● Mycoplasma species relevant to the urogenital tract include mycoplasma hominis,
mycoplasma genitalia and ureaplasma urealyticum. Their occurrence in the context of
urogynaecological disease has been demonstrated in urethritis, cystitis and upper renal
● Their role in hyperactive bladder and interstitial cystitis/painful bladder syndrome is
controversial. All the above-mentioned microorganisms can occur as commensals or as
potential pathogens. In most cases their role in any particular pathology cannot be
proven, only presumed.
● It hurts when you pee. Belly pain.
● Pain, odor, or discharge from the vagina.
● Swelling at the opening of the urethra.
● Unprotected sex. Discharge from the urethra.
● Been exposed. Multiple sexual partners.
Pharmacology treatments if recommended:
Current treatment options include:
● azithromycin 1 g as a single dose
● azithromycin 1,5 g total dose given over 5 days
● or doxycycline 100 mg 2× daily for 7 days.
● Treatment success should be tested three weeks after treatment at the earliest,
especially in the case of mycoplasma genitalium. In the presence of bacterial
persistence common antibiotic regimes are
● metronidazole 500 mg 2×/day for 5–7 days plus azithromycin for 5 days
or doxycycline for 7 days
or moxifloxacin 400 mg per os 1×/day for 7–14 days 33 .
● Moxifloxacin should be used with caution and only in the context of treatment failure
since it can cause a rare but severe liver reaction. Mycoplasma genitalium infection
acquired in Southeast Asia is resistant to macrolides and quinolones in 10% of cases
and pristinamycin is the only effective antibiotic in these patients 34 .
● Treatment of the patientʼs partner with the same antibiotic shown to be effective in the
index patient is generally recommended. Condom use or abstinence from sexual
intercourse is recommended until symptoms have resolved.
● Outlook for the future New laboratory methods and gene analyses provide promise for
the future: it has recently become possible to determine the female microbiome in
catheter urine using culture and 16S RNA sequencing.
● This has already led to the finding that urine of symptom-free patients contains bacteria
and is not sterile as previously assumed. Urine appears to constitute its own
microbiological niche that is extremely diverse and may include typical uropathogens
such as mycoplasma and ureaplasma species per the National Library of Medicine.