Ureaplasma Infection Management

Diagnosis and Treatment

The Centers for Disease Control and Prevention recommends confirming urethritis through symptoms including dysuria, urethral pruritus, or urethral discharge, or objective signs such as mucopurulent or purulent discharge, greater than 5 WBCs per oil immersion field on Gram stain of urethral secretions, positive leukocyte esterase test on first-void urine, or greater than 10 WBCs per high-power field on microscopic examination of first-void urine 1, 2
Treatment is only indicated if the patient has documented symptoms or objective signs of urethritis—a positive Ureaplasma test alone in an asymptomatic patient does not warrant treatment, as stated by the American College of Physicians 1
First-line treatment for urethritis is doxycycline 100 mg orally twice daily for 7 days, with alternative regimens including azithromycin 1 g orally as a single dose, erythromycin base 500 mg orally four times daily for 7 days, erythromycin ethylsuccinate 800 mg orally four times daily for 7 days, ofloxacin 300 mg orally twice daily for 7 days, and levofloxacin 500 mg orally once daily for 7 days 3, 1, 4

The Centers for Disease Control and Prevention recommends that all sexual partners require evaluation and treatment, with treatment of partners with last sexual contact within 30 days of symptom onset for symptomatic patients and within 60 days of diagnosis for asymptomatic patients 3, 1, 4
Both patient and partners must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of 7-day regimen, as recommended by the American College of Physicians 3, 1, 4

Test of cure is not routinely recommended after completing doxycycline or azithromycin treatment unless symptoms persist or reinfection is suspected, according to the Infectious Diseases Society of America 4
Retest only if symptoms persist or recur after treatment, reinfection is suspected, therapeutic compliance is questionable, or patient was treated with erythromycin, as stated by the American College of Physicians 4
If test of cure is performed, wait at least 3 weeks after completion of therapy, as recommended by the Centers for Disease Control and Prevention 4