Ureaplasma and mycoplasma: what are these, what do they mean, and do they need treatment?

If your vaginal microbiome test has flagged Ureaplasma or Mycoplasma species, you are likely full of questions, and possibly a little anxious.  Here is what you need to know.  

What is Ureaplasma?

Ureaplasma belongs to a family of bacteria called Mollicutes.  These are among the smallest known organisms of their type. Unlike most bacteria, they have no cell wall, which makes them behave differently from more familiar microbes, and also makes them harder to treat with standard antibiotics.

There are two main species found in the genitourinary tract: Ureaplasma parvum and Ureaplasma urealyticum. Both are included in our Vaginal Microbiome Test, because understanding what is present, and at what level, is an important part of building a complete picture of your vaginal health.

Ureaplasma is commonly found in the genital and urinary tracts of both men and women. Many people carry it without any symptoms.  In those symptomatic, symptoms include painful or burning urination, unusual genital discharge and lower abdominal pain.  

It is transmitted through sexual contact and can also pass to newborns during pregnancy, though it is not classified as a sexually transmitted infection in the same way as chlamydia or gonorrhoea, and is generally considered significantly less harmful.

The critical thing to understand from the outset is this: detection does not equal infection.  Finding Ureaplasma in a microbiome test does not automatically mean something is wrong, but it is something to review in the context of your personal health goals and history.

When can Ureaplasma become a problem?

Ureaplasma can behave as a commensal, quietly existing in the microbiome without causing harm. In some women, it remains at very low levels throughout their lives with no clinical significance (we may see this taking up roughly 0.01% of a woman’s microbial flora for example, this would be classed as low).

In other women however, and in less common situations, it becomes opportunistic: if the vaginal environment is disrupted, if Lactobacillus levels decline, or if immunity is lowered, Ureaplasma can proliferate and begin to drive symptoms of inflammation.  We may see levels increase to up to around 5% of the microbiome, this being a lot more significant than levels of 0.01%. 

When this happens, it has been associated with a range of conditions.

For women:

• An increased susceptibility to bacterial vaginosis (BV)
• Urethritis and recurrent urinary tract infections
• Premature rupture of membranes during pregnancy
• Chorioamnionitis: infection of the uterine contents during pregnancy, where Ureaplasma has been identified as the most common associated organism
• Pregnancy loss: one study found that 66.3% of people who experienced pregnancy loss had Ureaplasma parvum in the placenta; overall, treatable genital tract infections are thought to account for 15% of early pregnancy loss and 66% of late pregnancy loss

For male partners:

• Ureaplasma can adhere to sperm and produce reactive oxygen species, impairing the sperm's ability to penetrate an egg and potentially contributing to reduced fertility

It is worth noting that the research in women is still evolving and results across studies are mixed; the female immune system plays a significant role in determining how Ureaplasma behaves, and context matters enormously.

To treat or not to treat?

This is the question we are asked most often, and the honest answer is: it depends.

There is a growing trend, particularly online, for the detection of Ureaplasma and Mycoplasma (more on that below) to trigger a recommendation for antibiotics. This is not always the right approach. The question should not simply be "is it there?" but rather: what is it doing, and what are your health goals?

Treatment is generally more appropriate when:

• Microbial levels are relatively high (its good to compare the levels to other microbes).
• Symptoms are significant, persistent and not rectified with previous treatment.
• In cases of fertility, particularly a history of pregnancy loss, recurrent infection or difficulty conceiving, treatment may be considered. 

If none of these apply and Ureaplasma is present at low levels with no symptoms and no active fertility concerns, a watchful, supportive approach may be entirely appropriate.

It is also worth noting that not all Ureaplasma species behave the same way. Ureaplasma parvum tends to be less inflammatory than Ureaplasma urealyticum, and in many cases responds well to microbiome-supporting interventions without requiring antibiotics.

If antibiotics are the right choice

When treatment is clinically indicated, antibiotics can be an appropriate and effective intervention. However, antibiotics do not act in isolation, they affect multiple microbiomes simultaneously, including the gut and vaginal microbiome.  This means that the plan around the prescription matters just as much as the prescription itself.

If you are taking antibiotics for Ureaplasma, it is important to:

• Support your gut microbiome throughout the course
• Take a targeted Lactobacillus probiotic during and after treatment to help restore the vaginal microbiome, such as our Ultimate V containing lactobacilli strains found native to a healthy vaginal canal*. 
• Be vigilant for thrush, which commonly occurs in the aftermath of antibiotic use
• Discuss partner treatment with your clinician, as reinfection is possible and this is undesirable
• Retest after a period of recovery to understand where your microbiome has landed

* A randomised controlled trial investigating whether oral Lactobacillus probiotic supplements could positively influence the vaginal microbiome in women with unexplained infertility found a reduction in ureaplasma species when women took a probiotic blend of Lactobacillus strains (found in our probiotic formulations).  The researchers concluded that these Lactobacillus strains appear to have a protective effect, helping to suppress harmful bacteria and restore vaginal balance.  

..and what about Mycoplasma? 

Ureaplasma is often discussed alongside Mycoplasma hominis, another member of the Mollicute family that appears on our vaginal microbiome test and is similarly nuanced in its clinical relevance to ureaplasma, but is a lot less common. 

Its very important to distinguish between the types of Mycoplasma: there’s Mycoplasma hominis (which we test for), and then there's Mycoplasma Genitalium, which is an STI and requires antibiotic treatment - this latter species if often included in medical STI panels. 

What does this mean for your test results?

If Ureaplasma or Mycoplasma has appeared on your vaginal microbiome test, the most important thing is not to panic, and not to reach for antibiotics before speaking with someone who can review your full picture.

Our Intimate Health Specialist Jessica Childs offers personalised consultations to help you interpret your results in the context of your symptoms, health history and goals, whether that is managing recurrent infections, supporting your microbiome through perimenopause, or preparing for a fertility journey.

In summary, the vaginal microbiome is not a simple ecosystem, and Ureaplasma is not a simple organism.  But with the right information and the right support, it is entirely manageable. 

References / further reading:

Oliveira et al. (2020) Association of spontaneous abortion and Ureaplasma parvum detected in placental tissue. Epidemiology & Infection.2020;148:e126. doi: 10.1017/S0950268820001302 (PMC7339087)

Liu et al. (2025) Ureaplasma infections: update on epidemiology, antimicrobial resistance, and pathogenesis. Critical Reviews in Microbiology. 2025;51(2):317–347. doi: 10.1080/1040841X.2024.2349556

Schenk et al. (2021) Effect of probiotics on vaginal Ureaplasma parvum in women suffering from unexplained infertility. Reproductive BioMedicine Online. 2021;43(3):503–514. doi: 10.1016/j.rbmo.2021.06.004 (PMID: 34315695)

Kukoyi OS, et al. (2025). Ureaplasma urealyticum upregulates seminal fluid leukocytes and lowers human semen quality: a systematic review and meta-analysis. Basic Clin Androl. 2025 Apr 17;35(1):14. doi: 10.1186/s12610-025-00262-5. PMID: 40247169; PMCID: PMC12004628.