Ureaplasma urealyticum is a bacterium that sits in the genital tract of plenty of people without causing anything. A positive result therefore does not always mean you have something that needs treating. In 2018 the European STI Guidelines Editorial Board published a position statement with exactly that question as its title, and the answer is cautious (Horner, 2018).
That is a different story from the one most test pages tell.
Search for ureaplasma and you mostly find clinics selling a separate STI test for it. We do not sell that test. Below you will read why, and what you can do if you got a positive result somewhere else.
What is ureaplasma urealyticum?
Ureaplasma urealyticum is a very small bacterium without a cell wall, related to mycoplasma. It lives on the linings of the urinary and genital tract. In a considerable share of sexually active adults it is present without anything being wrong at all.
That last part is the whole point.
In microbiology such a bacterium is called a commensal: it belongs to normal flora and in that role causes no disease. Some commensals can cause symptoms under certain conditions. So with ureaplasma, the difference between "present" and "the cause of your symptoms" is not self-evident.
Is ureaplasma an STI?
Not in the way chlamydia is. The bacterium does pass on through sexual contact, but it is also found in people without symptoms and without recent risk. That is why it is not on the list of infections routinely tested for in the Netherlands, and why the RIVM does not track it in routine STI surveillance.
The contrast with mycoplasma genitalium matters here.
Mycoplasma genitalium does count as an established STI and has its own European guideline (Jensen, 2022). Ureaplasma and Mycoplasma hominis sit in a different category. Commercial test pages regularly lump all three together, and that is what gives people an unnecessary fright.
| Chlamydia | Mycoplasma genitalium | Ureaplasma urealyticum | |
|---|---|---|---|
| Established as an STI | Yes | Yes | No, contested |
| Often present without symptoms | Yes | Partly | Yes, very |
| Routine testing advised | Yes | Only with symptoms | No (Horner, 2018) |
| In our panel | Yes | No | No |
What does a positive ureaplasma result mean?
Usually it means the bacterium is present, and no more than that. If you have no symptoms, a positive result on its own is not a reason for concern. The position of the European STI Guidelines Editorial Board is that routine testing for this bacterium in people without symptoms mainly produces confusion (Horner, 2018).
A quick real-world example.
Say you order a broad panel with 10 causes on it from an online clinic. Chlamydia negative, gonorrhoea negative, ureaplasma positive. You get a fright, you search, and you land on pages using the word STI.
In most of those cases there is no infection that needs treating. That you read this nowhere is what we've come to see as the real problem here, not the bacterium itself.
If you do have symptoms, it sits differently. Then the question is whether ureaplasma is the cause or an incidental passenger, and a doctor answers that question, not a result.
Ureaplasma treatment: when and when not?
Treatment comes into view when there are symptoms that fit inflammation and when other, more likely causes have been ruled out. In people without symptoms, treating is generally not on the table. That weighing up is for your GP or a sexual health clinic, not an online testing provider.
There is also a reason to hold back.
Antibiotics given without a clear indication contribute to resistance. With the related bacterium mycoplasma genitalium that is exactly what happened, with a clearly visible rise in resistance to macrolides. That story is in mycoplasma genitalium treatment.
The Dutch GP standard on the STI consultation describes which causes are tested for as standard in Dutch primary care. Ureaplasma is not among them.
What if symptoms persist?
Then it makes more sense to look at the causes that produce symptoms more often. Research into non-gonococcal urethritis shows that several causes are regularly involved at once, and that in a share of men no known cause is found at all (Jordan, 2020). Ureaplasma is rarely the prime suspect on that list.
So the practical order is the reverse of what many people do.
Rule out chlamydia and gonorrhoea first, because those are found most often and have a clear treatment route. You can do that with a test for chlamydia, gonorrhoea and trichomonas. If symptoms persist after that, it is the GP's turn.
Thuisarts.nl explains in plain language how to raise a complaint like this.
Further reading
For the full overview of what can inflame a urethra: urethritis. For the bacterium that does count as an STI but sits outside a standard panel: mycoplasma genitalium.
The closely related bacterium with the same debate around it is mycoplasma hominis.
References
- Horner P, et al. Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? A position statement from the European STI Guidelines Editorial Board. Journal of the European Academy of Dermatology and Venereology, 2018. PMID 29924422.
- Jordan SJ, et al. Aetiology and prevalence of mixed-infections and mono-infections in non-gonococcal urethritis in men: a case-control study. Sexually Transmitted Infections, 2020. PMID 31515293.
- Jensen JS, et al. 2021 European guideline on the management of Mycoplasma genitalium infections. Journal of the European Academy of Dermatology and Venereology, 2022. PMID 35182080.
- NHG-Standaard Het soa-consult, Dutch College of General Practitioners. Accessed July 2026.
- RIVM, Sexually transmitted infections in the Netherlands, annual report. Accessed July 2026.
- Thuisarts.nl, Pain when urinating. Accessed July 2026.
Every test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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