Ureaplasma is a genus of tiny bacteria that frequently colonizes the genitourinary tract in both men and women. These microorganisms lack a cell wall, which distinguishes them from many other bacteria and affects how they respond to certain antibiotics. While Ureaplasma is often considered a commensal organism, meaning it lives in the body without causing harm, an overgrowth or shift in the microbial balance can lead to infection and symptoms.
Understanding Ureaplasma Transmission
These organisms are frequently present in the lower urogenital tract of healthy, sexually active adults, with colonization rates in women ranging from 40% to 80%. The primary route of transmission is through direct contact, specifically during sexual activity, including vaginal, oral, and possibly anal sex.
Transmission is not limited to sexual contact, as the bacteria can also be passed from a mother to her offspring. This is known as vertical transmission, occurring either in utero or during childbirth. The presence of the organism in the genital tract often does not signify an active infection, but rather a state of colonization, which is why testing asymptomatic individuals is not routinely recommended.
Signs and Manifestations in Adults
For many individuals, the presence of Ureaplasma bacteria results in no noticeable symptoms, a state known as asymptomatic carriage. When symptoms do manifest, they can often be mistaken for other common sexually transmitted infections (STIs) or urinary tract infections (UTIs). The symptoms typically result from inflammation in the urinary or reproductive tracts.
In men, the infection is a common cause of non-gonococcal urethritis (NGU), inflammation of the urethra. This condition presents with a painful or burning sensation during urination, medically termed dysuria, and often involves a clear or watery discharge from the tip of the penis. Men may also experience general discomfort or wetness at the urethral opening.
In women, a symptomatic infection can present with signs of cervicitis, which is inflammation of the cervix, or vaginitis. Common signs include an unusual or unpleasant vaginal discharge, which may have an abnormal odor. Women may also report experiencing dysuria, pelvic pain, or pain during sexual intercourse. Since symptoms are often vague or absent, the infection can go unnoticed, allowing it to progress to more serious conditions.
Potential Complications and Risks
If an active Ureaplasma infection remains untreated, it can lead to more serious health consequences affecting the reproductive system. In women, the bacteria are associated with an increased risk of developing Pelvic Inflammatory Disease (PID), which can cause long-term damage to the fallopian tubes, uterus, and ovaries. The inflammatory response caused by the bacteria can also be a factor in unexplained infertility for both sexes.
In men, an ascending infection can cause inflammation of the epididymis, known as epididymitis, or the prostate gland, known as prostatitis. Furthermore, Ureaplasma colonization in women has been linked to adverse pregnancy outcomes, including spontaneous abortion, stillbirth, and preterm birth. The presence of the organism can trigger an inflammatory process in the amniotic fluid, potentially leading to premature rupture of membranes and early delivery.
For newborns infected during birth, the risks are particularly serious, involving potential neonatal morbidities. These complications can include congenital pneumonia, meningitis, and the development of chronic lung conditions like bronchopulmonary dysplasia. While the bacteria are generally considered low-virulence, they pose a significant threat to the health and development of premature infants.
Testing and Management Approaches
Diagnosing a Ureaplasma infection often relies on molecular testing methods, as the bacteria are difficult to culture in a standard laboratory setting. The preferred diagnostic technique is the Nucleic Acid Amplification Test (NAAT), which detects the organism’s genetic material. Samples for NAAT are typically collected using a simple first-void urine sample or a swab from the urethra, cervix, or vagina.
Treatment for symptomatic Ureaplasma infection involves specific antibiotics. The standard courses of treatment commonly use drugs from the tetracycline class, such as doxycycline, or macrolide antibiotics, including azithromycin. A typical regimen involves doxycycline taken twice daily for a week, or a single, larger dose of azithromycin.
Since Ureaplasma is frequently transmitted through sexual contact, treating the patient’s sexual partners is necessary for successful management and to prevent reinfection. Clinicians may perform antibiotic susceptibility testing in cases of persistent symptoms following initial treatment to guide the selection of alternative therapies.