Abstract
Ureaplasma spp. and Mycoplasma hominis are bacteria that commonly colonize the human urogenital tract but may also contribute to diverse genital and obstetrical infections. Their frequent detection in asymptomatic individuals complicates diagnostic interpretation, underscoring the need for reliable methods that enable species identification, semi-quantification, and antimicrobial susceptibility testing (AST). This study compared two updated commercial assays, Mycoplasma IST 3® (bioMérieux) and MYCOFAST® RevolutioN 2 (Elitech), against an in-house reference method (UZ Brussel). A total of 111 clinical specimens, including urine, genital swabs, and semen, were prospectively analysed. The IST 3® kit demonstrated a sensitivity of 83% and specificity of 95%, whereas MYCOFAST® achieved 75% and 96%, respectively. Both systems provided semi-quantification and AST, capabilities absent from the reference method. Most isolates were susceptible to the tested antimicrobials, with only three resistant strains identified (tetracyclines and fluoroquinolones). In addition to analytical performance, the IST 3® kit offered advantages in workflow integration, supporting its selection for routine implementation. A two-step diagnostic algorithm, consisting of initial chromogenic broth screening followed by confirmatory identification and AST with IST 3®, is proposed to optimize clinical management. Continued evaluation across additional specimen types and surveillance of resistance patterns remain warranted.
Keywords: Ureaplasma spp., M. hominis, Kit comparison
1. Introduction
Ureaplasma spp. (including U. parvum and U. urealyticum) and Mycoplasma hominis are classified within the Mollicutes class, a group of bacteria that are characterised by their absence of a cell wall, their small genome and their distinct membrane composition. These organisms have been identified in the human urogenital tract, typically as part of the commensal flora in healthy sexually active individuals [[1], [2], [3]]. In addition to their prevalence in asymptomatic hosts, both Ureaplasma spp. and M. hominis have traditionally been implicated in urogenital infections particularly in conditions such as non-gonococcal urethritis, bacterial vaginosis, and pelvic inflammatory disease [4]. The potential for pathogenicity of these bacteria, when combined with their ability to colonize healthy individuals, results in a challenging diagnostic interpretation and may lead to inappropriate antibiotic use. In patients exhibiting symptoms indicative of urethritis or vaginitis (including dysuria, abnormal discharge, pollakiuria, or burning micturition), the presence of these organisms is usually considered, but should be upon their demonstrable presence at a significant concentration and after the exclusion of the most frequent sexually transmitted pathogens Chlamydia trachomatis and Neisseria gonorrhoeae. Only in such cases, mainly M. genitalium but also Ureaplasma spp. and more controversially M. hominis can be considered likely etiological agents [5]. These pathogens have also been implicated in obstetrical and neonatal pathologies, such as spontaneous abortions or miscarriages, neonatal respiratory diseases, and chorioamnionitis [4]. Considering this clinical relevance, the capacity to detect and accurately identify these pathogens is important to ensure appropriate treatment. In case of probable Ureaplasma spp. and M. hominis infections, there are no specific guidelines for treatment. UpToDate treatment guidelines for Ureaplasma spp. and M. hominis can be found in 2016 European guidelines management of non-gonococcal urethritis [6] and 2021 guidelines management of non-gonococcal urethritis [7]. For non-complicated genital infections, doxycycline (100 mg orally twice daily for 7 days) is recommended. The treatment duration can be extended to 14 days in some cases such as pelvic inflammatory disease. Sexual partner should also be treated to avoid transmission. If failure of treatment, fluoroquinolones can be used as an alternative. If the patient is pregnant, clindamycin will be preferred in case of M. hominis infection and azithromycin in case of Ureaplasma spp. infection.
The latest resistance breakpoints guidelines about Ureaplasma spp. and M. hominis were issued by the Clinical and Laboratory Standards Institute (CLSI) in November 2011 [8]. To our knowledge, no other AST guidelines have been published since. Methods such as disk diffusion or McFarland standardised inocula are not applicable to Ureaplasma spp. and M. hominis, as they cannot grow as confluent lawns on an agar plate due to the auto-toxic nature of their metabolites and their small size [8]. The broth microdilution method is therefore preferred. CLSI breakpoints are valid for inocula of 104 and 105 CFU/mL. If growth occurs for either Ureaplasma spp. or M. hominis, quantification must be performed prior to AST. It can be challenging to obtain the optimal inoculum for AST. Prior to 2011, various manufacturers introduced a few commercial assays for the detection and antimicrobial susceptibility testing (AST) of Ureaplasma spp. and M. hominis. However, these early-generation tests had significant limitations, as described by Beeton and Spiller [3]. A significant limitation was identified as their restricted capacity for semi-quantitative analysis, which hindered precise estimation of the bacterial inoculum. Consequently, it was not possible to verify whether the inoculum concentration met the standardised range (104−5 CFU/mL) required for reliable and reproducible susceptibility testing. This limitation had a detrimental effect on the interpretability and clinical relevance of AST results. The second limitation of these tests was, in case of a positive test and a resistant strain, the inability to determine whether it was a resistant strain of Ureaplasma spp. or M. hominis. Given the intrinsic resistance of M. hominis to macrolides, it becomes impossible to accurately assess macrolide susceptibility of Ureaplasma spp. in such co-infected samples. For reliable AST, it is therefore critical to work with purified isolates. The last and biggest limitation is that the antibiotic concentrations were not the same as recommended by the CLSI breakpoints leading to misinterpretation in antibiotic susceptibility and use. For all these reasons, updates in Ureaplasma spp. detection and AST were needed. Both Mycoplasma IST 3 (bioMérieux, Marcy-l'Étoile, France) and MYCOFAST® RevolutioN 2 (EliTech Diagnostic, Puteaux, France) kits have been updated to address these limitations. Both tests involve semi-quantification, germ(s) identification (also in case of co-infected samples) with germ-specific ASTs, and antibiotic concentrations adjusted to CLSI breakpoints. The objective of this study is to evaluate and compare Mycoplasma IST 3 and the MYCOFAST® RevolutioN 2 kit to identify the better-performing method and implement a robust diagnostic algorithm meeting both analytical and practical laboratory requirements. To conduct these analyses, the LHUB-ULB microbiology laboratory currently relied on a third-party laboratory (UZ Brussel) that uses an in-house method that involves only germ identification without semi-quantification or AST. In the light of the recent legislation (European Union In Vitro Diagnostic Regulation (IVDR)) and given a relatively high local clinical demand, it is important to implement kit-based workflow and more comprehensive results in our laboratory.
2. Materials and methods
2.1. Clinical samples and study protocol
Clinical specimens were prospectively collected from patients as part of routine operations at the LHUB-ULB between August 2023 and April 2025, including midstream and first-void urine, vaginal, endocervical, and urethral swabs (transported in Amies or Universal Transport Medium (UTM)), or semen. During kit evaluation, the standard workflow involved sending samples (aliquots were collected prior) to UZ Brussel (Brussels, Belgium) for Ureaplasma spp. and M. hominis testing using their in-house method, used as the reference method for this study. Since the aliquots were leftover clinical samples, they were considered medical waste and did not require patient consent.
2.2. Studied kits and reference method
Both tested kits rely on the presence of enzymes that metabolize urea (urease) and arginine (arginine dihydrolase) for Ureaplasma spp. and M. hominis respectively [4,9]. Each kit enables identification, semi-quantification, and AST using galleries containing 24/25 wells. Table 1 outlines the key characteristics of each kit. All procedures were performed in accordance with the manufacturers' instructions, with slight changes, mentioned below. Instructions are very similar between kits, the main difference being in the inoculated broth: BioMérieux “R1-R2” broth is chromogenic (already contains pH indicator and metabolites) prior to wells inoculation while Elitech “UMMt” broth is not; the chromogenic reaction is triggered in the well by pre-incorporated colour indicators. Changes to the manufacturer's instructions include the type of urine sample required. The BioMérieux insert only mentions the initial void of male urine. However, in this study, we included midstream urine from both men and women to obtain a sufficient sample size and reflect the reality of the prescription, even if it means searching for these pathogens under conditions that are not recommended by the guidelines. UZ Brussel laboratory uses a chromogenic broth-based in-house method. If positive, the broth is plated on A7 agar (EliTech Diagnostic, Puteaux, France) for identification under a 10x microscope. No semi-quantification or AST is provided.
Table 1.
Characteristics of each tested kits and practical considerations.
| Germ | Elitech MYCOFAST® RevolutioN 2 | BioMérieux IST 3 | ||
|---|---|---|---|---|
| Identification method | Ureaplasma spp. | Colorimetry by metabolization of urea and pH indicator | ||
| M. hominis | Colorimetry by metabolization of arginine and pH indicator | |||
| Broth |
Ureaplasma spp. M. hominis |
UMMt (liquid) 300 μL sample in UMMt Non chromogenic |
R1 (liquid) and R2 (lyophilized) 200 μL of sample in R1 → 3 mL of inoculated R1 in R2 Chromogenic |
|
| Semi-quantification (UFC/mL) | Ureaplasma spp. | 103 104 ≥105 |
≥103 ≥104 ≥106 |
|
| M. hominis | ≥104 | ≥104 ≥106 |
||
| Tested antibiotics (mg/L) | Ureaplasma spp. | LVX | Levofloxacin 2; 4 | Levofloxacin 2; 4 |
| MXF | Moxifloxacin 2; 4 | Moxifloxacin 2; 4 | ||
| TET | Tetracycline 1; 2 | Tetracycline 1; 2 | ||
| ERY | Erythromycin 8; 16 | Erythromycin 8; 16 | ||
| TEL/DOX | Doxycycline 1; 2 | Telithromycin 4 | ||
| M. hominis | LVX | Levofloxacin 1; 2 | Levofloxacin 1; 2 | |
| MXF | Moxifloxacin 0,25; 0,5 | Moxifloxacin 0,25; 0,5 | ||
| TET | Tetracycline 4; 8 | Tetracycline 4; 8 | ||
| CLI | Clindamycin 0,25; 0,5 | Clindamycin 0,25; 0,5 | ||
| DOX | Doxycycline 4; 8 | / | ||
| Manipulation time | / | ≈5 min/sample | ≈7 min/sample | |
| Incubation time | / | 24-48h in anaerobic condition | ||
| Closing device | / | Sealed | Laid on top (not sealed) | |
2.3. Test performance
Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the overall detection and considering separately each pathogen and cases of co-detection, using the UZ Brussel method as the reference. PPV and NPV were calculated, knowing that the studied population might not be representative of general population (patients presenting urethritis or vaginitis symptoms). Semi-quantification and AST results were compared only between the two tested kits, as UZ Brussel did not provide corresponding data.
2.4. Clinical algorithm
Our findings contributed to the development of a laboratory testing algorithm for Ureaplasma spp. and M. hominis. This algorithm is intended to improve clinical management and reduce the use of inappropriate antibiotics.
3. Results
A total of 111 samples from 62 men and 49 women with a median age of 36.5 years (range: 19–79) were included in this study. Sample types consisted of 46 midstream urine, 6 first-void urine, 32 swabs (vaginal, endocervical, and urethral, including Amies and UTM), and 26 semen samples. According to our reference method, 24 out of the 111 samples tested positive. Table 2 summarizes analytical performances and details of the species. Data concerning Mycoplasma hominis and co-detections of both pathogens should be interpreted with caution due to small sample sizes (respectively only 1 and 4 positive samples)
Table 2.
Performance of Elitech MYCOFAST® RevolutioN 2 and BioMérieux IST 3® compared with the reference standard for detection of Ureaplasma spp. and Mycoplasma hominis. Over 100% detection indicates discordance with the reference method. Sensitivity, specificity, predictive positive value and predictive negative values are expressed as percentages with 95% confidence intervals (CI) calculated using the Wilson method. Results for Mycoplasma hominis and co-infections should be interpreted with caution due to small sample sizes.
| Pathogen/Result | Reference standard | Elitech MYCOFAST® RevolutioN 2 | BioMérieux IST 3® |
|---|---|---|---|
| Total positive samples (n) | 24 | 21 (87.5%) | 24 (100%) |
| Ureaplasma spp. | 19 | 17 (89.4%) | 20 (105%) |
| M. hominis | 1 | 1 (100%) | 1 (100%) |
| Co-detection of Ureaplasma spp. and M. hominis | 4 | 3 (75%) | 3 (75%) |
| Sensitivity (95% CI) | |||
| Overall detection (Ureaplasma spp. and/or M. hominis) | 75.0 (55.1–88.0) | 83.3 (64.1–93.3) | |
| Ureaplasma spp. only | 68.4 (46.0–84.6) | 78.9 (56.7–91.5) | |
| M. hominis only | 100 (20.7–100) | 100 (20.7–100) | |
| Co-detection of Ureaplasma spp. and M. hominis | 75.0 (30.1–95.4) | 75.0 (30.1–95.4) | |
| Specificity (95% CI) | |||
| Overall detection (Ureaplasma spp. and/or M. hominis) | 96.2 (89.3–98.7) | 94.9 (87.7–98.0) | |
| Ureaplasma spp. only | 96.1 (89.0–98.6) | 94.8 (87.4–98.0) | |
| M. hominis only | 100 (95.1–100) | 100 (95.1–100) | |
| Co-detection of Ureaplasma spp. and M. hominis | 100 (95.0–100) | 100 (95.0–100) | |
| PPV (95% CI) | |||
| Overall detection (Ureaplasma spp. and/or M. hominis) | 85.7 (65.4–95.0) | 83.3 (64.1–93.3) | |
| Ureaplasma spp. only | 81.3 (57.0–93.4) | 78.9 (56.7–91.5) | |
| M. hominis only | 100 (20.7–100) | 100 (20.7–100) | |
| Co-detection of Ureaplasma spp. and M. hominis | 100 (43.9–100) | 100 (43.9–100) | |
| NPV (95% CI) | |||
| Overall detection (Ureaplasma spp. and/or M. hominis) | 92.6 (84.8–96.6) | 94.9 (87.7–98.0) | |
| Ureaplasma spp. only | 92.4 (84.4–96.5) | 94.8 (87.4–98.0) | |
| M. hominis only | 100 (95.1–100) | 100 (95.1–100) | |
| Co-detection of Ureaplasma spp. and M. hominis | 98.6 (92.7–99.8) | 98.6 (92.7–99.8) | |
Notably, the bioMérieux broth (R1-R2) demonstrated similar performance to the full gallery in all but one case. In that particular sample, the broth yielded a positive result while the gallery was negative, and UZB confirmed a positive result. Incorporating this finding increases the sensitivity of the screening step to 88%. However, according to the insert, this indicates that the concentration is too low, and the test should not be interpreted.
Semi-quantitative results were available for 19 samples. Eight samples showed concordant semi-quantitative results between Elitech MYCOFAST® RevolutioN 2 and bioMérieux IST 3®. Eleven samples were discordant. Among these, nine showed differences in reported concentration categories between the two kits, while two samples presented discordances affecting clinical interpretation. These two cases involved semen samples positive for Ureaplasma spp. and are detailed in Table 3A.
Table 3.
Comparison of semi-quantitative results and antimicrobial resistance detection by Elitech MYCOFAST® RevolutioN 2 and bioMérieux IST 3®. Semi-quantitative categories differ between kits due to distinct predefined concentration thresholds. Clinical treatment thresholds were defined according to current recommendations. (R) resistant; (S) susceptible.
| A. Semi-quantitative comparison (n = 19) | |||
|---|---|---|---|
| Category | Definition | Number of samples | Clinical impact |
| Concordant |
|
8 | None |
| Apparent discordance without clinical impact | Different reported categories due to distinct kit thresholds, with concentrations remaining above treatment thresholds:
|
9 | None (treatment indicated with both kits) |
| True discordance with potential clinical impact | Discordant categories crossing clinical decision thresholds:
|
2 | Potential difference in treatment decision |
| B. Detected resistance (n = 3) | ||
|---|---|---|
| Pathogen/Result | Elitech MYCOFAST® RevolutioN 2 | BioMérieux IST 3® |
| Isolate 1:M. hominis |
|
|
| Isolate 2:Ureaplasma spp. |
|
|
| Isolate 3:Ureaplasma spp. |
|
|
AST showed that most isolates were sensitive (86% for Elitech MYCOFAST® RevolutioN 2 and 91% for BioMérieux IST 3®) to the panel of antibiotics tested (see Table 3B). Three strains were resistant.
4. Discussion
In this study, the BioMérieux IST 3® kit demonstrated good analytical performance, with a sensitivity (83%) and specificity (95%) close to those reported in the literature, albeit slightly lower than the multicentre results of Boostrom et al. [10]. The Elitech MYCOFAST® RevolutioN 2 kit showed slightly lower sensitivity (75%) but marginally higher specificity (96%). These findings suggest that both systems offer satisfactory diagnostic reliability for detecting urogenital mycoplasmas. When performance was analysed according to pathogen, both kits showed lower sensitivities for Ureaplasma spp. compared with overall detection, with IST 3® maintaining a higher sensitivity (79%) than MYCOFAST® (68%), while specificities remained high and comparable between systems (>94%). These findings highlight a moderate decrease in sensitivity when focusing specifically on Ureaplasma spp., which should be considered when interpreting negative results in this context. Performances for Mycoplasma hominis and for co-detection of Ureaplasma spp. and M. hominis, which appeared excellent for both kits (sensitivities and specificities approaching 100%), must be interpreted with caution due to the very limited number of positive cases, which resulted in wide confidence intervals and reduced robustness of the estimates. Overall, while both kits demonstrated reliable global performance, pathogen-specific analyses underline the importance of cautious interpretation, particularly for less frequent targets and co-infections, and support the complementary use of clinical context and confirmatory methods when indicated.
A key point in this comparison is the ability, offered by both tested kits, to perform semi-quantification and AST in routine practice, whereas the reference method previously used by the UZ Brussel laboratory did not provide such results. As mentioned in the introduction, semi-quantification is important for interpreting positive results, and treatment should only be introduced at a high load (≥103 CFU/mL for the first urine sample and ≥ 104 CFU/mL for a urethral swab [11]). A low concentration suggests colonization, which was not possible to distinguish with the reference method and may have led to the inappropriate use of antibiotics. Overall, semi-quantitative results showed good agreement between the two kits, with 8 of 19 samples (42%) yielding concordant concentration categories. Comparison of semi-quantitative results between the two assays is nevertheless complicated by differences in predefined concentration thresholds and reporting categories. Most discordant results observed in this study did not reflect true differences in bacterial burden but rather methodological discrepancies between the assays. In nine (47%) of the eleven discordant cases, Elitech MYCOFAST® RevolutioN 2 reported concentrations >105 CFU/mL, whereas bioMérieux IST 3® reported concentrations >104 CFU/mL, corresponding to an intermediate bacterial load range between 104 and 106 CFU/mL. Importantly, these discrepancies did not translate into differences in clinical management, as all values exceeded recommended treatment thresholds for Ureaplasma urealyticum, regardless of specimen type. Only two samples showed true discordances with potential therapeutic implications. In one case, Elitech reported a concentration of 104 CFU/mL while bioMérieux reported >103 CFU/mL, whereas in the other case Elitech reported 103 CFU/mL and bioMérieux >104 CFU/mL. These discordances occurred in both directions and were observed at concentrations close to clinical decision thresholds, highlighting the inherent limitations of semi-quantitative categorization. Overall, these findings underscore that semi-quantitative results should be interpreted as approximate indicators of bacterial load and integrated with clinical context rather than used as absolute values for inter-assay comparison.
In the studied epidemiological context (Brussels, Belgium), resistance rates for Ureaplasma spp. and M. hominis remain low, in line with European and North American data [[12], [13], [14]]. The resistance found in this study concerned two isolates with tetracycline and one fluoroquinolone resistance. Among the three resistant isolates, there was one discrepancy in AST. It was unrelated to the MIC itself, which was concordant, but related to the interpretation provided by the kit. This discrepancy concerned isolate 3 (see Table 3), which is a Ureaplasma spp. with a tetracycline MIC of 1 mg/mL. The Elitech MYCOFAST® Revolution 2 kit would interpret this isolate as resistant, while the BioMérieux IST 3® kit would interpret it as sensitive. According to CLSI, the threshold for Ureaplasma spp. for tetracycline is 1 mg/mL or less for an isolate to be considered susceptible. According to the CLSI, then, BioMérieux IST 3® would give a better interpretation in this case. The low resistance prevalence, added to the fact that tetracycline is not the recommended treatment, might suggest that AST is not essential for most uncomplicated cases. However, it is precisely in the most complex situations—treatment failures or immunocompromised patients— that susceptibility data can become critical. Another advantage of systematically performing AST is to enhance therapeutic accuracy in settings where resistance is more frequent, especially in China, South Africa, Tunisia, UK and Greenland where higher resistance rates have been reported [[15], [16], [17], [18]].
The decisive advantage of the BioMérieux kit lied in its combination of slightly higher sensitivity and adapted integration into a high-throughput laboratory workflow (the ability to include a screening step with the R1-R2 broth, not possible with Elitech “UMMt” broth), which lead to choosing the kit for routine implementation. From the laboratory perspective, implementing a two-step algorithm (illustrated on Fig. 1) optimizes efficiency. The first step is quite rapid (reconstitute R2 broth with inoculated R1 broth), allowing only positive cases to be inoculated on the Mycoplasma IST 3® gallery, which significantly reduces the number of samples to inoculate and saves time on the inoculation step. Although the chosen workflow is very efficient for high demand, one limitation is that, if positive, the turnaround time (TAT) for identification, semi-quantification, and antimicrobial susceptibility testing (AST) is elongated. Knowing which microorganism and its concentration is important to decide whether to administer treatment.
Fig. 1.
Screening with the chromogenic R1-R2 broth followed, if positive, by identification, quantification, and AST using the IST 3® gallery.
One limitation of the selected kit is its incompatibility with respiratory specimens, which prevents its application in diagnosing neonatal respiratory infections. This limitation is notable given the importance of respiratory screening in neonates, where Ureaplasma spp. may be implicated in bronchopulmonary pathologies and other complications [1]. Future developments should aim to expand matrix compatibility to include respiratory samples, although this application would currently fall outside IVD-approved indications. This exploration has successfully been done for Elitech MYCOFAST® RevolutioN [19] but not for BioMérieux IST3 to our knowledge.
Recent official French guidelines [11] have clarified the current international recommendations. They advise against routinely testing women for Ureaplasma spp. and Mycoplasma hominis, as these organisms are no longer considered to be the cause of cervicitis. In men, the guidelines recommend testing only for Ureaplasma urealyticum, and only after excluding other, more common pathogens. Moreover, they add that detection should rely exclusively on quantitative molecular biology techniques. Considering these updated recommendations, the diagnostic kits evaluated in this study may still retain a limited role in specific contexts. Their use could be justified in male patients, if clinicians are appropriately informed not to prescribe such tests for women. Furthermore, molecular diagnostic methods are not universally available, particularly in low-resource settings or smaller laboratories. In these environments, culture-based gallery tests such as those assessed in this study may still represent a practical alternative. An additional advantage of these kits is their capacity for antimicrobial susceptibility testing (AST), which remains valuable in regions where resistance to conventional antibiotics has been reported. However, a major limitation lies in their inability to distinguish Ureaplasma urealyticum from Ureaplasma parvum, as only U. urealyticum appears to be clearly implicated in non-gonococcal urethritis. Although the French guidelines offer a precise and rational framework that may improve clinical management, culture continues to be regarded as the reference standard in many laboratories. While molecular assays are more sensitive, they are also at the moment more expensive and require trained personnel, limiting their accessibility in routine diagnostic settings [20,21] which allows the tested kits to retain their place in the detection and semi-quantification of these pathogens, particularly Ureaplasma urealyticum.
5. Conclusion
The BioMérieux Mycoplasma IST 3 kit provides a reliable and comprehensive method for the detection and management of Ureaplasma spp. infections. Its implementation within a two-step algorithm ensures both diagnostic accuracy and clinical relevance. Future evaluations should explore its applicability to additional sample types and continue to monitor resistance trends.
CRediT authorship contribution statement
Juliette Beaucarne: Writing – review & editing, Writing – original draft, Validation, Project administration, Methodology, Data curation. Ivana Buttice: Investigation. Nada Riahi: Investigation, Conceptualization. Ethel Seyll: Supervision, Project administration. Mony Hing: Writing – review & editing, Validation. Bram Vanmechelen: Writing – review & editing. Delphine Martiny: Writing – review & editing, Visualization, Validation, Supervision, Project administration, Methodology, Conceptualization.
Declaration of generative AI and AI-assisted technologies in the writing process
During the preparation of this work the author(s) used CHATGPT to organize ideas and help formulation and abstract conception. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the published article.
Funding sources
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Data availability
Data will be made available on request.
References
- 1.Waites K.B., Katz B., Schelonka R.L. Mycoplasmas and ureaplasmas as neonatal pathogens. Clin. Microbiol. Rev. 2005;18:757–789. doi: 10.1128/CMR.18.4.757-789.2005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Taylor-Robinson D, Lamont RF. OBGYN, https://obgyn.onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02766.x (accessed 9 May 2025).
- 3.Beeton M.L., Payne M.S., Jones L. The role of Ureaplasma spp. in the development of nongonococcal urethritis and infertility among men. Clin. Microbiol. Rev. 2019;32 doi: 10.1128/CMR.00137-18. e00137-18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Sweeney E.L., Dando S.J., Kallapur S.G., et al. The human ureaplasma species as causative agents of chorioamnionitis. Clin. Microbiol. Rev. 2017;30:349–379. doi: 10.1128/CMR.00091-16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Horner P., Donders G., Cusini M., 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. J. Eur. Acad. Dermatol. Venereol. 2018;32:1845–1851. doi: 10.1111/jdv.15146. [DOI] [PubMed] [Google Scholar]
- 6.Horner P.J., Blee K., Falk L., et al. 2016 European guideline on the management of non-gonococcal urethritis. Int. J. STD AIDS. 2016;27:928–937. doi: 10.1177/0956462416648585. [DOI] [PubMed] [Google Scholar]
- 7.Workowski K.A. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm. Rep. (Morb. Mortal. Wkly. Rep.) 2021;70 doi: 10.15585/mmwr.rr7004a1. Epub ahead of print. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Waites K.B., Bade D.J., Bébéar C., et al. Clinical and Laboratory Standards Institute; Wayne (PA): 2011. Methods for Antimicrobial Susceptibility Testing for Human Mycoplasmas; Approved Guideline.http://www.ncbi.nlm.nih.gov/books/NBK544375/ [PubMed] [Google Scholar]
- 9.Redelinghuys M.J., Ehlers M.M., Dreyer A.W., et al. Antimicrobial susceptibility patterns of Ureaplasma species and Mycoplasma hominis in pregnant women. BMC Infect. Dis. 2014;14:171. doi: 10.1186/1471-2334-14-171. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Boostrom I., Bala Y., Vasic J.M., et al. Evaluation of the MYCOPLASMA IST3 urogenital mycoplasma assay in an international multicentre trial. J. Antimicrob. Chemother. 2021;76:3175–3182. doi: 10.1093/jac/dkab320. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Diagnostic Biologique Des Mycoplasmes Urogénitaux Dans Les Infections Génitales Basses – Rapport D’Évaluation - Actualisation D’Avril 2025. Haute Autorité de Santé, https://www.has-sante.fr/jcms/p_3356494/fr/diagnostic-biologique-des-mycoplasmes-urogenitaux-dans-les-infections-genitales-basses-rapport-d-evaluation-actualisation-d-avril-2025 (accessed 14 October 2025).
- 12.Pónyai K., Mihalik N., Ostorházi E., et al. Incidence and antibiotic susceptibility of genital mycoplasmas in sexually active individuals in Hungary. Eur. J. Clin. Microbiol. Infect. Dis. 2013;32:1423–1426. doi: 10.1007/s10096-013-1892-y. [DOI] [PubMed] [Google Scholar]
- 13.Cantón R. Antibiotic resistance genes from the environment: a perspective through newly identified antibiotic resistance mechanisms in the clinical setting. Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis. 2009;15(Suppl 1):20–25. doi: 10.1111/j.1469-0691.2008.02679.x. [DOI] [PubMed] [Google Scholar]
- 14.Krausse R., Schubert S. In-Vitro activities of tetracyclines, macrolides, fluoroquinolones and clindamycin against Mycoplasma hominis and Ureaplasma ssp. isolated in Germany over 20 years. Clin. Microbiol. Infect. 2010;16:1649–1655. doi: 10.1111/j.1469-0691.2009.03155.x. [DOI] [PubMed] [Google Scholar]
- 15.Song J., Wu X., Kong Y., et al. Prevalence and antibiotics resistance of Ureaplasma species and Mycoplasma hominis in Hangzhou, China, from 2013 to 2019. Front. Microbiol. 2022;13 doi: 10.3389/fmicb.2022.982429. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Ramaloko W.T., Maningi N.E., Osei Sekyere J. Global prevalence, resistance rates, and underlying resistance mechanisms of clinical Mycoplasma and Ureaplasma species. J. Appl. Microbiol. 2025;136:lxae308. doi: 10.1093/jambio/lxae308. [DOI] [PubMed] [Google Scholar]
- 17.Boujemaa S., Mlik B., Ben Allaya A., et al. Spread of multidrug resistance among Ureaplasma serovars, Tunisia. Antimicrob. Resist. Infect. Control. 2020;9:19. doi: 10.1186/s13756-020-0681-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Govender S., Gqunta K., le Roux M., et al. Antibiotic susceptibilities and resistance genes of Ureaplasma parvum isolated in South Africa. J. Antimicrob. Chemother. 2012;67:2821–2824. doi: 10.1093/jac/dks314. [DOI] [PubMed] [Google Scholar]
- 19.Kusanovic J.P., Vargas Paula, Ferrer Fernando, et al. Comparison of two identification and susceptibility test kits for Ureaplasma spp and Mycoplasma hominis in amniotic fluid of patients at high risk for intra-amniotic infection. J. Matern. Fetal Neonatal Med. 2020;33:3409–3417. doi: 10.1080/14767058.2019.1572742. [DOI] [PubMed] [Google Scholar]
- 20.Redelinghuys M.J., Ehlers M.M., Dreyer A.W., et al. Comparison of the new Mycofast revolution assay with a molecular assay for the detection of genital mycoplasmas from clinical specimens. BMC Infect. Dis. 2013;13:453. doi: 10.1186/1471-2334-13-453. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Waites K.B., Xiao L., Paralanov V., et al. Molecular methods for the detection of Mycoplasma and Ureaplasma infections in humans: a paper from the 2011 William Beaumont Hospital symposium on molecular pathology. J. Mol. Diagn. 2012;14:437–450. doi: 10.1016/j.jmoldx.2012.06.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
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Data Availability Statement
Data will be made available on request.