Ureaplasma and Mycoplasma#

Ureaplasma species and Mycoplasma hominis are small bacteria in a group called Mollicutes. They lack a cell wall and are commonly found in the genital tract without causing disease.

Depending on the population and testing method, Ureaplasma species and Mycoplasma hominis can be detected in many people without symptoms. Carriage increases with sexual exposure, but detection alone does not prove that these organisms are causing an infection.

The key clinical point is that a positive result often reflects colonization rather than disease. For that reason, testing and treatment should be used cautiously.

A useful way to think about Ureaplasma and Mycoplasma hominis is that they're a bit like the harmless bacteria already living on your skin or in your gut - present in many healthy people without causing illness. A positive test tells you the organism is there - but not that it's causing a problem. This is what clinicians call colonization.

A helpful analogy: Group A Strep (the bacteria that causes strep throat). About 1 in 4 healthy school-aged children carry Group A Strep at any given time without being sick. We don't treat them just because a throat swab is positive - we treat them when they have symptoms that match strep throat. The presence of the bacteria alone is not a diagnosis.

The same principle applies to Ureaplasma and Mycoplasma hominis:

• A positive result alone is not a diagnosis - it's a finding.
• A negative result does not necessarily rule out the cause of your symptoms - many other things cause urethritis, cervicitis, or genital discomfort.
• This is why these organisms are intentionally excluded from routine STI panels and why we recommend testing only in specific situations.

Practical implications:

• Most people don't need testing for these organisms.
• Symptoms - and the exclusion of more established causes - drive testing decisions, not partner status, infertility concerns, or a desire for "complete STI screening."

No. Routine screening is not recommended. These organisms are commonly found in people without symptoms, and a positive result often does not explain the patient's symptoms or require treatment.

Testing is generally not recommended as part of routine STI screening and is usually not useful in asymptomatic patients.

Testing may be considered only in selected situations, such as:

• Persistent or recurrent urethritis in men after more established causes have been ruled out, including chlamydia, gonorrhea, Mycoplasma genitalium, and trichomoniasis where relevant.
• Ongoing symptoms where a clinician has already assessed for common STI and non-STI causes and still suspects a less common infectious cause.

Even in symptomatic patients, routine testing for Mycoplasma hominis, Ureaplasma parvum, or Ureaplasma urealyticum is controversial. International expert guidance emphasizes that broad testing can lead to overdiagnosis, anxiety, unnecessary antibiotics, and antimicrobial resistance.

Generally no - with one important exception. Even if you tested positive without symptoms, current guidelines do not generally recommend treatment. Because these organisms can be part of normal genital flora, testing in asymptomatic patients usually provides no clinical benefit and can lead to unnecessary antibiotic use.

Exception: partner-driven treatment to prevent ping-pong reinfection. If your sexual partner is symptomatic and has tested positive for Ureaplasma or Mycoplasma hominis, and you also test positive (even without your own symptoms), treatment may be offered to you to prevent the cycle where you re-infect your partner after their treatment ends. This is a partnership-level treatment goal, not a diagnosis of disease in you. See "Will TeleTest treat my partner if they test positive?" below for the full scenarios.

If you have symptoms such as burning with urination, urethral discharge, vaginal discharge, pelvic discomfort, or genital irritation, the first step is to test for more established causes, such as:

• chlamydia
• gonorrhea
• trichomoniasis, where relevant
• Mycoplasma genitalium, if symptoms are persistent or recurrent
• bacterial vaginosis or yeast, when vaginal symptoms are present
• non-infectious causes such as irritation, friction, dermatitis, or urinary tract causes

A positive Ureaplasma or Mycoplasma hominis result by itself often does not prove that these organisms are the cause.

In Ontario, Public Health Ontario offers urogenital and non-respiratory Ureaplasma/Mycoplasma culture for appropriate clinical indications. This type of culture can detect Ureaplasma species and large-colony Mycoplasma, mainly Mycoplasma hominis.

This culture does not detect Mycoplasma genitalium (Mgen). Mgen is difficult to culture and requires a separate molecular test, usually NAAT/PCR. Public Health Ontario notes that its page covers Ureaplasma/Mycoplasma culture at PHO and separate reference PCR testing for Mgen through the National Microbiology Laboratory in selected circumstances.

See Mycoplasma genitalium for the separate Mgen testing flow.

It depends on whether you have symptoms:

• If you also have symptoms of urethritis, cervicitis-type symptoms, vaginal discharge, pelvic discomfort, or urinary symptoms, request a consultation. The clinician will first consider more established causes, such as chlamydia, gonorrhea, trichomoniasis, Mgen, BV, yeast, urinary tract infection, and non-infectious irritation. Ureaplasma/Mycoplasma hominis testing is not usually a first-line test.
• If you have no symptoms, testing is reasonable to consider primarily to support your partner's treatment - if you also test positive, treating you helps prevent the "ping-pong" reinfection cycle (you re-infect your partner after their treatment ends). Testing in this context isn't usually about diagnosing disease in you (since colonization is common); it's about supporting partnership-level treatment for a symptomatic partner.
• If you develop new symptoms, request a consultation at that point.

The general rule for these organisms: clinical symptoms and the exclusion of more established causes drive testing decisions, not partner status alone.

Partner treatment for Ureaplasma and Mycoplasma hominis is not handled the same way as partner treatment for infections such as chlamydia, gonorrhea, or Mgen. The decision depends on whether the index patient (the first person diagnosed) has symptoms.

Scenario A: You are symptomatic, tested positive, and are being treated

• Your sexual partner can request their own TeleTest consultation to discuss whether testing is appropriate for them.
• If your partner also tests positive, we can prescribe treatment to them - even if they are asymptomatic - because not treating them creates a "ping-pong" cycle where you re-acquire the organism from your partner after your own treatment ends.
• The clinical goal is to prevent your reinfection, not to treat your partner's carriage on its own.
• Partners must complete their own TeleTest consultation - we do not offer expedited partner therapy (your partner cannot pick up a prescription written for you).

Scenario B: You are asymptomatic, with only a positive result

• Routine testing or treatment of your partner is not recommended in this case.
• Both partners with no symptoms simply represent normal carriage and do not need antibiotics.

Scenario C: Both partners have persistent symptoms with no clear cause

• The clinician may individualize the approach after more established causes have been ruled out.

• Sexual contact is one route of acquisition in adults, and carriage is associated with sexual exposure and number of partners.
• These organisms can also be found in people without symptoms, and detection does not necessarily mean a recent STI exposure.
• Vertical transmission from parent to baby can occur. It is mainly a concern in specific pregnancy, preterm birth, or neonatal contexts, rather than in routine adult STI screening.

Risk reduction:

• Condoms reduce transmission but - because these organisms are widely carried as normal flora - condoms don't "prevent" colonization in the same way they prevent gonorrhea or chlamydia. The clinical implication of any given carriage is usually limited.
• The most important thing isn't preventing carriage; it's recognizing and managing symptoms when they occur.

Treatment is not based on a positive result alone. Because Ureaplasma and Mycoplasma hominis commonly represent colonization, treatment is only considered when:

• symptoms are present;
• more established causes have been assessed and treated or ruled out; and
• the clinician believes the organism may be clinically relevant.

There is no single universally accepted treatment pathway for these organisms, and eradication does not always correlate with symptom resolution. The clinician will choose a regimen only if treatment is appropriate, considering symptoms, pregnancy status, allergies, drug interactions, prior antibiotic exposure, and the likelihood that the result represents colonization rather than disease.

Repeat testing is not routinely needed if symptoms have resolved.

If symptoms persist, the next step is not always simply repeating Ureaplasma/Mycoplasma testing. The clinician may reassess for other causes, including chlamydia, gonorrhea, Mgen, trichomoniasis, BV, yeast, urinary tract causes, dermatitis/irritation, pelvic pain syndromes, or post-infectious inflammation.

If repeat molecular testing is used after treatment, it is generally reasonable to wait at least 3 weeks after treatment completion to reduce the chance of misleading results from residual nucleic acid.

A positive Ureaplasma or Mycoplasma hominis result does not mean that infertility will occur, and routine testing or treatment to prevent infertility is not recommended.

The evidence is mixed and difficult to interpret because these organisms are common colonizers and are often found alongside other conditions, especially bacterial vaginosis or established STIs. International reviews have found no adequate evidence that Mycoplasma hominis, Ureaplasma parvum, or Ureaplasma urealyticum clearly cause cervicitis, PID, or infertility in women. For men, Ureaplasma urealyticum has been inconsistently associated with urethritis and infertility, but causation remains uncertain.