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The potential dangers of ureaplasma
infection
In adults Non-specific
urethritis, Pelvic Inflammatory Disorder, infectious
arthritis in hypogammaglobulinemic and immuno-suppressed
patients, bronchopulmonary dysplasia, infertility
In pregnant women Placental
inflammation, miscarriage, premature labour, endometritis,
chorioamnionitis, post-partum or post-abortion
fever
In babies Neonatal death
due to bloodstream invasion or lung disease, congenital
pneumonia, bacteremia, meningitis, low birth weight
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"If I can eradicate ureaplasma,
why wouldn't I?" says Montreal infectious disease specialist
and microbiologist Dr David Portnoy of the little-known
bacterial STI found in up to 80% of patients.
But his brother, Dr Joseph Portnoy,
also an infectious disease specialist and microbiologist
in Montreal, thinks David is wasting his time. "So many
people are carriers that as you keep eradicating it,
it keeps coming back," says Joseph.
This family feud mirrors a schism
in the way Canadian medical practice looks at the little-known
Ureaplasma urealycticum infection.
COMMON
BACTERIA
The 2006 Canadian Guidelines on Sexually Transmitted
Infections advises physicians that ureaplasma may be
a cause to consider in urethritis infections, pelvic
inflammatory disease and pelvic pain (see the sidebar
for a list of conditions suspected to be caused by the
bacteria). However, standard practice in Canada is to
neither screen for nor treat ureaplasma.
The Portnoy brothers' disagreement
stems in part from the difficulty of identifying the
infection: it doesn't have a gram-stain reaction. Also,
ureaplasma can exist as normal flora, as opposed to
other STIs, such as Chlamydia and gonorrhoea. And symptoms
like genital and urethral burning, itching and abnormal
discharge are also caused by Chlamydia, gonorrhea, non-specific
urethritis, herpes, vaginosis, PID and other genital
mycoplasma species, creating a veritable Rubik's Cube
for diagnosticians.
SIBLING
RIVALRY
Dr David Portnoy explains that in his practice many
people come in with symptoms similar to Chlamydia or
gonorrhea and test negative for both, but positive for
ureaplasma.
David treats patients even if they
are asymptomatic — as the majority are — because
of possible links with infertility. "If you only treated
people with symptoms, then 95% of men and 50% of women
with Chlamydia would never get treated," he says.
But his brother disagrees. "There
is no way to link the symptoms with the bacteria," insists
Joseph. In the absence of better evidence, he says he
rarely screens for or treats the bacteria, occasionally
doing so when he receives a request because of a patient's
infertility or multiple miscarriages.
'QUESTION
MARK'
Even if you do decide to test for ureaplasma, treatment
can be a challenge. Because of high tetracycline resistance,
doxycycline treatment is sometimes supplemented by erythromycin
and azithromycin.
"Ureaplasma, as a pathogen, has
a big question mark and is still a research question,"
says Dr Robert Brunham, the executive director of the
British Columbia Centre for Disease Control.
Although several recent studies
confirm the connection between ureaplasma and neo-natal
infection, others reach inconclusive results, and others
still present conflicting information on the relationship
between ureaplasma and infertility. Dr. Brunham admits
Canadian physicians are largely on their own when it
comes to ureaplasma. "It is difficult to know what to
do with the information that a patient has ureaplasma,"
he says. "The bacteria is not a priority at the moment."
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