Ureaplasma + Mycoplasma: Treatment Failure, Antibiotic Resistance and the Limitations of the CDC STI 2021 Guidelines 

by Dr. Alex Shteynshlyuger

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Ureaplasma & Mycoplasma: What You Need to Know 

Ureaplasmas are a type of mycoplasma. Mycoplasma and ureaplasma are closely related organisms. There are a number of mycoplasma and ureaplasma strains that commonly cause symptoms in men and women.  Mostly, they are believed to be transmitted through sexual activity. 

Common causes of urinary problems (burning, pain, frequent urination, urgency), pelvic pain, vaginal pain, and burning (vaginitis, cervicitis), urethritis in men and women, and probably epididymitis and prostatitis in men. They might also cause rectal and anal pain, burning, and itching (proctitis).

  • Mycoplasma genitalium (M. genitalium)
  • Ureaplasma urealyticum (U. urealyticum)

Other types of mycoplasma and ureaplasma may also cause similar symptoms.

It is difficult to ascertain but it appears that ureaplasma and mycoplasma also affect fertility and may cause infertility in men (decreased sperm quality) and women.  They possibly cause premature labor in women.

What is the Problem with 2021 CDC Guidelines on Mycoplasma Genitalium

First of all, CDC falsely states that there is limited evidence that ureaplasma species cause urethritis and other urinary and genital symptoms.  We have overwhelming evidence from diagnosing and treating of hundreds of patients with urethritis that contradict CDC statement.

Much of the CDC recommendations are based on the available “standard of care” treatment of mycoplasma genitalium, which is a single dose of azithromycin. It has been well-known for many years that a single-dose treatment with azithromycin has a high failure rate.  Specialists in the treatment of ureaplasma and mycoplasma have not used a single-dose treatment for >10 years. Much of the data on which the CDC based its recommendations is outdated and irrelevant to the US. Many studies come from Australia, where antibiotics that are not available in the US are used (Pristinamycin). 

Infectious disease doctors see a tiny number of men and women with infectious diseases and an even smaller number of patients with STIs and ureaplasma or mycoplasma. In fact, most infectious disease doctors treat hospitalized patients.  That has significant repercussions for the published literature and CDC recommendations.

High Failure Rates: Understanding the Causes

Understanding the causes of treatment failure with antibiotics is crucial to addressing it and improving cure rates.

High treatment rates for ureaplasma and mycoplasma have three causes: (1) antibiotic resistance, (2) incomplete or inadequate treatment, and (2) re-infection.

Antibiotic Resistance Causes

Antibiotic resistance has a few different causes:

    1. Pre-existing antibiotic resistance – there is nothing one can do other than choose an antibiotic to which the bacteria is not resistant
    2. Development of NEW antibiotic resistance – this can occur from inadequate dose of antibiotics or inadequate duration. The effectiveness, dose, and duration of antibiotics is not a simple science. It can also occur from a selection of resistant strains but that is usually unavoidable.

CDC looked at the studies that almost universally used inadequate doses and/or suboptimal duration of antibiotics. As a result, CDC spent millions of dollars creating a largely useless report.

While treatment of simple acute UTI/STI (urethritis) may require only a small dose of antibiotics, treatment of a chronic infection that affects the bladder (cystitis), prostate, and epididymis in men or uterus in women requires a higher dose. Similarly, the treatment of an acute mild infection in a woman is different from treating a severe chronic infection in terms of antibiotic dose and duration.  Despite “infectious disease” dogma, recent studies show that a longer course of antibiotics often results in higher cure rates (for UTIs).

Incomplete or Inadequate Treatment

First, it is important to note that many patients do not receive adequate treatment. The CDC guideline notes that “a 1-g dose of azithromycin should not be used.”  We often see patients being treated with that dose (which may be appropriate as an empiric dose before the test results show ureaplasma or mycoplasma). The ‘best’ studies on which CDC relies used a 3-day Azithromycin treatment and 7-day doxycycline treatment, which are often inadequate for severe, chronic infections. Certainly, no high-level studies show that a 7-day dose of doxycycline is sufficient for epididymitis, prostatitis, or cystitis. On top of it, the ‘high-cure’ studies were not reported based on the ‘intention to treat’ analysis. Many patients are excluded and possibly failures are not included in the analysis.  It is also important that most studies considered by the CDC are from outside the US with high antibiotic resistance rates.

In some men and women, Ureaplasma urealyticum (U. urealyticum) can cause significant urinary problems.  Ureaplasma has also been implicated as a cause of infertility.

The CDC, in all its insanity, recommends that essentially every patient with STI symptoms is treated with moxifloxacin, which can have significant side effects. There is zero consideration for minimizing exposure to toxic treatment.

Re-Infection with Ureaplasma and/or Mycoplasma

Reinfection from sexual partners is a common reason for antibiotic treatment failure in men and women with ureaplasma or mycoplasma. The problem can occur because the partner has not been tested or treated appropriately. Often, the partner goes to his/her doctor and says, “my partner” got an STI and gets tested for everything EXCEPT for ureaplasma/mycoplasma.  Over 90% of the time, “STD testing” does not include ureaplasma and/or mycoplasma testing. The patient is told, “We tested you for everything.” Other times, the partner is tested for STIs with a “culture’ test instead of a “nucleic acid” or an RNA or DNA-based test. Culture tests are falsely negative 50% of the time.

No such thing as “tested for all STDs.”

We advise patients to get a copy of their partner’s test results. Otherwise, often it’s impossible to cure because of re-infection.  We advise partners to use condoms or avoid sexual activity until both partners retest negative for infection.

Finally, insanely enough, for an infection with high resistance rates and that is sexually transmitted, potentially exposing others to it, the CDC does not recommend a test of a cure if the patient is asymptomatic. But most patients with the infection are asymptomatic, which is the reason that it is spreading like fire.  We recommend a test of cure 2-3 weeks after you finish antibiotics.

Where to Get Tested and Treated for Ureaplasma and Mycoplasma in NYC?

At New York Urology Specialists, we offer same-day mycoplasma and ureaplasma testing and treatment for men and women.

We also perform comprehensive STD testing for other infections. We offer confidential appointments. Our prices are affordable with or without insurance.  Call/text today: 1-646-663-4125 or make an appointment online.  

Scheduling Appointments for STI Treatment and STD Testing at New York Urology Specialists

If you have any questions about testing or treatment for sexually transmitted infections (STI), to schedule a consultation, please contact us or call/text: 1-646-663-4125.  

We have excellent reviews from patients and their partners. 

STDs are Treatable in Nearly Every Man and Woman

Excellence-Urology_Care-banner2At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of sexually transmitted infections (STI).  We understand the challenges that STDs such as chlamydia, herpes, gonorrhea, and ureaplasma create for our patients, their relationships, and their self-esteem.  We help you find an effective treatment for your symptoms that may be caused by STD, UTI or another cause. 

Urologists are doctors specializing in the treatment of infections in men and women caused by sexually transmitted diseases as well as bladder infections (UTI). By virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man and woman with urinary problems and bladder control problems.   

We treat some of the most complex STD problems, including:

Schedule an Appointment with Dr. Shteynshlyuger:

Call today: (646) 663-4125 or make an appointment online

Dr. Alex Shteynshlyuger is a fellowship-trained, board-certified urologist with expertise in the evaluation and treatment of urological problems in men and women using modern, effective, and proven treatment methods.  He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.