Ureaplasma urealyticum, Mycoplasma hominis, and Mycoplasma genitalium are among the smallest known living organisms, known as Mollicutes. Mollicutes do not have a cell wall, which makes them hard to culture/identify and difficult to treat, that is, if they become clinically relevant. 

You see, mollicutes are considered commensal organisms of the genital tract in sexually active men and women, which means they are usually “innocent” colonizers. At least 60% of asymptomatic women have been shown to harbor Ureaplasma in their genital tract. However, these organisms have also been implicated in cases of chronic prostatitis in men, urgency/frequency syndromes in women, and up to 40% of nongonococcal urethritis cases. More recently, Ureaplasma has been implicated in infertility, as well as some complications of pregnancy, like preterm labor. 

While Ureaplasma and Mycoplasma can play a role in genitourinary symptoms, such as urological pelvic pain syndromes, it is of utmost importance that patients be clinically evaluated for many other confusable diagnoses. These include, peripheral neuropathies, myofascial trigger points, orthopedic issues with referred pain to the GU system and central sensitization. Identifying these other causes are especially important as the prevalence of multi-drug resistance has been gradually increasing, and many patients who test positive may be able to avoid unnecessary antibiotic therapies. 

Frenkl, Potts: Sexually transmitted and associated diseases in Campbells-Walsh Urology, 10th edition, Saunders Elsevier, 2011.

Frenkl, Tara L., Potts, Jeanette. Sexually Transmitted Diseases, in Practical Urology: Essential Principles and Practice, edited by Christopher C.R. Chapple and William D. Steers, Springer 2011.

Potts, Frenkl: Sexually Transmitted Infections; in Urologic Clinics of North America, Nickel and Resnick (Editors)Volume 35, Number 1, Elsevier, February, 2008

Potts, Ward, Rackley: Association of chronic urinary symptoms in women and ureaplasma urealyticum. Urol, 55(4): 486-89, 2000.

Potts, Sharma, Pasqualotto, Nelson, Hall, Agarwal: Association of ureaplasma urealyticum with abnormal reactive oxygen species levels and absence of leukocytospermia. J Urol, 163: 1775-78, June 2000.

Frenkl, Potts: Sexually transmitted infections, Part I and Part II. AUA Update STD’s. 2006

Potts, Rackley: Ureaplasma urealyticum in men: A commensal or pathogen? American Urologic Association, 1997