Ureaplasma is a common microorganism found in the human genitourinary tract. This bacterium often resides harmlessly as part of the normal microbiome, particularly in sexually active individuals, without causing any symptoms. However, it can become an opportunistic pathogen, leading to various health complications. Understanding the difference between simple colonization (presence without symptoms) and an active infection is central to addressing public concern.
What Exactly is Ureaplasma
Ureaplasma belongs to the Mollicutes group of bacteria, distinguished as some of the smallest free-living organisms capable of self-replication. A defining feature is the complete lack of a rigid cell wall, which makes it structurally unique compared to most other bacteria. This structural difference has implications for how it is treated with antibiotics. The genus Ureaplasma is named for its ability to hydrolyze urea. There are two primary species found in humans: Ureaplasma urealyticum and Ureaplasma parvum. Both species primarily colonize the mucosal surfaces of the respiratory and urogenital tracts.
Is Ureaplasma a Normal Resident
Ureaplasma is widely considered a commensal organism, meaning it lives in harmony with its host without typically causing disease, especially in the lower genitourinary tract. Prevalence rates are significantly higher in sexually active adults, with studies showing that 40% to 80% of asymptomatic, sexually active women may be colonized in the cervicovaginal area. Colonization rates are generally lower in men but still substantial. The organism can also be transmitted from mother to offspring, with over 20% of liveborn infants potentially colonized, although this colonization often resolves naturally within the first few months of life. The presence of Ureaplasma in individuals who are not sexually active, such as children, is rare, which strongly suggests that sexual contact is the primary mode of transmission in adults.
When Does Ureaplasma Cause Symptoms
The transition from a harmless colonizer to a pathogen typically occurs when the organism overgrows or invades tissues, often in the setting of a compromised immune system.
Manifestations in Adults
One of the most common clinical manifestations is Non-gonococcal Urethritis (NGU) in men, which is inflammation of the urethra not caused by gonorrhea or chlamydia. Symptoms of NGU include a burning sensation during urination, pain, and discharge. In women, Ureaplasma has been associated with conditions like Pelvic Inflammatory Disease (PID) and chronic endometritis. PID causes lower abdominal pain and may lead to scarring in the reproductive organs, which is a common cause of infertility.
Pregnancy and Neonatal Risks
Evidence links Ureaplasma to adverse pregnancy outcomes when it colonizes the upper reproductive tract. Specific complications during pregnancy include chorioamnionitis (inflammation of the fetal membranes) and an increased risk of preterm birth. Its presence in the amniotic fluid or placenta is a factor in pregnancy loss and complications. In newborns, particularly premature infants, the organism can cause serious invasive infections such as pneumonia, meningitis, and the chronic lung disease bronchopulmonary dysplasia.
Testing and Treatment Protocols
Diagnosis of Ureaplasma is typically performed using molecular methods, such as Nucleic Acid Amplification Tests (NAAT) or Polymerase Chain Reaction (PCR), which detect the organism’s genetic material. These sensitive tests can be performed on various samples, including first-void urine from men and vaginal or cervical swabs from women. Culture-based testing is less common because the organism requires specialized conditions to grow.
Treatment is generally reserved for individuals who are experiencing symptoms or those who belong to high-risk groups, such as pregnant women with a history of complications. The lack of a cell wall makes Ureaplasma naturally resistant to common antibiotics like penicillin and cephalosporins. Standard treatment protocols rely on specific classes of antibiotics, primarily tetracyclines like doxycycline, often administered twice daily for seven days. Macrolide antibiotics, such as azithromycin, are often used as an alternative treatment, particularly if doxycycline is contraindicated, such as during pregnancy. If the initial treatment fails, a doctor may consider a fluoroquinolone antibiotic, like moxifloxacin, based on the potential for antibiotic resistance.