others 4
• Testing for traditional STIs (Neisseria gonorrhoeae, Chlamydia trachomatis) should still be performed to exclude coinfection 4

Common Pitfalls to Avoid

• Do not delay treatment while awaiting test results - this increases risk of complications and ongoing transmission 4
• Ensure both you and your partner complete the full treatment course - incomplete treatment is a major cause of persistent infection 4, 3
• Do not resume sexual activity before the recommended abstinence period ends - this is the most common cause of treatment failure and reinfection 1, 2

Follow-Up Strategy

• Return for evaluation only if symptoms develop or persist after completing therapy 1, 2, 3
• Test-of-cure is not routinely recommended for asymptomatic treated partners 2, 3
• If symptoms persist after treatment, reassess for treatment compliance and possibility of reinfection from an untreated partner 4, 3

Special Populations

• If you are HIV-positive, you should receive the same treatment regimen - no modification is needed 4, 1, 3
• If you are pregnant, erythromycin base 500 mg orally four times daily for at least 7 days is the preferred regimen 6

Clinical Context

While Ureaplasma and Mycoplasma can be part of normal genital flora, their detection in a symptomatic partner warrants treatment of sexual contacts 4, 7. Ureaplasma urealyticum is implicated in up to one-third of nongonococcal urethritis cases 4. The key distinction is that you are being treated as an epidemiologic contact, not based on your own symptoms or test results, which aligns with standard STI partner management protocols 4.