Updated: 11/28/2018

Ureaplasma urealyticum

Review Topic
  • 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.
  • 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
  • Symptoms
    • urinary frequency
    • pain with urination
  • Physical exam
    • low-grade fever
    • urethral discharge
  • 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
  • Gonorrheal infection
    • distinguishing factor
      • gram-negative diplococci on Gram stain
  • Chlamydial infection
    • distinguishing factor
      • visualization of intracytoplasmic inclusions (reticulate bodies) on histology
  • Medical
    • doxycycline or tetracycline
      • indication      
        • first-line
    • azithromycin
      • indication
        • second-line
  • Disseminated disease

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