Ureaplasma urealyticum infection

Ureaplasma urealyticum is a bacteria which belongs within the Mycoplasma species which are a group of microorganisms that can involve the respiratory and genital tracts in man to produce clinical disease.  The respective organisms that affect each part of the body are listed below:  
• Respiratory:     Mycoplasma pneumoniae cause of atypical pneumonia
• Genital tract:    Mycoplasma fermantans
                             Mycoplasma primatum
                             Mycoplasma hominis
                             Mycoplasma genitalium
                             Ureaplasma urealyticum

The 2 major pathogens in the female genital tract are Ureaplasma urealyticum & Mycoplasma hominis which can be the cause of disease during pregnancy and in particular Ureaplasma urealyticum can be responsible for the following clinical problems: 
• Pregnancy: - spontaneous miscarriage
                        - stillbirths 
                        - postpartum infection
                        - chorioamnionitis 
                       - preterm labour & preterm rupture of membranes
                       - neonatal infection particularly in preterm infants
• Gynaecology: - vaginal discharge   
                           - infertility
                           - pelvic inflammatory disease & pelvic pain 

In the male Ureaplasma urealyticum infection can cause non-specific urethritis or male factor infertility with a poor semen analysis.  Most commonly however, the male is an asymptomatic carrier of Ureaplasma urealyticum and as such is able to pass the infection onto any of his sexual partners.  Once the Ureaplasma urealyticum has been passed onto the female partner, it may be present for many years wihin the lower genital tract without causing symptoms.  With time it does gain access to the upper genital tract where it can cause significant clinical problems.  The treatment of Ureaplasma urealyticum infection is with oral Doxycycline 100mg daily for 28 days with a similar course for the sexual partner.  There may be resistant strains of Ureaplasma urealyticum so that a repeat swab should be taken 3 months later to ensure eradication of the infection.  In pregnancy the preferred antibiotic is Erythromycin 250mg 3 times daily which is often taken for the duration of the pregnancy as the microorganism if difficult to eradicate while pregnant.

The Mycoplasma organisms are a form of bacteria but lack a cell wall and therefore require stringent conditions for survival usually as intracellular pathogens within the body.  Ureaplasma urealyticum and Mycoplasma hominis therefore can only be acquired as sexually transmitted infections.

Gardnerella vaginalis is another microorganism that can involve the lower genital tract to cause an offensive vaginal discharge.  The diagnosis can be suspected on presentation on the history of a fishy amine odour which occurs after intercourse and is confirmed by microscopy and culture of a vaginal swab.  Gardnerella vaginalis may occur in association with other microrganisms such as Ureaplasma urealyticum as both are sexually acquired infections.  Treatment of Gardnerella vaginalis is with Metronidazole 400mg 3 times daily for 14 days with the partner also being treated to prevent recurrence.