Partner Testing for Ureaplasma: A Guideline-Based Approach
If you are treating the index patient for Ureaplasma, then all sexual partners from the past 60 days must be evaluated and treated, but routine testing and treatment of Ureaplasma should only occur when strict clinical criteria are met—not based on a positive test alone. 1
When Treatment (and Therefore Partner Management) Is Indicated
The decision to treat Ureaplasma—and consequently manage partners—requires meeting ALL of the following criteria simultaneously:
Objective urethritis must be documented by any of: mucopurulent/purulent urethral discharge on exam, Gram stain showing ≥5 WBCs per oil immersion field, positive leukocyte esterase on first-void urine, or microscopy showing ≥10 WBCs per high-power field 1
All true STI pathogens must be excluded first: Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis 1, 2
Only U. urealyticum with high quantitative load should be considered pathogenic—not U. parvum or M. hominis, which are typically commensals 1, 2
Symptoms must persist despite appropriate evaluation and exclusion of other causes 1
This restrictive approach is critical because asymptomatic carriage of Ureaplasma occurs in 40-80% of sexually active individuals, and the urethral inflammatory response to Ureaplasma is significantly lower than to C. trachomatis or M. genitalium 2, 3. The CDC explicitly recommends against treatment based solely on positive Ureaplasma test results 1.
Partner Management Protocol When Treatment Is Warranted
If the index patient meets criteria for treatment and is being treated:
All sexual partners with contact within 60 days must be evaluated and treated with the same regimen as the index patient 1, 4
Both patient and partners must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of the 7-day regimen 1, 4
Partner treatment should occur without waiting for test results to prevent reinfection, which is the most common cause of treatment "failure" in STIs 5
The rationale for partner management mirrors established STI principles: patients who appear to fail therapy are most likely reinfected by untreated sexual partners 5. This is particularly important because many infections are acquired from asymptomatic partners unaware of their infection 5.
Treatment Regimen for Index Patient and Partners
First-line treatment: Doxycycline 100 mg orally twice daily for 7 days 1
Alternative regimens: Azithromycin 1 g orally as single dose, or erythromycin base 500 mg orally four times daily for 7 days 1
For patients with severe gut dysbiosis concerns, azithromycin 1 g single dose minimizes microbiome disruption with only 1 day of antibiotic exposure versus 7 days with doxycycline, while maintaining a 97% cure rate 6.
Critical Pitfalls to Avoid
Do not routinely test or treat asymptomatic individuals for Ureaplasma. The European STI Guidelines Editorial Board explicitly states we have no evidence that detecting and treating M. hominis, U. parvum, and U. urealyticum colonizations does more good than harm 2. Routine testing leads to unnecessary antimicrobial use, selection of resistance in both these organisms and true STI pathogens, and substantial economic costs 2.
Do not attribute symptoms to Ureaplasma until traditional STI agents are excluded. The commercialization of multiplex PCR assays detecting Ureaplasma alongside true STIs has worsened inappropriate treatment 2.
Persistent Ureaplasma after treatment is common even with appropriate antibiotics—one study found 44% of couples remained positive after initial treatment despite in vitro sensitivity 7. This reflects the challenge of eradicating colonization versus treating true infection.
Follow-Up Strategy
Test-of-cure is not routinely recommended unless symptoms persist or reinfection is suspected 1
Patients should return for evaluation only if symptoms persist or recur after completing therapy 1
Do not perform NAAT within 3 weeks of treatment as it can detect dead organisms and yield false-positive results 6