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Updated: Nov 28 2018

Ureaplasma urealyticum

  • 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
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