Snapshot A 37-year-old man presents to a local free clinic for evaluation of urethral discharge and pain with urination for 3 days. He denies having any new sexual partners and reports having sex with the same man for the past 3 years. He wants sexually-transmitted infection testing. He is started empirically on antibiotics. Testing comes back positive for a urease-positive, non-gram-staining bacteria. He tested negative for gonorrhea and chlamydia. Introduction Classification Ureaplasma urealyticum urease-positive, pleomorphic bacteria without a cell wall (thus, cannot use Gram stain) related to Mycoplasma spp. (same family, Mycoplasmataceae) also known as “T-strain” mycoplasmas clinical syndromes urinary tract infection (UTI) urethritis prostatitis transmission via direct contact Epidemiology risk factors multiple sexual partners immunosuppression Pathogenesis U. urealyticum colonizes the lower urogenital tract Prognosis typically resolves with treatment Presentation Symptoms urinary frequency pain with urination Physical exam low-grade fever urethral discharge Studies Labs bacterial culture detection of DNA via polymerase-chain reaction testing urease positive does not Gram stain Making the diagnosis based on clinical presentation and laboratory studies Differential Gonorrheal infection distinguishing factor gram-negative diplococci on Gram stain Chlamydial infection distinguishing factor visualization of intracytoplasmic inclusions (reticulate bodies) on histology Treatment Medical doxycycline or tetracycline indication first-line azithromycin indication second-line Complications Disseminated disease