Ureaplasma Infection Guidelines

Introduction to Ureaplasma

Ureaplasma is sexually transmitted and can cause disease in specific contexts, but it exists in a gray zone—it is not classified as a traditional STD like gonorrhea or chlamydia because it frequently colonizes healthy individuals without causing symptoms 1, 2

The CDC recommends treating Ureaplasma only when patients have documented urethritis symptoms (mucopurulent discharge, dysuria, urethral pruritis) or 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) 1, 2, 3
U. urealyticum (but not U. parvum) is associated with male infertility based on meta-analysis evidence from the European Association of Urology 4

First-line treatment is Doxycycline 100 mg orally twice daily for 7 days 5, 6
Alternative treatment is Azithromycin 1 g orally as single dose (for compliance concerns) 5, 6
Second alternative treatment is Erythromycin base 500 mg orally four times daily for 7 days 5, 6

Sexual partners require evaluation and treatment, with treatment indicated for partners with last sexual contact within 30 days of symptom onset for symptomatic patients or within 60 days of diagnosis for asymptomatic patients 5, 6
Both patients and partners must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of 7-day regimen 5

Do not routinely screen asymptomatic individuals for Ureaplasma—there is no evidence that treatment of genital tract infections without symptoms improves conception rates, even when organisms are detected 4
Do not treat based on positive Ureaplasma testing alone without documented urethritis symptoms or objective signs of inflammation 4, 6
Do not confuse U. urealyticum with U. parvum—only U. urealyticum is associated with infertility and has stronger pathogenic evidence 4
Do not assume that treating asymptomatic Ureaplasma colonization in infertility workups will improve pregnancy outcomes—randomized controlled trials with live birth as primary outcomes are needed to establish this benefit 4

Ureaplasma urealyticum is primarily transmitted through sexual contact, and can also be passed from a pregnant woman to her infant during pregnancy, delivery, or via the birth canal, affecting both adult and neonatal populations. 7