How Mycoplasma and Ureaplasma Are Sexually Transmitted Infections

Understanding Mycoplasma and Ureaplasma: The Hidden STIs

Mycoplasma and ureaplasma are among the most commonly overlooked sexually transmitted bacterial infections in the UK. These tiny organisms can cause persistent symptoms, yet they're frequently missed because they aren't included in standard STI screening panels. If you've experienced recurring urogenital symptoms despite negative test results, these infections could be the underlying cause.

What Are Mycoplasma and Ureaplasma?

Mycoplasma and ureaplasma are unique bacteria that lack a cell wall, making them the smallest free-living organisms known. This unusual structure makes them naturally resistant to many common antibiotics, including penicillin and other cell-wall-targeting medications.

Mycoplasma Genitalium

Mycoplasma genitalium infection was only discovered in 1980 and has since been recognised as a significant cause of urethritis in men and cervicitis in women. It's now considered one of the most important emerging STIs worldwide, with prevalence rates comparable to gonorrhoea in many populations.

Key facts about Mycoplasma genitalium:

• Estimated to affect 1-2% of the general population
• Causes approximately 15-20% of non-gonococcal urethritis cases in men
• Often asymptomatic but can cause persistent symptoms
• Increasingly antibiotic-resistant, making treatment challenging

Ureaplasma Species

Ureaplasma urealyticum and Ureaplasma parvum are closely related organisms commonly found in the urogenital tract. While they can be normal inhabitants in some individuals, they can also cause symptomatic infections, particularly when present in high numbers.

Ureaplasma characteristics:

• Found in 40-80% of sexually active women (often asymptomatically)
• Can cause urethritis, prostatitis, and epididymitis in men
• Associated with pregnancy complications
• Often co-exists with other urogenital infections

How Are These Infections Transmitted?

Both mycoplasma and ureaplasma are primarily transmitted through sexual contact:

Primary Transmission Routes

Sexual transmission:

• Vaginal intercourse (most common)
• Anal intercourse
• Oral sex (less common but possible)
• Genital-to-genital contact without penetration

Vertical transmission:

• Mother to baby during childbirth
• Concerns about STIs during pregnancy make testing particularly important for expectant mothers

Other factors affecting transmission:

• Longer duration of sexual contact increases risk
• Multiple sexual partners increase exposure
• Inconsistent condom use
• Previous STI history

Why These Infections Spread Easily

Several factors contribute to the efficient spread of mycoplasma and ureaplasma:

1. Asymptomatic carriage – Many infected individuals have no symptoms
2. Delayed diagnosis – Not included in routine screening
3. Treatment failures – Antibiotic resistance is increasing
4. Partner notification gaps – Partners may not be informed or treated

Symptoms in Men

Men with mycoplasma or ureaplasma infections may experience a range of urogenital symptoms. Understanding these can help identify when testing is needed.

Common Symptoms

Urethral discharge and burning urination are the hallmark symptoms in men:

• Urethral discharge – Often clear or whitish, sometimes purulent
• Dysuria – Burning or stinging sensation when urinating
• Urethral irritation – Itching or discomfort at the tip of the penis
• Urinary frequency – Needing to urinate more often than usual

Less Common Symptoms

• Testicular pain – May indicate epididymitis or orchitis
• Pelvic pain – Discomfort in the lower abdomen or groin
• Pain during ejaculation – Suggests prostatic involvement
• Joint pain – Reactive arthritis can occur in some cases

Asymptomatic Infection

Up to 50% of men with mycoplasma genitalium have no symptoms at all. This silent infection means:

• You can transmit the infection unknowingly
• Complications can develop without warning signs
• Regular testing is the only way to detect infection

Symptoms in Women

Women often experience different and sometimes more severe manifestations of these infections.

Common Symptoms

• Vaginal discharge – Abnormal in colour, consistency, or odour
• Dysuria – Pain or burning during urination
• Intermenstrual bleeding – Bleeding between periods
• Post-coital bleeding – Bleeding after sexual intercourse
• Pelvic pain – Lower abdominal discomfort

Cervicitis and PID Risk

Mycoplasma and ureaplasma can cause inflammation of the cervix (cervicitis) and may ascend to cause pelvic inflammatory disease risk. PID symptoms include:

• Persistent pelvic or lower abdominal pain
• Deep pain during sexual intercourse
• Fever and general unwellness
• Heavy or painful periods

Warning: Untreated PID can lead to:

• Chronic pelvic pain
• Tubal scarring and infertility
• Increased risk of ectopic pregnancy

Pregnancy Complications

Ureaplasma in particular has been associated with:

• Preterm labour and delivery
• Low birth weight
• Chorioamnionitis (infection of fetal membranes)
• Neonatal respiratory infections

Why These STIs Are Missed by Routine Screening

One of the most frustrating aspects of mycoplasma and ureaplasma infections is that they're frequently excluded from standard STI panels. Here's why:

Not Included in NHS Standard Screening

Most NHS sexual health clinics test for:

• Chlamydia
• Gonorrhoea
• HIV
• Syphilis

Mycoplasma and ureaplasma testing requires specialist techniques and isn't routinely offered unless:

• Symptoms persist after treating other STIs
• Specific risk factors are present
• The patient requests it

Testing Challenges

Technical requirements:

• Requires nucleic acid amplification testing (NAAT) or PCR
• Culture is difficult and time-consuming
• Specialised laboratory facilities needed

Interpretation difficulties:

• Ureaplasma can be a normal commensal organism
• Distinguishing colonisation from infection can be challenging
• Quantitative testing may be needed

When Testing Is Recommended

Consider mycoplasma and ureaplasma testing if you have:

• Persistent urethritis despite chlamydia/gonorrhoea treatment
• Recurrent cervicitis or vaginitis
• Chronic pelvic pain without clear cause
• Recurrent urinary symptoms with negative cultures
• A partner diagnosed with these infections
• Fertility concerns or recurrent pregnancy loss

Diagnosis and Testing

Accurate diagnosis requires specific testing methods that go beyond standard STI screens.

Testing Methods

Nucleic Acid Amplification Tests (NAAT/PCR):

• Most sensitive and specific method
• Detects bacterial DNA or RNA
• Results typically available within 1-3 days
• Can identify antibiotic resistance markers for M. genitalium

Sample types:

• First-void urine (men and women)
• Vaginal swabs (self-collected or clinician-taken)
• Urethral swabs
• Cervical swabs
• Rectal or pharyngeal swabs if indicated

Testing at Our Clinic

We offer comprehensive testing for mycoplasma and ureaplasma as part of our extended STI screening options. Our testing includes:

• High-sensitivity PCR testing
• Resistance testing for M. genitalium (where indicated)
• Rapid results with same-day appointments available
• Full clinical consultation included

Antibiotic Treatment

Treatment of mycoplasma and ureaplasma requires careful antibiotic selection due to resistance concerns.

Mycoplasma Genitalium Treatment

Antibiotic treatment for mycoplasma has become increasingly complex due to resistance:

First-line treatment:

• Doxycycline followed by azithromycin
• Single-dose azithromycin (if sensitivity confirmed)

Second-line treatment (for resistant strains):

• Moxifloxacin – highly effective but reserved for resistant cases
• Pristinamycin – available through specialist clinics

Important considerations:

• Resistance testing before treatment is now recommended where available
• Treatment failure rates with standard azithromycin exceed 50% in some populations
• Complete the full course as prescribed
• Avoid sexual contact until treatment is complete and verified

Ureaplasma Treatment

Ureaplasma is generally more treatable:

Recommended antibiotics:

• Doxycycline (100mg twice daily for 7-14 days)
• Azithromycin (if doxycycline isn't suitable)

Treatment duration:

• Typically 7-14 days depending on symptoms and clinical response
• Partner treatment is essential to prevent reinfection

Partner Treatment

Both partners must be treated simultaneously to prevent reinfection:

• Inform all recent sexual partners
• Partners should be tested and treated
• Avoid sexual contact until both have completed treatment
• Use barrier protection if resuming sex before treatment verification

Prevention Strategies

Preventing mycoplasma and ureaplasma infections requires a comprehensive approach to sexual health.

Barrier Methods

• Condoms – Significantly reduce but don't eliminate transmission risk
• Dental dams – For oral sex, particularly cunnilingus
• Consistent use – Protection is only effective when used every time

Regular Testing

• Test with each new sexual partner
• Annual screening for those with multiple partners
• Immediate testing if symptoms develop
• Consider comprehensive panels that include these organisms

Risk Reduction

• Limit number of sexual partners
• Open communication with partners about STI testing
• Avoid sexual contact when symptoms are present
• Complete all prescribed treatments fully

Healthy Genital Flora

• Avoid douching (disrupts natural balance)
• Wear breathable cotton underwear
• Practice good genital hygiene without harsh products
• Address any concurrent infections promptly

When to Seek Private Testing

Visiting a private sexual health clinic for testing may be beneficial in several situations:

Consider Private Testing If:

• You want testing for infections not covered by standard NHS panels
• You need rapid results for peace of mind
• You prefer a more discreet and convenient service
• NHS waiting times are lengthy in your area
• You want same-day appointments and faster turnaround
• You require extended opening hours (evenings or weekends)

What We Offer

Our comprehensive sexual health services include:

• Full STI screening including mycoplasma and ureaplasma
• Same-day appointments with no GP referral needed
• Confidential results within 1-3 days
• Clinical consultation with experienced specialists
• Treatment prescriptions included if needed
• Partner notification support

Key Takeaways

Understanding mycoplasma and ureaplasma is essential for comprehensive sexual health:

1. These are genuine STIs – Transmitted through sexual contact just like chlamydia and gonorrhoea
2. Often asymptomatic – Many carriers have no symptoms but can still transmit
3. Missed by routine screening – Standard panels don't typically test for these organisms
4. Can cause serious complications – PID, infertility, and pregnancy problems if untreated
5. Treatment is available – Antibiotics work, though resistance is a growing concern
6. Prevention is possible – Condoms, regular testing, and partner treatment are key

Take Action for Your Sexual Health

If you've had persistent symptoms, unexplained fertility issues, or simply want comprehensive peace of mind, testing for mycoplasma and ureaplasma is a sensible step. These infections are treatable when properly diagnosed – the challenge is ensuring they're looked for in the first place.

Book your confidential STI test today and get the complete picture of your sexual health.

*This article was reviewed by sexual health specialists and reflects current UK clinical guidance. For personalised medical advice, please consult a healthcare professional.*