Treatment for Ureaplasma urealyticum Infections

First-Line Treatment Options

The European Association of Urology recommends doxycycline 100 mg orally twice daily for 7 days as the primary treatment for Ureaplasma urealyticum infections 1, 2

Azithromycin 1 g orally as a single dose is an effective alternative first-line option, particularly when compliance with a 7-day regimen may be an issue 2
Erythromycin base 500 mg orally four times daily for 7 days is an alternative treatment option 2
Levofloxacin 500 mg orally once daily for 7 days is an alternative treatment option 2
Ofloxacin 300 mg orally twice daily for 7 days is an alternative treatment option 2

For urethritis caused by Ureaplasma urealyticum, the European Association of Urology recommends doxycycline 100 mg orally twice daily for 7 days 1, 2

For persistent urethritis despite doxycycline treatment, the Centers for Disease Control and Prevention recommend confirming objective signs of urethritis before initiating further antimicrobial therapy 3
Moxifloxacin 400 mg orally once daily for 7-14 days is a treatment option for macrolide-resistant infections 1

The Centers for Disease Control and Prevention recommend that sex partners be referred for evaluation and treatment 2
Partners with last sexual contact within 30 days of symptom onset for symptomatic patients or within 60 days of diagnosis for asymptomatic patients should be treated 2

The European Association of Urology recommends against treating based on symptoms alone without confirming the presence of Ureaplasma through appropriate testing 3
Failing to address possible reinfection from untreated partners is a common pitfall to avoid 2, 3

The European Association of Urology recommends only treating U. urealyticum when there are symptoms of urethritis (urethral discharge, dysuria, urethral pruritus) or documented urethritis (≥5 PMNs/HPF on urethral smear) 4, 5, 6
The European Association of Urology notes that the pathogenic role of Ureaplasma species is debated, with recent data suggesting U. urealyticum (but not U. parvum) is an etiological agent in NGU 4, 5, 6
The European Association of Urology advises not to treat asymptomatic bacteriuria unless the patient is undergoing traumatic urinary tract procedures 6

For men, the European Association of Urology considers extending treatment to 14 days when prostatitis cannot be excluded 4, 7

The European Association of Urology warns against using fluoroquinolones empirically in patients from urology departments or those who have used fluoroquinolones in the last 6 months due to high resistance rates 5, 7