Treatment for Partner Positive for Ureaplasma
Treat the partner with doxycycline 100 mg orally twice daily for 7 days, the same regimen used for nongonococcal urethritis, regardless of symptoms. 1, 2
Partner Treatment Regimen
The partner should receive empiric treatment even if asymptomatic, as Ureaplasma urealyticum is a recognized cause of nongonococcal urethritis (NGU) and can be transmitted sexually. 1, 3
First-line options include:
- Doxycycline 100 mg orally twice daily for 7 days (preferred for compliance monitoring) 1, 2, 3
- Azithromycin 1 g orally as a single dose (alternative when compliance with multi-day regimen is uncertain) 1, 2
The CDC guidelines explicitly state that specific diagnostic tests for Ureaplasma are not routinely indicated because detection is difficult and would not alter therapy—treatment is based on the partner's positive result. 1
Alternative Regimens
If the partner cannot tolerate doxycycline or azithromycin:
- Erythromycin base 500 mg orally four times daily for 7 days 1, 2
- Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days 1
- Ofloxacin 300 mg orally twice daily for 7 days 1, 2
- Levofloxacin 500 mg orally once daily for 7 days 1, 2
Critical Management Points
Sexual abstinence is mandatory: Both the index patient and partner must abstain from sexual intercourse for 7 days after treatment initiation (for single-dose therapy) or until completion of the full 7-day regimen, provided symptoms have resolved. 1, 2 This abstinence period minimizes reinfection risk, which is the most common cause of treatment failure rather than true antimicrobial resistance. 1
Timeframe for partner notification: All sexual partners within the preceding 60 days should be evaluated and treated with the same regimen, regardless of their symptom status or test results. 1, 2 If the last sexual contact was more than 60 days before diagnosis, treat the most recent sexual partner. 1
Concurrent Gonorrhea and Chlamydia Treatment
Since the expanded question mentions existing treatment for gonorrhea and chlamydia, ensure the partner receives appropriate coverage for these as well:
- Ceftriaxone 250-500 mg IM single dose for gonorrhea 1, 4
- The doxycycline or azithromycin regimen already covers Chlamydia trachomatis 1
Follow-Up Recommendations
Test of cure is not routinely required for partners treated with recommended regimens who remain asymptomatic. 1 However, the partner should return for evaluation if symptoms develop or persist after completing therapy. 1, 2
Do not re-treat based on symptoms alone—objective signs of urethritis (mucopurulent discharge, ≥5 WBCs per oil immersion field on Gram stain, or ≥10 WBCs per high-power field in first-void urine) must be documented before initiating repeat antimicrobial therapy. 1
Common Pitfalls to Avoid
Do not skip partner treatment: Even asymptomatic partners must be treated to prevent reinfection of the index patient. 1 Reinfection from untreated partners is the primary cause of persistent or recurrent urethritis, not treatment failure. 1
Do not use azithromycin monotherapy for gonorrhea: While azithromycin 1 g covers Ureaplasma and Chlamydia, it is insufficient for gonorrhea and should not be used alone if gonococcal infection is present or suspected. 1, 4
Medication should ideally be provided and administered in the clinic to ensure compliance, particularly for multi-day regimens. 1
Special Populations
Pregnancy: Pregnant partners should receive azithromycin 1 g orally as a single dose, as doxycycline and fluoroquinolones are contraindicated in pregnancy. 1, 4 For concurrent gonorrhea, use ceftriaxone 500 mg IM. 4
HIV-infected partners: Treat with the same regimens as HIV-negative individuals—no modification is needed. 1, 2