Ureaplasma Infection: Symptoms, Causes, Treatments and Prevention

What Is Ureaplasma?

Ureaplasma is a group of very small bacteria that naturally live in the urinary and genital tracts. They belong to the Mycoplasma family, which are some of the smallest organisms capable of reproducing on their own. A unique feature of ureaplasma is that it does not have a cell wall. This difference not only makes it distinct from many other bacteria but also affects how it responds to treatment.

In most cases, ureaplasma lives harmlessly in the body without causing problems. Many sexually active adults carry it at some point in their lives without ever knowing. However, if the immune system is weakened or the bacteria multiply excessively, they can cause infections, inflammation, and related symptoms.

People often ask, “Is ureaplasma an STD?” While it can be passed through sexual contact, it is not usually classified as a typical sexually transmitted disease like chlamydia or gonorrhea. This is because many healthy people carry it without symptoms, and it does not always lead to illness. For this reason, it is often described as an opportunistic bacterium that may cause problems under certain conditions.

How Common Is Ureaplasma Infection?

Ureaplasma is very common worldwide. Studies suggest that a large percentage of people carry it, often without knowing. Women tend to be colonized more often than men, with research showing that 40% to 80% of sexually active women may carry ureaplasma. In men, the rate can reach 50% or more. The exact numbers may vary depending on age, sexual activity, and geographic region.

How Is Ureaplasma Transmitted?

The most common way ureaplasma spreads is through sexual contact, including genital-to-genital contact. Because of this, it is frequently found among sexually active adults. It can also be passed from a pregnant person to their baby during childbirth, which makes it important in prenatal care. Still, carrying the bacteria does not always mean a person will develop symptoms or health problems.

Ureaplasma Symptoms

Most people with ureaplasma never develop symptoms because their immune system keeps the bacteria in check. When an overgrowth does occur, it can lead to infection and inflammation. The signs can differ between men and women and are often similar to those of other conditions, making proper testing important.

Symptoms of Ureaplasma in Females

In women, an overgrowth of ureaplasma is sometimes linked to bacterial vaginosis (BV) or other vaginal infections. Research shows that ureaplasma can increase vaginal pH, making it less acidic. This imbalance allows harmful bacteria to grow more easily.

Possible symptoms in women include:

• Thin, grayish-white vaginal discharge
• A strong, fish-like odor, often more noticeable after sex
• Burning or stinging during urination
• Itching or irritation around the vagina

In more serious cases, ureaplasma has been linked to conditions like pelvic inflammatory disease (PID) and chronic endometritis, both of which can affect fertility if left untreated.

Ureaplasma in Men

In men, ureaplasma overgrowth often causes inflammation of the urethra, a condition known as urethritis. Because it is not caused by gonorrhea, it is usually referred to as nonspecific urethritis.

Common symptoms in men may include:

• Clear or cloudy discharge from the penis
• A burning or stinging sensation during urination
• Itching or irritation inside the penis

Some studies also suggest a possible link between Ureaplasma urealyticum and reduced sperm quality. This may include a lower sperm count and decreased sperm motility (movement), which could affect fertility in some men.

Potential Complications of Ureaplasma

Most people who carry ureaplasma never experience health problems. However, when the bacteria multiply excessively, they have been linked to certain complications, particularly those involving reproductive health and pregnancy. It is important to note that these are potential risks, and research is ongoing to better understand the exact role of ureaplasma in these conditions.

Ureaplasma and Fertility Concerns

One of the most discussed concerns about ureaplasma is its possible effect on fertility. If the bacteria move from the lower genital tract into the uterus, fallopian tubes, or ovaries, they may cause inflammation. This inflammation has the potential to create scarring or blockages that interfere with fertilization or the movement of an egg to the uterus.

Some researchers have linked ureaplasma to tubal factor infertility, a condition in which blockages in the fallopian tubes prevent sperm and egg from meeting. Studies on this topic have shown mixed results. A few suggest an association between Ureaplasma urealyticum in the upper genital tract and infertility, while others find no clear link. There is also interest in whether Ureaplasma parvum might play a greater role in these cases. At this time, the connection between ureaplasma and infertility remains under investigation and has not been fully proven.

Other Related Conditions

Researchers are also exploring possible links between ureaplasma and other inflammatory conditions:

• Prostatitis: This is an inflammation of the prostate gland in men. Some studies have suggested a potential association between ureaplasma and prostate inflammation or calcification, which can cause symptoms like painful urination, pelvic pain, and urinary urgency. However, other studies have not found a clear causal link, indicating that more research is needed.
• Endometriosis: This is a condition where tissue similar to the uterine lining grows outside the uterus, causing pain and heavy periods. Early laboratory studies in animals have suggested that a ureaplasma infection might increase inflammation in a way that could promote the development of endometriosis. This potential link in humans is still being investigated and is far from proven.

Ureaplasma During Pregnancy and in Newborns

The presence of ureaplasma bacteria is very common during pregnancy. However, in some cases, an overgrowth or infection has been associated with certain pregnancy complications and health issues for newborns. It is crucial to understand that while associations exist, many people with ureaplasma have completely healthy pregnancies and babies.

Risks During Pregnancy

An active ureaplasma infection during pregnancy has been linked to several concerns, including:

• Premature Rupture of Membranes (PROM): This is when the amniotic sac breaks before labor begins. Studies have found a higher presence of ureaplasma in individuals who experience PROM.
• Preterm Birth: Because infections and inflammation can trigger early labor, ureaplasma is considered a potential risk factor for delivering a baby before 37 weeks of pregnancy.
• Chorioamnionitis: This is a bacterial infection of the membranes around the fetus and the amniotic fluid. In some studies, ureaplasma was the most commonly identified bacteria in cases of this serious infection.
• Pregnancy Loss: Some research has found certain ureaplasma species, particularly Ureaplasma parvum, to be more prevalent in placental tissue after a pregnancy loss. Treatable genital tract infections are a known cause of a percentage of pregnancy losses.

Risks for Newborns

Newborns, especially those born prematurely, have developing immune systems that are more vulnerable to infection. If a baby is exposed to high levels of ureaplasma during birth, it can potentially lead to infections. These can range from respiratory issues like pneumonia to more serious systemic infections like meningitis or sepsis. Additionally, chronic inflammation from a ureaplasma infection has been linked to bronchopulmonary dysplasia, a lung development disorder common in preterm infants.

Diagnosing a Ureaplasma Infection

If you are experiencing symptoms that suggest a ureaplasma infection, a healthcare provider can order specific tests to check for its presence. Diagnosis can be challenging because ureaplasma is too small to be seen with a standard microscope and can be difficult to grow in a laboratory culture. For this reason, doctors usually rely on advanced molecular tests.

The most accurate method is a Nucleic Acid Amplification test (NAAT), often performed as a PCR test. This test detects the unique genetic material (DNA) of the bacteria and is highly sensitive, making it effective for identifying ureaplasma infections.

To perform the test, a healthcare professional will collect a sample depending on your symptoms and situation:

• For women: A swab may be taken from the vagina, cervix, or uterine lining (endometrium).
• For men: A urethral swab or a first-catch urine sample (the first part of the urine stream) is usually collected.
• For newborns: If a systemic infection is suspected, samples may include amniotic fluid, cerebrospinal fluid, or respiratory secretions.

In many cases, this test can also distinguish between the two most common species, Ureaplasma urealyticum and Ureaplasma parvum, often grouped together as Ureaplasma spp. The results help your doctor decide the most appropriate treatment plan for your condition.

Ureaplasma Treatment Options

If a ureaplasma infection is causing symptoms or complications, the primary treatment is a course of antibiotics. The goal of ureaplasma treatment is to eliminate the bacterial overgrowth, resolve inflammation, and alleviate symptoms. It is crucial to complete the entire prescribed course of medication, even if you start to feel better sooner.

Because ureaplasma bacteria lack a cell wall, common antibiotics like penicillin that target cell walls are ineffective. Instead, doctors prescribe antibiotics that work by inhibiting protein synthesis inside the bacterial cells.

Commonly used antibiotics for ureaplasma species treatment include:

• Azithromycin: A type of macrolide antibiotic often used as a first-line treatment.
• Doxycycline: A tetracycline antibiotic that is also very effective.
• Erythromycin or Clarithromycin: Other macrolide options.
• Certain Fluoroquinolones: May be used in cases where other antibiotics are not suitable or if there is resistance.

The choice of antibiotic, especially for Ureaplasma urealyticum treatment, depends on several factors, including the severity of the infection, whether the patient is pregnant, and local patterns of antibiotic resistance. In some cases, a follow-up test may be recommended to ensure the infection has cleared.

Partner Treatment: A Key to Prevention

A critical question many patients ask is, “If I have ureaplasma, does my partner need treatment?” The answer is generally yes. Because ureaplasma can be passed back and forth through sexual contact, treating only one partner often leads to reinfection. To successfully cure ureaplasma and prevent a cycle of recurrence, both sexual partners should be treated simultaneously, even if one is not showing any symptoms.

Preventing Ureaplasma Infection

Since ureaplasma is so common and often asymptomatic, completely preventing colonization can be challenging. However, you can take steps to reduce your risk of acquiring an overgrowth that leads to a symptomatic infection and to prevent passing it to others.

The strategies for preventing ureaplasma transmission are the same as those for preventing most sexually transmitted infections (STIs):

• Use Barrier Protection: Consistently and correctly using condoms during vaginal, anal, and oral sex can significantly reduce the risk of transmission.
• Practice Good Hygiene with Sex Toys: Clean sex toys thoroughly before and after every use, and consider using a condom on toys shared between partners.
• Get Regular STI Screenings: Open communication with your healthcare provider and getting tested as part of your regular health check-ups can help identify infections early.

Additionally, supporting your body’s natural defenses is important. The genital area has a delicate balance of bacteria and pH levels. To maintain a healthy environment:

• Gently wash the external genital area with warm water only; avoid using harsh soaps, douches, sprays, or scented products internally.
• Wear breathable, cotton underwear and avoid tight-fitting clothing for extended periods.
• Change out of wet clothing, like swimsuits or workout gear, as soon as possible.

Outlook and When to See a Doctor

The outlook for a ureaplasma infection is generally very good. With appropriate antibiotic treatment, most infections clear up completely without any long-term consequences. If the infection has contributed to other conditions like urethritis or BV, treating the ureaplasma will help resolve those issues as well.

You should speak with a doctor or healthcare provider if you experience any persistent symptoms, such as:

• Unusual discharge
• Pain or burning during urination
• Pelvic pain or discomfort
• Any other unexplained genital symptoms

It is especially important to seek prompt medical attention if you are pregnant, trying to conceive, or have a compromised immune system, as early diagnosis and treatment can help prevent potential complications.

Conclusion

Ureaplasma is a common bacterium that often lives in the body without causing harm. For many people, it is simply part of the normal microbial balance. However, when it grows excessively, it can trigger symptoms such as urethritis, bacterial vaginosis, or even contribute to fertility and pregnancy complications. Recognizing the symptoms, getting tested, and completing the prescribed antibiotic treatment for both partners are essential steps for proper management. Practicing safe sex and maintaining good genital health can also help reduce the risk of problems related to ureaplasma.

Frequently Asked Questions About Ureaplasma

Is ureaplasma an STD?

Ureaplasma is not typically classified as a standard sexually transmitted disease like chlamydia or gonorrhea. While it is often passed through sexual contact, it is also found in many healthy individuals without symptoms. Because of its high prevalence and tendency to cause illness only under certain conditions, it is usually considered an opportunistic bacterium rather than a classic STD.

What are the most common symptoms of ureaplasma in females?

Many women experience no symptoms at all. When ureaplasma overgrowth does occur, symptoms are often similar to bacterial vaginosis (BV). These may include:

• Thin, grayish-white vaginal discharge
• A strong fish-like odor, especially after sex
• Burning during urination
• Itching or irritation around the vagina

How is ureaplasma different from mycoplasma?

Both ureaplasma and mycoplasma are bacteria without cell walls, belonging to the same family. The main difference is that ureaplasma can break down urea for energy, while mycoplasma relies on other nutrients. Despite this difference, both can cause similar infections and are often tested for and treated in similar ways.

How do you test for ureaplasma?

Testing is usually done with a Nucleic Acid Amplification test (NAAT), such as PCR. Samples may include a vaginal or cervical swab for women, a urethral swab or urine sample for men, or other fluids if an infection is suspected in a newborn.

If I have ureaplasma, does my partner need to be treated?

Yes. It is strongly recommended that all sexual partners receive treatment at the same time, even if they have no symptoms. This prevents reinfection, which can occur if one partner is treated and the other is not.

Can ureaplasma cause infertility?

The relationship between ureaplasma and infertility is not fully understood. In some cases, if ureaplasma causes inflammation or damage in the reproductive tract, it may contribute to fertility issues. However, many people with ureaplasma do not experience infertility, and further research is needed to clarify the connection.

What is the difference between Ureaplasma urealyticum and Ureaplasma parvum?

These are the two most common species of ureaplasma found in humans. Ureaplasma urealyticum has been linked more often to urethritis in men, while Ureaplasma parvum may be more widespread. Despite some differences, testing and treatment are the same for both species.

Can ureaplasma go away on its own?

In some cases, the immune system can keep ureaplasma under control or resolve mild overgrowths. However, if symptoms are present or an infection is diagnosed, treatment is important. Leaving it untreated may lead to complications and increase the risk of passing it to partners.

Is ureaplasma a serious infection?

For most healthy adults, ureaplasma is not considered a serious infection and responds well to antibiotics. However, if untreated, it may lead to complications like pelvic inflammatory disease. Extra care is needed during pregnancy, as it has been associated with risks such as preterm birth and infections in newborns.