Ureaplasma Infection

Ureaplasma urealyticum and Ureaplasma parvum are genital mycoplasmas that colonize the lower genital tract of a significant proportion of sexually active adults asymptomatically, making their role as true pathogens versus incidental colonizers genuinely debated and context dependent.

They are implicated in a subset of cases of non-gonococcal urethritis in men, and have been associated with chorioamnionitis, preterm birth, and neonatal complications (particularly bronchopulmonary dysplasia in very preterm infants) when ascending into the upper genital tract or amniotic cavity in pregnancy.

Most colonized individuals are entirely asymptomatic.

Where symptomatic, presentation in men is typically non-gonococcal urethritis: mild to moderate urethral discharge and dysuria, clinically indistinguishable from chlamydial or other causes of NGU without specific testing.

In pregnancy, ascending infection is associated with preterm labor and, in the neonate born very preterm, has been linked to congenital pneumonia and chronic lung disease.

NAAT testing is available where clinically indicated, though routine screening of asymptomatic individuals is not recommended given the high background colonization rate and uncertain clinical significance of a positive result in this context.

Testing is more appropriately reserved for men with persistent non-gonococcal urethritis symptoms after chlamydia, gonorrhea, trichomonas, and Mycoplasma genitalium have been excluded, or in specific reproductive or neonatal contexts where a causal role is being specifically investigated.

• Doxycycline 100 mg PO bd for 7 days is first line where treatment is indicated (symptomatic urethritis with ureaplasma identified as the likely cause after excluding other pathogens)
• Azithromycin 1 g PO single dose is an alternative
• Macrolide resistance is increasingly recognized, and treatment failure should prompt reconsideration of the diagnosis or a change in agent (a fluoroquinolone such as moxifloxacin may be used in resistant or persistent cases, though evidence specific to ureaplasma is more limited than for Mycoplasma genitalium)
• Treatment of asymptomatic colonization is not generally recommended, including in pregnancy, given the lack of clear evidence that treatment improves outcomes and given the very high background prevalence of colonization

Referral: sexual health services for persistent non-gonococcal urethritis; neonatology/infectious disease input where ureaplasma is implicated in a specific neonatal complication.