By Dr. Moira Bradfield Strydom, PhD, M.Acu, B.Nat
At Intimate Ecology, we regularly work with people who, through vaginal microbiome testing, discover the presence of Ureaplasma and Mycoplasma species, members of the Mollicutes family. Usually, the testing has been done because there are pre-existing health symptoms like recurrent symptoms or if people are embarking on fertility planning. Which raises the question Ureaplasma and Mycoplasma… antibiotics or not?
And almost immediately, the more questions follow.
Is this causing my symptoms?
What does this mean for my fertility… or my partner?
There’s a lot of noise around these microbes, and understandably it can be quite stressful and worrying to find the bacteria, fall in an internet black hole of their potential to harm and to not be offered any perspective. So let’s zoom out and look at the bigger picture.
Presence doesn’t automatically mean infection
One of the most important things to understand is this:
Detection does not equal infection.
One important exception: Mycoplasma genitalium
Mycoplasma genitalium is a confirmed STI, and antibiotic treatment is appropriate. Left untreated, it can drive significant inflammation in both the vaginal microbiome and the pelvis, similar to what we see with chlamydia.
Seeing Ureaplasma spp. or Mycoplasma hominis on a vaginal microbiome test doesn’t automatically mean antibiotic treatment is required. Context matters, microbial load, symptoms, clinical history, and individual risk all play a role in deciding what to do next. There are of course many instances where they need address but knowing when matters. We also know that dysbiosis (imbalance of microbes in a microbiome) is a spectrum and we can of course see issues without overt infection and we can see a microbiome fluctuate over a course of time like a menstrual cycle.
Commensal or culprit?
The real question around treatment needs should centre around:
- Mycoplasma hominis
- Ureaplasma urealyticum
- Ureaplasma parvum
There’s a growing trend, especially online, where the presence of any of these microbes triggers an almost automatic recommendation for antibiotics. Usually a 7-10 day course of two antibiotics (sometimes even longer). A big hit for medications that in many instances are reserved for much bigger infections.
When we look at the research around these bacteria we see conflicting and more nuanced information.
These organisms may act as commensals in some individuals, quietly existing within the genitourinary microbiome without causing harm. In other people, they may contribute to symptoms or inflammation, perpetuating disorder or even being the main infective microorganisms driving specific urinary and vaginal symptoms.
So the question isn’t simply “Are they there?”
It’s “What are they doing?”
Ureaplasma and Mycoplasma…antibiotics or not?
There are absolutely scenarios where antibiotics are the right call.
Clinically, this tends to be when:
- Microbial levels are high (relative abundance on next generation testing)
- Symptoms are significant and not explained by other organisms
- Acute infection confirmed via PCR and in alignment with signs and symptoms and risk
- There’s a fertility context with a history of loss, infection, or increased risk
In these cases, antibiotics can be an appropriate and effective intervention.
There may be a choice of appropriate antibiotic interventions that aren’t quite as damaging (species specific).
But even then, it’s not just about the prescription, it’s about the plan around it.
It is about supporting multi microbiomes to recover. It is also making sure you know about the risks of re-infection and if applicable partner treatment.
If you’re using antibiotics, support matters
Antibiotics don’t act in isolation, they impact multiple microbiomes.
So if treatment is chosen, we also need to think about:
- Protecting the gut microbiome
- Minimising collateral damage on the gut, oral, vaginal microbiomes and everything they impact e.g. hormones, immune etc
- Preventing vulvovaginal candidiasis (thrush) during treatment
- Considering partner treatment and retesting where relevant
And importantly, what happens after.
Because often, these microbes don’t exist alone, they sit within a broader microbial landscape that may include BV-associated organisms, aerobic imbalances and fungal opportunity.
So essentially, we can’t assume that everything is ok because you have used the antibiotic approach. We still need to restore, rebuild and address the “why”.
What about a holistic approach?
For those choosing a non-antibiotic pathway, expectations need to shift, particularly around time. Reduction of these weird little bacteria without cell walls can take months of support and nudging the microbiome. There are scenarios where the bacteria may move on quickly, but the reality is that there is little to be gained by retesting too soon.
There is emerging evidence that herbal and nutritional interventions can reduce and in some cases eradicate Ureaplasma and Mycoplasma species. Clinically, we also see reduction without full eradication, alongside symptom resolution and microbiome stabilisation.
Which raises an interesting question:
Do we always need eradication… or do we need balance?
Are we overreacting to detection?
If you have heard me talk about this before you would have heard me voice the questions:
- Are we demonising microbes simply because they’ve been detected?
- Is this like the hunt for Blastocystis in the gut (killing without considering relevance and role)?
- What are we risking in other microbiomes when we use antibiotics for a low microbial load?
- Would a strategy focused on stabilisation, microbial crowding, and resilience lead to better long-term outcomes?
- There aren’t perfect answers here, but these are the right questions.
Species, strategy, and timelines matter
Not all Mollicutes behave the same.
- Mycoplasma genitalium → requires antibiotics, highly inflammatory and considered an STI
- Mycoplasma hominis → may respond to less disruptive or local options if treatment is needed (Clindamycin), less inflammatory
- Ureaplasma urealyticum → more inflammatory, amounts matter
- Ureaplasma parvum → less inflammatory and in my opinion moves on much easier than other Mollicutes when holistic interventions are used
And if you’re taking a holistic route:
- It will take time
- It needs to be targeted (oral and intravaginal herbs, nutrients, pre and probiotics), probiotics alone will likely not cut it
- Partner treatment still matters
When symptoms persist after treatment
One of the more frustrating scenarios we see is when antibiotics are used… and symptoms remain.
Yes, these microbes can drive inflammation, but if symptoms persist post-treatment, we need to ask:
- What’s maintaining the inflammation?
- Has there been some remodelling around inflammation, histamine and neuronal signalling?
- What actually needs to shift now?
- Should we be retesting the microbiome?
Because the focus may need to move toward:
- Resolving inflammation
- Supporting post-treatment recovery
- Rebuilding a stable, predominantly Lactobacillus-dominant microbiome
And importantly, ensuring that Lactobacillus itself isn’t contributing to symptoms through overgrowth or imbalance (Cytolytic vaginosis and lactobacillus overgrowth disorders).
This is rarely a single-organism story.
It’s a systems story, one that requires both a big-picture view and attention to detail.
The right intervention depends on your symptoms, your history, your microbiome, and your goals.
Need support?
If you’d like help navigating this, working with a clinician can make a significant difference.
We can help you:
- Interpret your microbiome results
- Understand the levels and relevance of Ureaplasma and Mycoplasma
- Explore the appropriateness and decision making for both antibiotic and holistic options
- Build a treatment and restoration plan that’s actually tailored to you
If antibiotics are part of that plan, we also support you through microbiome protection and recovery.
Need support? Book an appointment with an Intimate Ecology practitioner here
And if you’d like to go deeper, you can explore our Instagram posts on this topic.
Ureaplasma and Mycoplasma…antibiotics or not?
- Ahh, I have Ureaplasma is it going to be a problem? View instagram post here
- Discharge so thick I have to insert a finger to scoop it out. View instagram post here
- Can I reinfect myself with Ureaplasma with a sex toy? View instagram post here
- Mycoplasma and Ureaplasma (amounts) View instagram post here
- A video chat with Dr Moira (PhD) on ureaplasma perspectives. View instagram post here
- General Ureaplasma urealyticum spotlight post. View instagram post here
Practitioner needing more insight into treatment?
Visit the Intimate Ecology online school for a Tea Twat education on holistic treatment options and consideration.
New extended webinar coming in 2026.
View entire online school here