Ureaplasma urealyticum/parvum

Ureaplasma has a unique position of being a commensal infection in most people, meaning it can exist in healthy people, producing no symptoms and require no treatment. It can also behave as a sexually transmitted infection, as well as an opportunistic infection in others. 

Ureaplasma was first discovered in 1954 whilst our understanding of these infections has slowly evolved over the years, it is not yet a well-understood infection. It belongs to the Mycoplasma family, and has some features in common with Mycoplasma genitalium, as well as Mycoplasma hominis.

Like other bacteria, Ureaplasmas produce signature antibodies in the host they infect. 14 different ureaplasma types have been identified in the humans based on their antibody response. These 14 serotypes of Ureaplasmas have been placed into 2 different species namely Ureaplasma parvum (serotypes 1, 3, 6 and 14) and Ureaplasma Urealyticum (remaining 10 serotypes).

Clarifications

What is Ureaplasma?

Ureaplasma has a unique position of being a commensal infection in most people, meaning it can exist in healthy people, producing no symptoms and require no treatment. It can also behave as a sexually transmitted infection, as well as an opportunistic infection in others. 

Ureaplasma was first discovered in 1954 whilst our understanding of these infections has slowly evolved over the years, it is not yet a well-understood infection. It belongs to the Mycoplasma family, and has some features in common with Mycoplasma genitalium, as well as Mycoplasma hominis.

Like other bacteria, Ureaplasmas produce signature antibodies in the host they infect. 14 different ureaplasma types have been identified in the humans based on their antibody response. These 14 serotypes of Ureaplasmas have been placed into 2 different species namely Ureaplasma parvum (serotypes 1, 3, 6 and 14) and Ureaplasma Urealyticum (remaining 10 serotypes).

    What is the difference between Ureaplasma urealyticum and Ureaplasma parvum?

    These are 2 common species of Ureaplasma infections found in humans. They behave in a very similar fashion clinically but can be distinguished from each other by genetic tests and other laboratory characteristics.

    Of the 2 species of Ureaplasma, Ureaplasma urealyticum is more likely to be sexually transmitted and more likely to produce symptoms compared to Ureaplasma parvum.

    How common is Ureaplasma?

    There is no published study of any significance to inform us about the true prevalence of Ureaplasma infections in the UK, either in the general population or in patients attending sexual health clinics. This is because molecular diagnostic methods have only become available in the last few years, and the access to these sophisticated tests is very limited in most countries due to advanced technology, as well as cost.

    Ureaplasmas have been tested and managed in Eastern European countries for much longer, which has contributed to our understanding of this complex infection.

    Is Ureaplasma a STI or not?

    Ureaplasma is present in the mouth and genitals of many healthy men and women, causing no  symptoms and requiring no treatment. Such harmless infections in the body are called commensals.

    However, Ureaplasma can also be sexually transmitted by unprotected oral or vaginal sex, and produce symptoms in men including urethritis and occasionally epididymitis. In women, Ureaplasma is associated with conditions such as Bacterial Vaginosis, Cervicitis, Pelvic Inflammatory Disease and infertility.

    Ureaplasma urealyticum is more likely to be an STI, and associated with Bacterial Vaginosis,  whilst Ureaplasma parvum is more likely to be a commensal.

    How do I know if the Ureaplasma I have got is ‘commensal’ or a ‘STI’?

    It is not always easy or possible to work out if the Ureaplasma you have is commensal or an STI. Establishing the cause of the infection as a STI can be difficult, as it is retrospective, and prone to errors.

    It is often narrowed down by assessing factors such as a previous negative test results, a history of unprotected sexual contact, subsequent development of symptoms, and a resolution of symptoms after a course of antibiotics.

    What should I do if I think I have Ureaplasma infection?

    It is not always easy or possible to work out if the Ureaplasma you have is commensal or an STI. Establishing the cause of the infection as a STI can be difficult, as it is retrospective, and prone to errors.

    It is often narrowed down by assessing factors such as a previous negative test results, a history of unprotected sexual contact, subsequent development of symptoms, and a resolution of symptoms after a course of antibiotics.

    Ureaplasma Symptoms

    What are the symptoms of Ureaplasma in men?

    • Pain on passing urine
    • Wetness at the penile tip
    • Unusual or foul smelling discharge
    • Urethral discomfort
    • Irritation in the water pipe

    What are the symptoms of Ureaplasma in women?

    • Abnormal vaginal discharge
    • Foul smelling vaginal discharge

    Could the symptoms of Ureaplasma also be that of another STI and/or infection?

    Yes. Symptoms such as pain on passing urine and unusual discharge can also be symptoms of other STIs including Chlamydia, Gonorrhoea and Mycoplasma.

    It is extremely important to get tested regularly, especially if you are showing symptoms or if you are concerned about your sexual health.

    Can I have Ureaplasma without knowing it?

    Yes. There are often no symptoms from Ureaplasma when they are living in balance with the body. This means that even if you have the infection, it doesn’t necessarily mean it’s bad for you.

    Ureaplasma Complications

    What are the complications of Ureaplasma in men?

    Urethritis in men.

    Urinary calculi (Kidney stones): Ureaplasma may play a role in the formation of kidney stones in some people. Kidney stones can cause severe pain in the pelvic area, lower back, abdomen, fever, problems urinating, and cloudy, bloody, or foul-smelling urine.

    Those with a healthy immune system do not get any symptoms outside of genitalia. Only people with an antibody deficiency (a rare condition affecting the immune system) can develop serious infections of the lungs, joints and bones as a result of the ureaplasma infection.

    What are the complications of Ureaplasma in women?

    Bacterial Vaginosis, Cervicitis and Pelvic Inflammatory Disease in women.

    Those with a healthy immune system do not get any symptoms outside of genitalia. Only people with an antibody deficiency (a rare condition affecting the immune system) can develop serious infections of the lungs, joints and bones as a result of the ureaplasma infection. 

    There is some evidence to suggest that Ureaplasma can produce premature birth, but studies are very limited.

    If you are experiencing symptoms of Ureaplasma, we would recommend getting tested and begin treatment without delay.

    Ureaplasma Causes

    How do I get a Ureaplasma infection?

    • Unprotected vaginal or oral sex
    • Mother to the foetus in the womb
    • Mother to the newborn at the time of childbirth

    Whilst there is no evidence, Ureaplasma may be transmitted via unprotected anal sex.

    In many patients, the presence of Ureaplasma is long standing and harmless, especially in the mouth, genitalia and respiratory tract.

    What can increase my chances of getting a Ureaplasma infection?

    • Multiple sexual partners
    • Unprotected sexual contact

    How can I prevent getting Ureaplasma?

    There is no vaccine available for Ureaplasma currently, but transmission can be sometimes avoided by the following measures:

    • Have protected vaginal, oral and anal sex
    • Use a condom, femidom and/or dental dam with a new partner
    • Only use sex toys that you know are clean
    • You and your new partner get tested before having sex
    • Recommend your partner to get tested if they’ve had another partner recently
    • Abstain from sex with your partner if they were treated for Ureaplasma less than 7 days ago.

    Ureaplasma Testing

    Detects Ureaplasma urealyticum and Ureaplasma parvum by PCR

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    Window Period

    14 days after exposure

    Sample required for men

    For men: urine sample (please don’t urinate 1-2 hours before your appointment)

    For women: (self-taken) high vaginal swab

    Time for test results

    Within 4 working days 

    Cost of test

    £130 (or £80 if taken with another test)

    Do I need a Ureaplasma test?

    We do not recommend routine testing of Ureaplasma species in healthy individuals.

    The testing for ureaplasma may be considered in the following conditions:

    1. As part of NSU work-up where all other test results are negative.
    2. As part of Cervicitis and PID work-up in the women where all other tests are negative.
    3. As part of investigation for recurrent bacterial vaginosis (BV) as this infection can be isolated from 60-95% of patients with BV.
    4. As part of a comprehensive STI screen where you want to know your ureaplasma status as a baseline.
    5. When your partner has tested positive.

    When should I take this test?

    We recommend taking this test 14 days after sexual contact if you are not experiencing symptoms. If you are experiencing symptoms, please speak to a sexual health professional to discuss appropriate timing of the test.

    What do the results mean?

    The results will be either NOT Detected (i.e. negative) or DETECTED (i.e. positive).

    In some cases, the test may come back EQUIVOCAL which means that a conclusive result was unavailable from the sample given. If this happens, we will ask for another sample to run the test again (at our own cost).

    Do I have to tell my partner, if I test positive for Ureaplasma?

    We will give you all the necessary support in conveying your diagnosis to your partner and get them tested. We will discuss the risk of passing on the infection and any tests and/or treatment they may need.

    Ureaplasma Treatment

    Method of treatment

    Oral antibiotics

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    Length of Treatment:

    7 days

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    Further actions:

    Varies from person – this will be discussed with your clinician, depending on your medical/sexual history and test results.

    Cost of treatment

    £30 (or £80 if not tested with us)

    Can Ureaplasma be treated?

    Yes, Ureaplasma can be treated.

    However, treatment may not always be necessary in those who do not have any symptoms. This is particularly so in the cases where the Ureaplasma bacteria is existing harmlessly in the body (i.e. is a commensal organism).

    What is the treatment for Ureaplasma?

    The treatment involves a course of oral antibiotics. The choice and duration of antibiotics depends on your symptoms, signs and the outcome of the antibiotics you may have already had.

    How long does it take for treatment to work?

    Most patients will begin to notice improvement in a few days after starting the course of antibiotics, and should have complete resolution of their symptoms by the time they have finished the course.

    However, some may not experience much improvement even after completing the course of antibiotics. This may suggest that the symptoms are not due to Ureaplasma and further investigations may be required.

    How effective is the treatment for Ureaplasma?

    Treatment of Ureaplasma infection is complex as the success rate of treatment can vary from 40% and 100%. This is because Ureaplasma doesn’t have a cell wall which is what common antibiotics attack to resolve the infection.

    What would cause my treatment for Ureaplasma to fail?

    • If your symptoms are not due to Ureaplasma (even if your Ureaplasma test was positive)
    • if you have got infection with a resistant type of Ureaplasma
    • if you develop antibiotic resistance while taking the antibiotics
    • if you are not able to take the antibiotics as prescribed (you miss one or more tablets)
    • if you vomit or have a loose motion soon after taking the antibiotics (this can reduce the level of antibiotics in your blood and tissues to ineffective levels) 
    • if you have sexual contact with your infected partner before their infection has been properly treated

    Are there any side effects?

    Antibiotics used to treat Ureaplasma are very safe but can give side effects in many patients. The nature of side effects you may experience will depend on the antibiotics chosen to treat you. Fortunately side effects are mild in most cases, allowing you to get on with your normal life. Side effects improve soon after finishing the course of antibiotics.

    How long do I have to wait before having sex again?

    Ideally you should avoid any sexual contact for the duration of course of antibiotics, or for 7 days in cases of single dose treatment.

    Do I have to get re-tested?

    Whilst a test of cure (TOC) can be done 5 weeks after starting the course of antibiotics, it is not routinely recommended.

    A persistent positive Ureaplasma test result at the time of TOC should not be a matter of concern especially if there are no symptoms. Such a situation suggests that Ureaplasma infection in the person is more like a commensal than a cause of a disease.

    What happens if I don’t get treated?

    Ureaplasma is believed to be a harmless chronic infection, without causing any immediate or major long term health issues. So not having a treatment, and receiving a course of antibiotics if symptoms do develop is a reasonable option.

    In some cases, the infection may resolve by itself in due course without requiring any treatment.

    Page reviewed by Dr. Manoj Malu (Clinical Director)

    Last reviewed date: 13 July 2020
    Next review due: 13 July 2023

    Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.

    References & Further Reading

    If you think you may have Ureaplasma

    It is important to refer to a healthcare provider as soon as possible. Our experience combined with timely detection can help put you on the right track without delay and avoid complications in the future.

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