Ureaplasma is a common bacterium found in the genitourinary tract, often existing without causing symptoms. As a sexually transmitted microorganism, it is frequently detected in sexually active adults. When overgrowth occurs or the bacteria invades tissues, it can lead to symptomatic infection and various health concerns. This article explores the nature of Ureaplasma and the necessity of treatment for symptomatic cases.
Understanding Ureaplasma
Ureaplasma belongs to the Mollicutes class of bacteria, distinguished by their small size and lack of a rigid cell wall. This biological feature significantly impacts how the infection must be treated. The organism is considered one of the smallest self-replicating life forms known.
The two main species that colonize humans are Ureaplasma urealyticum and Ureaplasma parvum. While often considered commensal, changes in the environment or immune status can trigger them to become pathogenic. Transmission occurs primarily through sexual contact, but it can also pass from a birthing parent to an infant during pregnancy or delivery.
Why Medical Treatment is Required
For individuals experiencing symptoms, Ureaplasma generally does not resolve on its own. Spontaneous clearance is rare in symptomatic cases, as the bacteria’s ability to adhere to mucosal surfaces prevents effective immune eradication. When left untreated, the infection persists, and the bacterial load remains high.
Untreated Ureaplasma can lead to several complications, particularly in the reproductive and urinary tracts. In women, it is associated with cervicitis, pelvic inflammatory disease, and bacterial vaginosis. For both men and women, the infection causes non-gonococcal urethritis (NGU), which is an inflammation of the urethra. Persistent infection is also linked to adverse pregnancy outcomes, including chorioamnionitis and preterm birth.
Standard Treatment Protocols
Because Ureaplasma lacks a cell wall, common antibiotics, such as penicillin-based drugs, are ineffective. These drugs target the cell wall structure, which this organism does not possess. Treatment must utilize specific classes of antibiotics that penetrate the cell membrane or interfere with protein synthesis.
The first-line treatments typically involve a course of tetracyclines, such as doxycycline (100 mg orally twice daily for seven days). Alternatively, macrolide antibiotics like azithromycin are used, often as a single 1-gram dose or a multi-day regimen. Successfully treating the infection requires full adherence to the prescribed medication, even if symptoms improve quickly. All sexual partners must also be treated simultaneously to prevent immediate reinfection, a common cause of treatment failure.
If the initial course fails, a second-line treatment, often a fluoroquinolone like moxifloxacin, may be prescribed. This approach is reserved for cases where antibiotic resistance is suspected or confirmed. Resistance rates for macrolides and tetracyclines exist and can vary depending on geographic location and prior antibiotic exposure.
Confirming Clearance and Addressing Persistence
After the antibiotic course is completed, a follow-up Test of Cure (TOC) is sometimes performed to confirm eradication. Retesting is strongly recommended if symptoms persist or if reinfection is suspected. Due to the nature of the molecular tests used, the TOC must be delayed for at least three weeks after the last dose of medication.
Retesting sooner can result in a false-positive reading by detecting the DNA of dead organisms. Persistence after treatment can be attributed to incomplete medication adherence, reinfection from an untreated partner, or the presence of an antibiotic-resistant strain. If persistence is confirmed, a healthcare provider will switch to an alternative antibiotic class.