Ureaplasma spp. are minuscule bacteria, representing some of the smallest free-living organisms known. The species Ureaplasma urealyticum and Ureaplasma parvum are commonly found in human respiratory and urogenital tracts. For many, these bacteria exist as harmless commensal organisms, and studies indicate 40-80% of sexually active women have Ureaplasma in their secretions while remaining healthy.
While they can live harmlessly in the body, an overgrowth can lead to an active infection. U. parvum is more common and often a benign colonizer, whereas U. urealyticum is less frequent but more often associated with clinical disease.
Symptoms and Transmission
Most individuals who carry Ureaplasma are asymptomatic. When the bacteria multiply and cause an active infection, the signs can differ between sexes. For men, a primary symptom is urethritis (inflammation of the urethra), which can manifest as a burning or painful sensation during urination, increased urinary frequency, or an unusual penile discharge. Some men may also experience a persistent ache in their genital area.
In women, symptoms can be more varied and may include an abnormal or watery vaginal discharge, lower abdominal discomfort, and pain during urination. These signs are often mistaken for other conditions like bacterial vaginosis or other STIs, making diagnosis based on symptoms alone difficult.
The primary mode of transmission for Ureaplasma in adults is through sexual contact. It can also be passed vertically from an infected mother to her baby during childbirth as the infant passes through the birth canal, which may affect the newborn’s respiratory system.
Associated Health Conditions
Untreated Ureaplasma infections can lead to complications if the bacteria ascend into the upper reproductive tract. In women, this can lead to cervicitis (inflammation of the cervix), endometritis (inflammation of the uterine lining), and Pelvic Inflammatory Disease (PID). PID is a serious infection of the female reproductive organs, including the uterus, fallopian tubes, and ovaries, and chronic inflammation can cause scarring that may contribute to infertility and increase the risk of an ectopic pregnancy.
During pregnancy, Ureaplasma is a concern because it is associated with adverse outcomes. The infection can lead to chorioamnionitis, an infection of the amniotic sac, which can trigger preterm labor and premature rupture of the membranes, increasing the likelihood of a baby being born too early. Vertical transmission to newborns can lead to neonatal pneumonia, meningitis, and bronchopulmonary dysplasia, a chronic lung disease.
The role of Ureaplasma in male infertility is still being researched, but some studies suggest a link. The infection is associated with prostatitis and epididymitis and could negatively impact sperm quality, count, and motility, potentially reducing fertility.
Diagnosis Process
Diagnosing a Ureaplasma infection requires specific laboratory tests because its symptoms mimic other conditions. The most reliable method is a Nucleic Acid Amplification Test (NAAT), such as a highly sensitive Polymerase Chain Reaction (PCR) test, which detects the bacteria’s genetic material.
To perform the test, a clinician collects a biological sample from the potentially infected area. Common samples include urine, a vaginal or cervical swab for women, or a urethral swab for men.
Testing for Ureaplasma is not part of routine STI screenings. A provider will order this test only when a patient has persistent symptoms, like unexplained urethritis or pelvic pain, or a history of complications like infertility or preterm birth.
Treatment and Management
A diagnosed pathogenic Ureaplasma infection is treated with antibiotics. The most commonly prescribed classes are tetracyclines and macrolides. Doxycycline is a frequent first-line treatment, while azithromycin is an effective alternative.
To prevent reinfection, it is important for all sexual partners to be treated simultaneously. Following a course of antibiotics, a follow-up test may be recommended to confirm the infection has been successfully eradicated.
A growing consideration is antibiotic resistance. If the bacteria do not respond to the initial treatment, a different antibiotic or a longer course of therapy may be necessary. This highlights the importance of completing the full prescribed course of medication.