Clinical Alert
Ureaplasma is often the cause of NGU (Non-gonococcal urethritis): symptoms appearing 1-3 weeks after contact when Gonorrhea and Chlamydia tests are negative.
What is Ureaplasma?
Ureaplasma (specifically Ureaplasma urealyticum and Ureaplasma parvum) are extremely small bacteria that inhabit the urinary and genital tracts. They are part of the family known as Mycoplasma.
What makes them unique—and dangerous—is that they lack a cell wall. Most bacteria have a rigid outer shell. Our immune system and many common antibiotics target this shell. Because Ureaplasma are essentially "ghosts" without this shell, they are invisible to Gram stains and immune to drugs like Penicillin.
Common Symptoms
Ureaplasma is often asymptomatic (silent), but when it does cause symptoms, they often mimic other STIs:
- Men: Burning sensation while urinating, clear/watery discharge from the penis, testicular pain.
- Women: Unusual vaginal discharge, pelvic pain, pain during intercourse.
Why Your Test Was Negative
Many patients come to us frustrated. They have symptoms, but their clinic results say "All Clear." This happens for two reasons:
1. It's not on the panel. Most standard STI panels only test for HIV, Syphilis, Gonorrhea, and Chlamydia. If you don't specifically ask for Ureaplasma/Mycoplasma, you won't be tested for it.
2. Standard cultures fail. Because Ureaplasma is so small and fragile, it often dies during transport if not handled correctly (see our Logistics article). Only PCR (DNA detection) is reliable for finding it.
Treatment Protocols
Because it lacks a cell wall, Ureaplasma requires specific antibiotics. The typical first-line treatment is Doxycycline, followed often by Azithromycin (a dual therapy approach) to clear resistant strains.
Warning: Do not self-medicate. Resistance is rising in Bangkok. You need a proper PCR test to confirm the species before starting treatment.
