Is Ureaplasma spp a STD? Should I get treatment for Ureaplasma?

Ureaplasma spp is a type of bacteria under the bacteria family of mycoplasma species. There are over 100 types of mycoplasma bacteria species; though about 17 types of mycoplasma can be found in human beings, most of the bacteria are harmless. Mycoplasma bacteria tend to thrive around mucosal regions such as the respiratory or the urogenital tracts. In the case of ureaplasma spp, the bacteria can be found in the urogenital system. 

Ureaplasma urealyticum and ureaplasma parvum are two subtypes of ureaplasma spp that one may notice on their medical checkup test results. Occasionally, the presence of the bacteria can cause anxiety and strains in relationships. In this article, we explore further the bacteria, the implications of having this bacteria in our body, and the role of testing and treating this bacteria. 

Ureaplasma bacteria as a colony versus pathogens

Bacterial colonisation is the establishment and physical growth of bacteria as a local community [1]. In the context of genitalia, ureaplasma spp can behave as a colony, making their constant presence over the mucosal linings over the vagina of a female or the urethra linings of a male. As a colony, ureaplasma spp co-exists with other background mucosal bacteria and does not cause harm or symptoms. 

In some circumstances, ureaplasma spp can become infectious and more harmful—they become pathogens. When pathogenic, ureaplasma spp can invade the mucosal lining of the urogenital system, causing inflammation and abnormal localised inflammatory symptoms. Although Ureaplasma spp generally has low pathogenicity and virulence, in a host (human) with a weakened immune system, one can present with infective symptoms [2].

It is imperative to note that a healthy, sexually active person (both female and male) can have ureaplasma bacteria colonisation in the urogenital region, and this is unlikely to be eradicated through repeated courses of antimicrobials [3]. Probiotics may be beneficial in encouraging the growth of good bacteria in the urogenital region, competing and inhibiting the growth of bacteria such as Ureaplasma spp. Abstinence from sexual partners may prevent recurrence once the bacteria has been eradicated. 

How is Ureaplasma spp transmitted? Is Ureaplasma spp a STD?

Ureaplasma spp can be passed on during sexual intercourse in both males and females. It can be passed on through the body fluid- be it- vaginal fluid, semen, saliva, or anal fluid. Less commonly, one can also transmit ureaplasma spp to the offspring during pregnancy and childbirth if the pregnant mother is having infective symptoms.

The term 'STD' or sexually transmitted disease, as its name has suggested, denotes any medical infectious disease that can be passed through sexual contact. Hence, if ureaplasma spp infection is passed between partners, the bacteria can also be considered a type of STD. The caveat is that ureaplasma spp can be a long-term colony bacteria in a person, so just 'having ureaplasma bacteria' may not necessarily mean being positive for STD. In simple layman's language, having ureaplasma spp bacteria in a person's body does not equate to being promiscuous.

Health implications associated with Ureaplasma spp infection

When ureaplasma spp bacteria become pathogenic, it can be associated with urogenital infections.

In men, ureaplasma spp can be associated with a condition known as non-gonococcal urethritis (NGU) [4]. Due to chronic invasion and inflammation of the ureaplasma spp bacteria, one can present with a burning or stinging sensation or even an itch over the urethral region. NGU is important to treat to reduce the risk of further infection of the urogenital region, with possible inflammation of the testicles. Medical literature has shown that ureaplasma spp can be associated with poorer sperm quality and lower sperm count [5]. 

In women, those with ureaplasma spp infection have a higher risk of acquiring other vaginal infections; this includes infections such as bacterial vaginosis [6]. A person with ureaplasma spp infection can experience persistent excessive vaginal discharge with associated unpleasant itch and odour. In more severe presentations, one can even have vaginal pain leading to reduced quality of life. In more severe circumstances, ureaplasma spp bacterial infection can be associated with cervicitis (inflammation of the cervix) or even pelvic inflammatory disease (PID), leading to chronic lower abdomen/pelvic pain and infertility disorders.

In pregnant women, ureaplasma spp active infection increases the risk of miscarriage, early pre-term labour, or serious conditions such as chorioamnionitis (infection of the amniotic fluid- the fluid and membrane enveloping the embryo) [7].

What are the symptoms of ureaplasma spp infection?

Abnormal urogenital symptoms include:

• Painful urination/ abnormal urinary symptoms (affecting both men and women)
• Abnormal vaginal discharge- excessive volume/ vaginal odour/ abnormal colour or consistency (women)
• Vaginal itch (women)
• Lower pelvic pain (women)

Seek medical attention if you have any of the above abnormal symptoms to evaluate and screen for any urogenital infection and receive appropriate treatment without further delay.

How can we screen for ureaplasma spp infection?

When one is experiencing abnormal genito-urine abnormal symptoms or if there is a concern of exposure to ureaplasma spp, your doctor may offer you testing in the form of a urine test or vaginal swab (in females) to screen for the bacteria. 

What is the current recommended screening advice for ureaplasma spp?

As ureaplasma spp can behave as a commensal or bacteria colony that 'do-no-harm' to the body, you do not need to regularly screen for the bacteria if you are well and asymptomatic. Screening for ureaplasma spp is advisable when a person has abnormal genito-urine symptoms or if a person has a persistent urogenital infection that is not recovering with treatment and time. This is a clinical decision and judgement that requires a careful discussion with your doctor on your clinical history and symptoms; your doctor will advise you further on whether you need to screen for this bacteria.

What is the treatment of ureaplasma spp infection?

Antimicrobials are usually used to treat ureaplasma spp infection. Antibiotics are often used to treat ureaplasma spp infection. Following worldwide progressive antibiotic resistance, there are increasing cases of treatment failure, requiring repeated cycles of antibiotics/different groups of antibiotics. It is advisable to abstain from sexual activities until you have completed your treatment to reduce chances of re-infection to yourself and other sexual partners.

If a person is well, with no abnormal symptoms, yet with test results showing ureaplasma spp present, your doctor may discuss with you the possibility of the bacteria being a colony rather than an infectious pathogen. In those instances, antibiotics may not be required.

Urogenital probiotics may be beneficial in boosting the amount of good microbes in the uro-genitalia areas, competing and preventing the growth and development of ureaplasma spp/mycoplasma spp on the mucosal linings.

What have I learnt today?

• Ureaplasma spp can be found in the urogenital region of sexually active individuals.
• Ureaplasma spp can function as a normal bacteria commensal. However, they can become infectious and invade the urogenital mucosal lining.
• When pathogenic, ureaplasma spp can be passed on between sexual partners.
• Ureaplasma spp can be associated with medical conditions such as urethritis, vaginal infection, cervical infection, and pelvic inflammatory disease and can cause infertility in both men and women.
• Ureaplasma spp infection can be treated with antibiotics.
• The need for treatment against ureaplasma spp depends on a person's clinical symptoms, test results and physician's clinical acumen, not merely the findings of positive test results.

Reference

1. Bacterial colonization. (n.d.). ScienceDirect Topics. Retrieved from https://www.sciencedirect.com/topics/immunology-and-microbiology/bacterial-colonization
2. Cole, L. K. (2019). The role of bacteria in the progression of chronic otitis media. Microorganisms, 7(9), 263. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750135/
3. Chason, R. (2023). Bacterial colonization of the respiratory tract. Medscape. Retrieved from https://emedicine.medscape.com/article/231470-overview
4. National Skin Centre. (n.d.). Non-gonococcal urethritis. National Skin Centre Singapore. Retrieved from https://www.nsc.com.sg/dsc/prevention-education/sexually-transmitted-infection/types-of-STIs/Pages/Non-Gonococcal-Urethritis.aspx
5. Kish, L. E., et al. (2023). The impact of bacterial colonization on wound healing. Journal of Wound Care, 32(5), 222-228. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10025488/
6. Pérez-Ros, P., & Martínez-Arce, A. (2023). Influence of bacterial colonization on chronic wound management. Journal of Clinical Medicine, 12(2), 197. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9944971/