Mycoplasma and ureaplasma colonisation in women with lower urinary tract symptoms

To assess the prevalence of mycoplasma and ureaplasma (MH/UU) in women with bladder symptoms with or without sterile pyuria and to assess the effect of long-term (3 months) antibiotics on symptom improvement in women with significant pyuria and positive culture for MH/UU, urine reports on midstream samples of urine sent from urogynaecology department of one tertiary referral centre over 1 year were studied. Notes for sterile pyuria with positive culture for atypical organisms were retrieved and the data were entered onto Microsoft Excel and analysed. A total of 1,032 urine specimens were analysed between January and December 2005. Out of these, 319 were studies for atypical organisms (31%) and 31 of these were samples repeated on the same patients. The total positive culture rate was 33.7% (97/288). The prevalence of ureaplasma only was 26% (75) and combined mycoplasma and ureaplasma was 7.6% (22) in the first test samples. Of the 97 samples that were positive for atypical organisms, 34% (33) were also positive for typical organisms. Out of the 14 case notes studied, 10 women reported improvement of symptoms (71.4%) with 3 months of antibiotics and 2/9 who had repeat culture were positive for ureaplasma in spite of improvement in symptoms. There was no correlation found for co-existence of typical and atypical UTI or for sterile pyuria and mycoplasma/ureaplasma colonisation. There is a trend towards improvement of symptoms following long-term (3 months) antibiotics in women who have positive culture of MH/UU. A larger prospective randomised controlled trial is necessary to assess the effectiveness of this intervention.