Order Guide: Ureaplasma/Mycoplasma

What are Ureaplasma and Mycoplasma?
Ureaplasma and Mycoplasma Hominus are small organisms called Mollicutes that are a normal part of genital flora (the normal mix of organisms we find in the genital area). Between 20- 80% of women have Ureaplasma (depending on the study referenced) and 5-50% of women have Mycoplasma in their genital tract.  Sometimes they can cause urinary tract symptoms.  Colonization with Ureaplasma and Mycoplasma increases with the total number of sexual partners one has had over your lifetime. 
Should I get tested for ureaplasma and mycoplasma as part of routine screening?
Canadian guidelines DO NOT recommend routine screening for Mycoplasma and Ureaplasma.  We only recommend screening for these in the presence of persistent urethritis (burning when urinating) after negative testing for gonorrhea, chlamydia and trichomonas when a sexually transmitted cause of symptoms is suspected.
I have no symptoms.  Should I get tested for ureaplasma and mycoplasma?
Even if you tested positive for ureaplasma and mycoplasma, current guidelines do not recommend treatment unless you have symptoms or a partner with symptoms.  Given that the organism can be a part of an individual’s normal genital tract flora, there is no value in testing unless you have symptoms.  Symptom of urethritis includes pain with urinating, discharge from the urethra and vaginal discharge in women.  We recommend testing for other causes for these symptoms (more common STIs and more common causes of vaginal discharge like yeast and BV) before testing for ureaplasma and mycoplasma. 
What kind of testing is available for ureaplasma and mycoplasma (PCR vs. culture)?
Public Health Ontario Labs only do culture testing for ureaplasma and mycoplasma.  Culture testing can show Ureaplasma and  Large Colony Mycoplasma (Mycoplasma Homonis) but does not typically show Mycoplasma Genitalium as this is difficult to culture in lab settings.  See Order Guide: Mycoplasma Genitalium for further guidance. 
My partner tested positive for ureaplasma and mycoplasma.  Should I be treated?
Canadian guidelines suggest current partners should be treated to prevent re-infection.
Should I test for gonorrhea, chlamydia and trichomonas AND with ureaplasma and mycoplasma?
We recommend initially screening for gonorrhea, chlamydia and trichomonas in individuals who are experiencing symptoms.  If you are concerned about sexual exposure and are still experiencing symptoms it would be reasonable to screen for ureaplasma and mycoplasma. If you require medical advice before ordering these tests, we recommend speaking to a health care provider first.
What is the treatment for mycoplasma genitalium and ureaplasma? 
Treatment for symptomatic Mycoplasma is an antibiotic called Azithromycin (500mg on day 1 followed by 250mg on days 2-5).  If symptoms persist after azithromycin, we change our antibiotic to moxifloxacin 400mg once daily for 7 days.
Treatment for symptomatic Ureaplasma is doxycycline 100mg twice daily for 7 days.  
Do I need a test of cure?
Test of cure (ensuring the organism is gone by repeating a test) should be completed for Mycoplasma if you are still experiencing symptoms.  If you are not experiencing symptoms, repeat testing isn’t necessary.  Canadian guidelines recommend waiting at least 21 days before completing a repeat test. 
Do ureaplasma and mycoplasma cause infertility?
There is currently no established link between the presence of ureaplasma, mycoplasma and infertility. 
References 
​https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/mycoplasma-genitalium.html​
​https://pubmed.ncbi.nlm.nih.gov/24982440/

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