Genital Mycoplasma & Ureaplasma Urealyticum

Both men and women can develop serious urological and reproductive problems as a result of genital mycoplasma and ureaplasma bacteria. These parasitic bacteria are mollicutes, some of the smallest known organisms that can reproduce. Because they lack a cell wall, mollicutes are incredibly difficult to identify, culture, and treat. What are the signs of mycoplasma and ureaplasma infections and how can they be treated?

Symptoms & Testing

Mollicutes in the genital tract are common and usually harmless. At least 60% of women have been shown to harbor ureaplasma bacteria in their genital tract without showing any symptoms of infection. However, an increased population of these organisms has been linked to the following conditions:

• Chronic prostatitis in men
• Urgency/frequency syndromes in women
• Dysuria (painful urination)
• Up to 40% of all nongonococcal urethritis cases (urethritis not caused by gonorrhea)
• Infertility and pregnancy complications, such as preterm labor

Mycoplasma and ureaplasma bacteria have been isolated as the sole pathogen in symptomatic patients. Women — especially young, sexually active women — with urgency/frequency syndrome whose urine cultures have been repeatedly tested as negative, may benefit from culture and subsequent treatment for mycoplasma and ureaplasma. Culturing for this organism should also be considered in men with symptoms previously attributed to prostatitis or in men with prior history of exposure to sexually transmitted infections (STIs).

In the past, because of their complex nutritional requirements, isolating and culturing these organisms was challenging. Today, molecular testing has made it easier to test patients for this potential infection. Specimens are obtained from the cervix, vagina, urethra, semen, expressed prostatic secretions, or urine. In order to obtain a urine sample for this test, I usually recommend that patients avoid urinating for at least 3 hours prior to the appointment, and to submit the first 10 mL of urine. If cultures are positive, treatment is recommended with subsequent surveillance for improvements in symptoms. Sexual partners should be evaluated and treated as well as refrain from sexual activity for 2 weeks during treatment.

Treatment

Historically, mycoplasma was highly sensitive to tetracycline. Today, however, up to 30% of strains may be resistant to these antibiotics, which may explain persistent symptoms in those patients treated empirically for nongonococcal urethritis or presumed chlamydia infection. Most tetracycline-resistant strains remain sensitive to the following antibiotics:

• Doxycycline - 100 mg twice daily for 2 weeks
• Azithromycin - a single 1-g dose, which can be repeated after 10 to 14 days
• Erythromycin - 500 mg 4 times daily
• Ofloxacin - 300 mg twice daily for 10 to 14 days

While ureaplasma and mycoplasma can play a role in genitourinary symptoms, such as urological pelvic pain syndromes, it is of utmost importance that patients be clinically evaluated for many other confusable diagnoses. These include peripheral neuropathies, myofascial pain syndrome (pain in soft tissues or muscles), orthopedic issues, gastrointestinal pain, and central sensitization (widespread chronic pain). Identifying these other causes are especially important as the prevalence of multi-drug resistance has been gradually increasing, and many patients who test positive may be able to avoid unnecessary antibiotic therapies.

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^{Potts, J.M.; Sharma, Rakesh; et al. Association of ureaplasma urealyticum with abnormal reactive oxygen species levels and absence of leukocytospermia. J Urol 163: 1775-78. June 2000.}

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