Ureaplasma and mycoplasma treatment

Ureaplasma and mycoplasma are not absolute pathogens and their presence in the test results does not require treatment, however this is not true in case you are planning pregnancy. This makes everything complicated and the doctor’s can not give a single answer whether the treatment is needed or not.

That’s why you need to discuss the issue of ureaplasma and mycoplasma treatment with your trusted treating physician.

Authors of this article will show the readers several opinions on this matter. It’s up to you to decide, which one to choose.

Our own opinion is that it is not right to attempt to cure the test results. You should not start taking antibiotics if nothing is bothering you, if there are no clinical manifestations and the smear test for flora is normal.

Ureaplasma and mycoplasma do not have clinical significance for obstetrics and gynaecology. They mostly act as agents of nonspecific urethritis in men rather than in women. In 30% and more cases ureaplasma and mycoplasma are representatives of the normal microflora of the reproductive tract. Identification of ureaplasma and mycoplasma by PCR testing is not considered to be a reason for targeted treatment even in presence of inflammation symptoms. It is reasonable to treat more frequent infection agents. Since they are usually chlamydiae and the drugs used to treat them also work for ureaplasma and mycoplasma, the question about treatment target is automatically resolved. Even if we consider that they have any significance, the treatment would anyway be the same as for other agents, so there is no sense in identifying ureaplasma and mycoplasma specifically.

There is no need for ureaplasma and mycoplasma diagnostics. You do not need to undergo any medical tests like blood for antibodies, inoculation (especially since determining antibiotic sensitivity is technically close to impossible)or PCR.

If you had the test anyway, do not pay attention to its results as they can not be considered as criteria for diagnosis or much less as indication for treatment.

Pregnancy planning and pregnancy itself are not reasons for having PCR diagnostics in general and PCR-testing for ureaplasma and mycoplasma in particular. Your tests will not be different from that of the non pregnant women: questions regarding your complaints and a smear test.

Doctors would treat something that bothers you, not your test results. If you have no complaints and the regular smear for flora shows normal number of the white blood cells you do not need any further testing or treatment. If you had the additional testing and the PCR results show something related to ureaplasma or mycoplasma, it still does not mean that you need any treatment. Besides the fact the ureaplasma and mycoplasma have no clinical significance, you also need to remember about the high frequency of false-positive results of the PCR testing. It might be considered unprofessional and non cost effective to prescribe this testing despite of absence of any complaints or, in case they are present, before or even instead of the smear test.

If the patient has complaints. but the smear test results from a reliable laboratory are good, there is no indication to start antibiotics treatment. Instead it is the reason to search for other reasons for complaints, such as dysbacteriosis, concomitant diseases, hormone imbalance, allergy and papillomatosis.

If there are complaints and signs of inflammation in the genitourinary system, an antibiotic therapy is prescribed based either on the results of additional tests (PCR and inoculation with the study of sensitivity) for various pathogens (chlamydia, gonorrhea, trichomonas, streptococcus, E. coli and so on), but not on urea- and mycoplasma, or “blindly” against the major agents of such diseases (gonococcs and chlamydie). Antichlamydial drug is prescribed obligatory in any case regardless of the test results, as this is the most frequent pathogen, and because it has no resistance to antichlamydial antibiotics (there is no such thing as the inoculation to evaluate the chlamydia sensitivity). All myco- and ureaplasma are sensitive to the antichlamydial drugs (exception – some types of ureaplasma are doxycycline resistant). That’s why even the pathogenicity and clinical significance of these organisms will be eventually proven, the adequate treatment of inflammatory conditions cures them without their identification anyway along with chlamydia. Therefore we may say it again – there is no reason in identifying the ureaplasma and mycoplasma. Contrary to what is being said now in many commercial medical centers, treatment in this case would not depend on the test results as there is only one scheme for it.

This scheme is very simple and cheap making the long and complex list of antibiotics given to the patient in case of positive PCR result for ureaplasma look unreasonable and sign of incompetency. Doxycycline is an old drug, but major agents of inflammatory illnesses in gynecology have retained sensitivity to it. However the course of treatment with doxycycline should last no less than 10 days. A single dose of Sumamed 1 g is equally effective against the major infection agents. For those who continues being afraid of ureaplasma this drug is the best choice as those ureaplasma which are resistant to doxycycline are sensitive to Sumamed. Scientific trials have proved the equivalence of the course treatment to the single dose of 1 g. Fast, simple and cheap.

It is hard to give an absolute answer regarding the clinical significance of genital ureaplasma, at least for now. The thing is, studies of their etiological role in various pathogenic conditions in female as well as in male urogenital systems have started just recently.

Even if there are some clinical manifestations of cervicytis and/or urethritis in women and men, it is not economically reasonable to perform testing for genital mycoplasma in the very beginning.. Even if gonococcs and chlamydia are not revealed by the available methods, it is necessary to treat them anyway. It is recommended to prescribe an antigonococcal drug (single administration of ceftriaxone or ciprofloxacin) in combination with antichlamydial (single administration of azithromycin or 7-days course of other medications). If the treatment is not effective, a repeat culture technique testing for gonorrhea and clamidiosis is needed. If gonococcs are confirmed a repeat treatment with the drug of another group will be assigned after evaluation of the infection sensitivity or in case it is impossible to evaluate. Chlamydia have not had any clinically significant resistance towards certain drugs (tetracyclines, erythromycin, azithromycin) determined so far.

Antichlamydial drugs in the same dosage are also effective against genital mycoplasma. . Tetracyclines work against both myco- and ureaplasma. Recently, however, was established that about 10% of ureaplasma are resistant to tetracyclines, so in case of noneffective treatment of urethritis with doxycycline it is necessary to prescribe erythromycin, azithromycin or ofloxacin.

Ureaplasma urealyticum species contain more than 14 serovars (subtypes of species that differ from each other by antigens) divided into 2 biovars (subtype of serovars). Previously they were titled biovar 1 or parvo and biovar 2 or Т960. Nowadays these biovars are considered to be 2 separate species: U.parvum and U.urealyticum respectively. They differ by their incidence. U.parvum is found in 81-90% and U.urealyticum in 7-30% of women, while sometimes they combine – in 3-6% of cases. U.urealyticum i.e. former biovar 2 (T960) prevails in women with inflammatory infection of pelvic organs and pregnancy complications and are often resistant to tetracyclines. Identification of these biovars is done for research and is not necessary or economically reasonable in everyday clinical practice.
Pregnant women should have tests for gonorrhea, genital chlamydia, trichomoniasis, bacterial vaginosis and receive antibacterial therapy if the results are positive. There are no reasons to perform targeted testing for genital mycoplasma and eradication of these microorganisms in pregnant women. Antibiotics should not be prescribed on a day-to-day basis for pregnancy prolongation to prevent premature termination except in case gonorrhea, chlamydia, trichomoniasis or bacterial vaginosis were identified.

What are ureaplasma and mycoplasma?

Ureaplasma and mycoplasma are small bacteria that live in the human oral pharynx, upper respiratory tract and urogenital system. Currently 17 species of mycoplasma parasiting in human beings are identified.
Four species of them might cause illnesses in humans. They are Mycoplasma, causing pneumonia (Mycoplasma pneumoniae), that lives in the oral pharynx and upper respiratory tract of a human being.

And three genital (sexual) mycoplasma types, living in the urogenital system:

• Human mycoplasma (Mycoplasma hominis);
• Ureaplasma (Ureaplasma species ), which is divided into 2 subspecies (Ureaplasma urealyticum and Ureaplasma parvum);
• Genital mycoplasma (Mycoplasma genitalium).

Recently pathogenicity (a health hazard) was identified in two more mycoplasma, found in humans. These are:

• Fermentative mycoplasma (Mycoplasma fermentans), found in the oral pharynx;
• Penetrative mycoplasma (Mycoplasma penetrans), inhabiting human urogenital system.

How frequent can mycoplasma be found in humans?

Ureaplasma (Ureaplasma sp.) is found in 40-80% of sexually active women, who have no health complaints. Frequency of ureaplasma identification in men is lower and is 15-20%. About 20% of newborns are infected with ureaplasma.

Human mycoplasma (Mycoplasma hominis) is found in 21-53% of sexually active women and in 2-5% of men.
About 5% of children older than 3 month and 10% of adults having no sexual life are infected with genital (sexual) mycoplasma.

How can I get mycoplasma?

There are only three ways to get genital mycoplasma (M. hominis,M. genitalium,Ureaplasma sp.,M.penetrans):

– during sexual intercourse ( including oral-genital contact );
– in case of infection transfer from a mother to a fetus through infected placenta or during childbirth;
– through transplantation of organs.

Respiratory mycoplasma (M.pneumoniae,М.fermentans) are transferred through droplet infection

You can not get genital mycoplasma from using swimming pools, toilets and bedsheets.

Which diseases can be caused by mycoplasma?

Mycoplasma are often found in healthy people. Reasons of why mycoplasma causes illnesses in some of these people are not yet fully known. Naturally, mycoplasma mostly causes illnesses in people with immunodeficiency secondary to HIV infection and with hypogammaglobulimenia (lowered number of certain antibodies), however mycoplasma can often cause illnesses in people with no immunodeficiency and normal levels of antibodies.

Genital mycoplasma can cause the following conditions

In men

Nongonococcal urethritis in men (inflammation of the urinary tube) is caused by ureaplasma (Ureaplasma sp) and genital mycoplasma (Mycoplasma genitalium).
Epididymitis (infammation of the epididimes) might be caused by the ureaplasma.
Worsening of the sperm quality, related to the ureaplasma affecting spermatozoon producing cells and parasitizing on the semen.

In women

Cervicitis (inflammation of the uterus neck) in women is caused by the genital mycoplasma (Mycoplasma genitalium)
Vaginosis (inflammation of vagina) – there are no proven facts that genital mycoplasma causes vaginosis, but ureaplasma and M.hominis are often found in women with bacterial vaginosis.

Inflammatory illnesses of pelvis in women – M.hominis is found in 10% of women with salpingitis, there are also reports on possible role of Ureaplasma sp. and M. genitalium in development of the pelvis inflammatory illnesses.
childbed fever and postabortal fever – approximately in 10% affected women M.hominis and (or) Ureaplasma sp. are found Pyelonephritis – in 5% of women with pyelonephritis the illness was caused by the M.hominis
Acute urethral syndrome (frequent and uncontrollable urination) in women is often related to the Ureaplasma sp.

In pregnant women

Risk of placenta infection which leads to premature termination of pregnancy, premature delivery or birth of babies with low weight.

In people of both genders

Sexually related reactive arthritis (joints disease) are caused by the М. fermentans, М. Hominis and Ureaplasma sp.
There is information on possible causal role of the М. Hominis and Ureaplasma sp. in development of subcutaneous abscesses and osteomyelitis.

Some studies show connection between the ureaplasma infection and development of the urinary stone disease.

In newborns

The most dangerous are diseases caused by the mycoplasma in newborns. A newly born child can get infected either through intrauterine infections during pregnancy or at birth.

Genital mycoplasma in newborns is related to the

• Acute pneumonia (lungs inflammation) in newborns.
• Chronic lung disease.
• bronchopulmonary dysplasia (malformation).
• bacteriaemia and sepsis (blood infection).
• meningitis ( inflammation of the brain tunics).

How are the illnesses related to the genital mycoplasma diagnosed?

If the present illness might be caused by the genital mycoplasma, a culture technique is used (bacteriological inoculation) and a PCR testing.

Evaluation of the presence and number of antibodies in blood is not used for diagnostics.

What is the way to treat illnesses related to the genital mycoplasma?

Various antibiotics are used for treatment of the illnesses related to the genital mycoplasma. The most frequently used are tetracycline (doxycycline), macrolides (erythromycin, clarytromycin), azalides (azithromycin), fluoroquinolones (ofloxacin, levofloxacin, moxifloxacin). It is necessary to know that different types of mycoplasma ave different sensitivity to various groups of antibiotics.

Efficacy of the immunomodulatory drugs, enzymes, vitamins, local and physiotherapy in treatment of diseases caused by the mycoplasma, was not proved and is not widely used.

How can I protect myself against the genital mycoplasma infection?

If you are not infected by the mycoplasma, you should use certain measures to prevent it. The most effective safety method is the use of condom.

I have had a PCR test which showed ureaplasma (mycoplasma), but I do not have any signs of the illness. Do I need to take treatment?

If your sexual partner does not have any signs of the illness, caused by mycoplasma, and you are not going to change him and(or) to get pregnant in the nearest future, the treatment will not be prescribed.

I am pregnant and is there are ureaplasma (nycoplasma) in my test results. Do I need to take treatment?

Multiple studies have shown that your placenta might get infected during pregnancy leading to the premature delivery and birth of children with low weight. It might also infect the fetus and cause pulmonary diseases and other complications in a new born chide. So many doctors would prescribe treatment in such case.

I was diagnosed with an illness related to the ureaplasma (mycoplasma), but my sexual partner has no signs of the illness and his tests do not contain the pathogens that I have. Does he need to have treatment?

No, he does not. Some doctors would recommend a repeat test of your sexual partner to be taken after some time (from 2 weeks to 1 month). During this period sexual contacts will be prohibited.

I have completed a course of treatment for condition related to the ureaplasma (mycoplasma) and the pathogen was not present in the control test results. However the condition symptoms returned after some time, the pathogen was again found in my test results. How can it be possible if I have not had any sexual contacts during this time?

Most often it might happen because the pathogen was not fully eradicated, but its amount was lowered so much that it was impossible to identify it with the contemporary diagnostic methods. The pathogen agents eventually multiplied and the condition has reappeared.

I have had a quantitative test for ureaplasma (mycoplasma) which showed them present in the amount (titer) less than 10 x 3. My treating physician says that I do not need any treatment as it is prescribed if the titer is more than 10 x 3. Is it true?

Necessity for treatment is not evaluated by the amount (titer) of the detected microorganisms, but by presence or absence of the condition caused by them.

If you have signs of the illness you should receive treatment.

In the following cases treatment would also be advised regardless of the number of titers in the quantitative test results and presence of illness symptoms.

If your sexual partner has any signs of the illness, caused by ureaplasma (mycoplasma), you are going to change him and(or) plan to get pregnant in the nearest future.