Ureaplasma Infection: Causes, Symptoms, Diagnosis, and Treatment

Ureaplasma infections are microbiological conditions that arise when a specific microorganism lacking a cell wall settles in the reproductive and urinary tracts and are transmitted predominantly through sexual contact. The most prominent symptoms of the disease include a burning sensation during urination, clear discharge from the urinary canal, tenderness in the lower abdomen, and chronic groin pain. Treatment is achieved by using special antibiotic groups that directly target the microorganism’s cellular mechanisms, since conventional antibiotics are ineffective due to the bacterium’s physical structure, and by placing both partners on the medical protocol simultaneously in order to completely break the infection cycle.

What Is the Ureaplasma Bacterium?

There are hundreds of different bacterial families in the world of microbiology, but some immediately stand apart from the others due to the unusual characteristics they possess. The bacterium in question belongs to a special family called Mycoplasmataceae and is considered one of the smallest microorganisms capable of reproducing independently in nature. The most striking structural feature that distinguishes this bacterium from ordinary infectious agents is the absence of a protective “cell wall” surrounding it against external factors. Most bacteria have a strong cell wall like the exterior bricks of a house. However, this specific microorganism lacks such armor. When grown in special culture media under laboratory conditions, they form highly characteristic small colonies resembling a “fried egg” under the microscope.

The absence of a cell wall is not merely an interesting biological detail; it is a vital factor that changes the entire course of treatment. A very large proportion of antibiotics commonly used in modern medical practice work on the principle of disabling bacteria by breaking down their outer cell walls. Naturally, no effect can be achieved when armor-breaking drugs are given to this bacterium, which has no armor. This situation clearly explains why the use of the wrong medication often fails.

Another important feature is the way this bacterium produces energy. While most microorganisms use sugar to survive, this bacterium uses “urea,” as its name suggests. It secretes a special enzyme to break down urea, which is naturally abundant in human urine. As a result of this breakdown process, a high amount of ammonia is released in the urine, and the naturally acidic structure of the urine is disrupted, making it basic (alkaline). This chemical change in the urinary tract creates a favorable environment for minerals such as magnesium and phosphate to precipitate and for struvite stones, popularly known as infection stones, to form.

This microorganism does not always have to be a disease-causing agent. It may live silently in the flora of many healthy people without causing any symptoms. However, when the immune system weakens or local tissue integrity is disrupted, it may multiply rapidly and turn into an opportunistic infection. It is divided into different subtypes, and while some species cause much more aggressive complaints, others remain extremely silent and may only emerge as an underlying factor in distressing situations such as pregnancy loss.

The subtypes that most commonly cause disease are as follows:

• Ureaplasma urealyticum
• Ureaplasma parvum

Although both species come from the same family, laboratory analyses show that the urealyticum species has a much higher rate of causing clinical symptoms. The parvum species, on the other hand, is known more as an insidious guest frequently encountered in placental tissues in obstetric practice in cases of unexplained recurrent miscarriage.

How Are Ureaplasma Infections Transmitted?

The transmission dynamics of these infections are among the areas patients are generally most concerned about and ask the most questions about. The main route of transmission occurs largely through physical contact. The bacterium’s capacity to survive in environmental conditions outside the body is extremely low. Once exposed to the external environment, it dries rapidly and loses viability. This fact largely disproves myths about transmission from shared spaces. In practical life, the possibility of contracting this bacterium from toilet seats, shared swimming pools, baths, or items in hair removal centers is almost nonexistent. The bacterium needs the warmth and moisture of the human body to survive.

The routes of transmission can be examined under two main headings. The first and most common route is unprotected contact with an individual carrying the bacterium. The fact that one of the individuals is a carrier and has no complaints does not mean that they cannot transmit the bacterium. During contact, the bacterium quickly adheres to the mucosal tissue of the other person and begins to colonize, meaning multiply. The second important transmission mechanism is the vertical route, which is more relevant to newborn health. An expectant mother carrying the bacterium may transmit the infection to her baby during pregnancy or, more commonly, during vaginal delivery as the baby passes through the birth canal. For premature babies whose immune systems have not yet developed, this condition has the potential to cause serious respiratory and nervous system problems that may affect the lungs and the membranes surrounding the brain.

The main routes in which transmission risk is present are as follows:

• Unprotected vaginal contact
• Unprotected anal contact
• Unprotected oral contact
• Transmission from mother to baby during childbirth
• Transmission through the placenta in the womb

Couples may often experience trust issues when an infection is detected in long-term monogamous relationships. However, the most important point to know is that this bacterium can remain dormant in the body for years without causing any symptoms. In other words, it is medically impossible to prove clearly in retrospect when and from whom a detected infection was transmitted.

What Problems Can Ureaplasma Cause in the Reproductive System If Left Untreated?

Mild symptoms or their periodic spontaneous disappearance may sometimes cause patients to delay seeking medical support. However, an infection that becomes chronic in the urinary canals or reproductive organs gradually begins to damage the anatomical structure in a way that is difficult to reverse. While trying to heal the inflamed area, the body forms a scar, meaning scar tissue, there. These tissues are rigid structures that have lost their elasticity and directly interfere with the function of the organ in which they are located.

From the perspective of male patients, an insidious inflammation lasting for months in the urinary tract may eventually cause the internal diameter of the urinary canal to narrow. This condition, known as urethral stricture, is characterized by difficulty urinating, splitting of the urine stream, and a feeling of incomplete bladder emptying, and it often requires surgical intervention to open it. The bacterium, not remaining limited to the urinary tract, may travel backward through the ducts and reach the testicles and sperm storage ducts. The inflammation it causes there may lead to painful testicular swelling and, more importantly, obstruction of the microchannels through which sperm are expelled, making it difficult to have a child naturally.

In female anatomy, the risks threaten much deeper tissues. The bacterium that settles in the cervix may ascend into the uterus and then reach the fallopian tubes. Damage occurring in the tubes may paralyze the hair-like structures that safely carry the egg to the uterus. This condition may cause the fertilized egg to become trapped in the tubes and create the basis for life-threatening emergencies such as ectopic pregnancy, while complete blockage of the tubes may also result in permanent infertility.

The main problems that may occur in men are as follows:

• Urethral stricture
• Testicular inflammation
• Epididymal infection
• Obstruction in the reproductive ducts
• Chronic groin pain syndrome

The possible risks that may occur in women are as follows:

• Pelvic inflammatory disease
• Scarring in the fallopian tubes
• Ectopic pregnancy
• Chronic pelvic pain
• Premature rupture of membranes
• Pregnancy losses

Considering these potential risks, it is of great importance not to ignore even mild complaints and to seek professional support at an early stage.

How Is Ureaplasma Diagnosed in Urology Practice?

Patients generally present with vague aches in the lower abdomen, mild burning sensations during urination, or colorless, clear discharge noticed in their underwear. The diagnostic process begins with asking the right questions and selecting targeted laboratory tests. Traditional culture methods are generally insufficient for this bacterium, which has no cell wall and grows under very delicate conditions. Therefore, more advanced molecular tests are needed.

In chronic cases, the patient’s complaints may continue even though standard urinalysis appears completely normal. This is because the bacterium may be hidden deep within the prostate gland or reproductive glands. In such cases, the prostatic fluid must be examined specifically to identify the source of the problem. This examination is performed using a special massage protocol involving staged urine collection after the patient has observed sexual abstinence for a certain period. The aim is to flush out possible inflammatory cells in the ducts and evaluate the number of inflammatory cells called leukocytes under the microscope.

Today, genetic-based tests are the most reliable way to definitively prove the presence of this insidious bacterium. Thanks to Polymerase Chain Reaction (PCR) technology, the genetic fingerprint of the bacterium is sought in a urine or swab sample. This technology is so sensitive that even if only a very small number of bacteria are present, they can be amplified and detected.

The tests and methods frequently used during diagnosis are as follows:

• Complete urinalysis
• Leukocyte esterase test
• Expressed prostatic secretion analysis
• Two-glass urine test
• Multiplex PCR panel
• Semi-quantitative culture kits

Advanced tests such as multiplex PCR screen for many different possible pathogens simultaneously from a single sample, preventing other accompanying infections from being overlooked. Correct diagnosis is the first and most critical step of successful treatment.

Does Ureaplasma Infection Cause Infertility and Sperm Damage in Men?

Although the role of infections in infertility research has been debated for many years, current data clearly show that certain microorganisms cause serious damage to sperm health. Especially in cases of unexplained infertility, investigating an underlying insidious infection has become a standard approach. Comprehensive analyses conducted at universities and research centers have revealed the presence of such silent infections in a significant proportion of men who have difficulty having children.

The negative effect of the bacterium on sperm cells generally does not occur by reducing sperm count or distorting their shape. The main damage occurs in the “functionality” of sperm. For sperm to achieve fertilization, they must swim a long distance. Thanks to their special adhesive properties, bacteria attach directly to the body of sperm cells and to the tail portions that act as flagella. A sperm carrying these bacteria loses its ability to move, much like a swimmer carrying a heavy load on their back, and cannot reach the target.

In addition, when the body’s immune system notices this situation, matters become even more complicated. Immune cells that arrive in the area to destroy the bacterium also begin to perceive the sperm cells covered with bacteria as foreign threats. The body produces antibodies against its own sperm and begins to stick and clump them together. As a result of this clumping, the sperm become unable to move. In addition, the dense inflammatory cells in the infection area may release chemical substances called free radicals and damage the genetic material of sperm.

The main mechanisms that impair sperm quality are as follows:

• Restriction of sperm tail movement
• Triggering the production of antisperm antibodies
• Adhesion of sperm to one another
• Genetic damage due to oxidative stress
• Blocking of fertilization capacity

This picture clearly demonstrates how critical infection treatment is not only for eliminating daily complaints but also for protecting future reproductive health.

Which Methods and Medications Are Used in Ureaplasma Treatment?

The treatment process initiated after the diagnosis is confirmed requires a slightly different strategy from conventional infection treatments. As stated previously, because the bacterium has no cell wall, a large proportion of the broad-spectrum antibiotic groups commonly seen in prescriptions remain completely ineffective in this treatment. Therefore, physicians must choose much more specific drug groups that target the bacterium’s protein production mechanisms or nucleic acid synthesis.

When planning treatment, the severity of the patient’s complaints, the area to which the infection has spread, and regional antibiotic resistance rates are taken into account. If the disease is limited only to the urinary canal, shorter-term oral tablet treatments are preferred, whereas if the infection has spread to the reproductive glands or pelvic region, the duration of treatment may be extended for weeks and supported with additional medications in injectable form.

Antibiotic resistance mapping studies conducted throughout Türkiye are among the most important data shaping treatment protocols. It has been determined that some antibiotic groups frequently prescribed for such infections in previous years now have almost no effect on the bacteria and that resistance rates have reached record levels. Over time, bacteria have recognized these drugs and developed ways to protect themselves from them. Therefore, physicians prefer specific molecules whose effectiveness rates still remain at very high levels.

The drug groups that provide successful results in treatment are as follows:

• Tetracycline-derived antibiotics
• Macrolide group antibiotics
• Doxycycline-containing agents
• Azithromycin-containing agents

The drug groups that are generally not preferred in treatment due to resistance are as follows:

• Fluoroquinolone group antibiotics
• Ciprofloxacin-containing agents
• Penicillin group medications
• Cephalosporin group medications

Which medication is used, at what dose, and for how long is planned entirely by the physician and personalized according to the patient’s clinical picture. Random antibiotic use not only fails to cure the disease but also causes the bacteria to become even more resistant, exhausting future treatment options.

Why Is Simultaneous Partner Treatment Important in Ureaplasma Treatment?

One of the most critical mistakes made in the management of sexually transmitted infections is treating only the person who shows symptoms. Patients may sometimes think that their partners do not need to take medication because they have no complaints. However, considering the bacterium’s silent carrier characteristic, assuming that a partner without complaints is completely healthy is not a medically correct approach.

If only one member of the couple receives treatment, a vicious cycle known in medical terminology as the “ping-pong effect” begins. The person using the medication becomes free of the bacterium; however, during the first unprotected contact with the untreated partner, the bacterium re-enters the body. This causes the infection to continue for months, leads to the unnecessary use of boxes of antibiotics, and ultimately causes the bacterium to develop strong resistance to the medications used. The only way to break this vicious cycle is for couples to accept the infection as a shared problem and follow a simultaneous treatment program.

The rules that should be observed for the treatment process to proceed smoothly are as follows:

• Both partners starting medication at the same time
• Regular use of medications without skipping doses
• Limiting sexual contact until treatment is completed
• Using condoms when necessary
• Maintaining precautions during the first week after treatment

Full compliance of both partners with treatment is the most important guarantee that the infection will be eliminated from the body without returning. The relief of symptoms within a few days should not create the misconception of recovery, and medications should be continued until the end of the period determined by the physician.

How Is It Confirmed That Ureaplasma Disease Has Completely Healed?

When the boxes of antibiotics are finished and complaints such as burning and stinging during urination disappear, the process is not automatically considered complete. A large proportion of patients neglect doctor check-ups because they think they have recovered once their complaints resolve. However, in some cases, even if the complaints are suppressed, microorganisms may manage to remain alive in very small numbers deep within the tissues. Therefore, a verification stage called a “test of cure” is needed to medically prove whether the treatment has truly been successful.

The timing of the PCR test to be performed for the test of cure is of great importance. Having the test done in the week immediately following the end of antibiotic treatment generally produces misleading results. This is because even if antibiotics kill and break down the bacteria, genetic fragments belonging to dead bacteria (DNA debris) continue to circulate in the urinary canals for a while. Highly sensitive PCR tests may detect these dead particles and report the result as positive. This condition, called a false positive, may cause panic in the patient and lead the physician to unnecessarily plan a second treatment.

It takes a certain amount of time for the body to naturally clear these dead remnants. Therefore, control tests should not be rushed in order to obtain accurate results, and the waiting period determined by the specialist physician should be followed.

The steps carefully applied during the test of cure process are as follows:

• Waiting for the recommended period after completing the medication
• Regular monitoring of complaints
• Obtaining a new sample for control purposes
• Performing a multiplex PCR confirmation test

The waiting period generally varies between approximately three and four weeks after the end of treatment. A negative test result obtained at the end of this period is the most concrete evidence that the bacterium has been cleared from the body. If the complaints flare up again or the test is positive at the end of this period, the physician will guide treatment with a different molecular strategy, taking into account the presence of accompanying microorganisms or multidrug resistance.

Frequently Asked Questions

Prof. Dr. Berkan Reşorlu

Prof. Dr. Berkan Reşorlu, born in Ankara in 1979, completed his medical education at Ankara University between 1997 and 2003, and his specialization in urology at Ankara University Faculty of Medicine between 2003 and 2008. Academically, he received the title of associate professor in 2013 and professor in 2022.

He has conducted extensive case series studies in the field of endoscopic stone surgery, contributed surgeries performed on children under the age of 1 to the literature, and has gained international recognition with his stone scoring system and experimental surgical models.