Ureaplasma and Mycoplasma
This urine test may be used to detect Ureaplasma urealyticum and Mycoplasma hominis.
About the Test
Purpose of the test
Mycoplasma testing, which may include ureaplasma testings is used to determine whether someone currently has or recently had a mycoplasma infection. The choice of tests and body samples collected depends on your age when tested, your general health status and symptoms, and on the health care practitioner’s clinical findings and suspicions of organ involvement.
Mycoplasmas are the smallest free-living microbes known. They may exist as part of the normal flora found in the throat, upper respiratory tract, and genitourinary tract. Unlike other types of bacteria in many ways, mycoplasmas can be difficult to culture and identify.
One type of Mycoplasma is M. pneumoniae, a common cause of upper respiratory infections, with an estimated 2 million cases in the U.S. each year. It is responsible for 15-20% of cases of community-acquired pneumonia, appearing as single cases and as periodic epidemics, especially in school-age children and in settings where people live in close quarters.
M. pneumoniae DNA testing may sometimes be ordered, along with other tests, such as Chlamydia pneumoniae, Bordetella pertussis, and Legionella species to help distinguish between these organisms as the cause of a respiratory infection.
Testing may occasionally be done to detect less common species of mycoplasma like Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma urealyticum. In adults, these organisms are primarily sexually transmitted, causing nongonococcal urethritis (NGU) and some inflammation of the prostate (prostatitis) in men, and sometimes associated with vaginal discharge and pelvic inflammatory disease (PID) in women.
M. hominis and U. urealyticum can also be passed from mother to baby during birth when the baby moves through an infected birth canal. Rarely, they can cause systemic infections in infants and in those with compromised immune systems.
M. hominis and U. urealyticum genital samples are typically tested using a culture method that takes several days to recover the microbes, but M. genitalium, which can take one to two months to grow, may be more reliably detected with DNA testing.
What does the test measure?
Mycoplasma testing is primarily used to help determine if M. pneumoniae is the cause of a respiratory tract infection. It may also be used to help diagnose a systemic infection that is thought to be due to other types of mycoplasma.
Two types of antibodies produced in response to an M. pneumoniae infection may be measured in the blood: IgM and IgG.
- IgM antibodies are the first to be produced by the body in response to infection. Levels of IgM rise for a short time period and then decline, often remaining detectable in the blood for several months.
- IgG antibody production follows IgM production, rising over time, and then stabilizing. Once you have had a mycoplasma infection, you will typically have some measurable amount of mycoplasma IgG antibody in your blood for the rest of your life.
In order to diagnose an active M. pneumoniae infection, a health practitioner may order both M. pneumoniae IgM and IgG antibody tests as acute samples and then collect another M. pneumoniae IgG test two to four weeks later. This combination of tests is ordered so that the change in the amount of IgG can be evaluated.
Direct Detection
M. pneumoniae detection involves finding the microbe in the respiratory secretions, blood, fluid, or tissue sample. This can be done either by culturing the mycoplasma in a supportive environment or by detecting its genetic material (DNA).
A mycoplasma culture is the traditional method of detection, but it is more difficult than culturing common bacteria such as staphylococci or streptococci. Mycoplasma lack cell walls and do not grow well on routine bacterial culture media; they also cannot be visualized with a Gram stain as done with most bacteria. Growing mycoplasma involves incubating your sample in a special nutrient media, which are slow to grow.
A negative M. pneumoniae culture must be held for three to four weeks to confirm that mycoplasma is not present, compared to two to four days for most bacteria. Antibody testing, or sometimes DNA testing, is usually ordered in addition to, or instead of, a M. pneumoniae culture because of this long incubation period before results can be released.
DNA testing is more rapid and sensitive, but only just started being done now that there are syndromic panels available that allow the detection of multiple respiratory pathogens that include M. pneumoniae. This has increased the ability of laboratories to test for this microbe.
Detecting mycoplasma DNA does not confirm current infection, though. The presence of mycoplasma DNA may indicate the microbe is colonizing you, or mycoplasma DNA may be detectable after the symptoms of infection have resolved and the organisms are no longer viable.
Testing may be used to determine if Mycoplasma hominis, Mycoplasma genitalium, or Ureaplasma urealyticum is the cause of an infection of the genital or urinary tract.
When should I get a mycoplasma test?
M. pneumoniae testing may be ordered when someone has severe respiratory symptoms that are not due to a typical bacterial infection, such as pneumococcal pneumonia. Some of these symptoms may include:
- Nonproductive cough that may persist for several weeks
- Fever
- Sore throat
- Headaches and muscle aches
Testing may be done when an infection spreads to the lower respiratory tract, causing “walking pneumonia,” and/or spreads to other parts of the body and causes complications such as rash, arthritis, encephalitis, inflammation of the heart muscle, or lack of response to standard treatments. It may also be ordered to help track and control the spread of M. pneumoniae infections during an outbreak.
Testing for other species of mycoplasma may be performed, in addition to M. pneumoniae testing, when very young infants and those with compromised immune systems have lung and/or systemic infections or complications that could be due to mycoplasma infection.
In general, IgM and IgG testing are performed when a health practitioner suspects that you have an active M. pneumoniae infection, and another IgG test may be performed two to four weeks later to document a rise in antibody levels in response to an infection. A M. pneumoniae culture and a DNA test may also be ordered when an active infection is suspected.
Testing of genital samples is not often done because mycoplasmas are frequently part of the normal flora of the genital tract. But a culture for M. hominis and U. urealyticum may sometimes be ordered when a sexually active male or female is suspected of having a genital mycoplasma infection after tests for gonorrhea and chlamydia have come back negative.
Finding a Mycoplasma Test
How can I get a Mycoplasma test?
To get a mycoplasma test, samples are typically collected in your health care practitioner’s office, but testing requires specialized equipment and will need to be done in a hospital or reference laboratory. In most cases, a doctor will order the test for you.
If you’re testing for the type of mycoplasma that may be causing symptoms to a sexual organ, though, there are urine tests you can order online as well as ureaplasma and mycoplasma at-home test kits available to conduct genital swabs on your own.
Can I take the test at home?
At-home ureaplasma and mycoplasma test kits are available if you’re checking for the presence of mycoplasma as it relates to your sexual health. For women, a collection kit via a vaginal swab is available, while men can provide a urine sample. Results take approximately three to four days.
How much does the test cost?
The cost of a mycoplasma depends on where the test is taken and what your insurance covers. If ordered by a doctor as bloodwork, that is normally at least partially covered by insurance, minus any copays or deductibles you are responsible to pay. Check with your doctor and insurance plan about the cost of the test.
At-home mycoplasma testing kits (using urine or vaginal swab) cost around $99. In-lab mycoplasma testing ordered from Testing.com is $259. Other types of mycoplasma testing costs will vary depending on where the sample is taken. For questions involving costs, it’s best to check in with your health plan or refer questions to your health care provider or lab.
Taking a Mycoplasma Test
Direct detection of mycoplasma may be done on a variety of samples, and some may require a special procedure to collect them.
- Antibody testing requires a blood sample, obtained by inserting a needle into a vein in the arm.
- For a respiratory infection, samples may include sputum, a washing of the bronchi in the lungs, or a throat swab.
- If systemic infection is being diagnosed, blood, joint fluid, body fluids, or tissue samples may be cultured.
- To detect a genital infection, a swab of the cervix or urethra may be collected.
Before the test
Special preparation is not usually required before taking a mycoplasma count test, but it’s always smart to ask your health care provider if there are any pre-test instructions to follow.
For mycoplasma tests involving urine, sputum, or vaginal swab, the technician conducting the exam will guide you. If using an at-home test kit, be sure to carefully follow instructions so that you collect the sample correctly.
During the test
A blood sample for mycoplasma is taken from a vein in your arm by a phlebotomist. They will begin by tying a tourniquet around the upper part of your arm and may ask you to pump your fist to make the vein easier to find. Then they will clean your skin with an antiseptic wipe, and insert a needle to draw blood into a tube.
You may feel a quick pinch in your arm, but it usually subsides once the needle is withdrawn.
If you’re doing a sputum culture, you may be asked to cough into a container, or a tech may try to collect a sample using suction. You may feel slight irritation in your throat afterward, depending on how invasive the exam needs to be.
A urine mycoplasma test is as simple as collecting a sample of urine in a collection container.
For a vaginal sample, a swab must be inserted into the vagina. This can be done on your own, or by a medical practitioner. You shouldn’t feel any discomfort since it only takes a second and the swab is small. If doing your own test, be sure to follow instructions so you know how to correctly collect the sample.
After the test
There aren’t any specific instructions to follow after you complete a mycoplasma test. You might experience very mild soreness at the blood draw site, or if a sputum culture was done, your throat may feel raspy.
Mycoplasma Test Results
Receiving test results
Mycoplasma result turnaround times vary depending on the type of test you did. Blood tests to detect antibodies to M. pneumoniae come back within a few days, and perhaps faster in a hospital setting, but doctors sometimes want a repeat test done a couple of weeks later to recheck levels.
M. pneumoniae culture tests take much longer, with negative tests held for three to four weeks to confirm that a mycoplasma is not present. However, DNA testing is much more rapid, so doctors often order both tests at the same time.
Vaginal swab or urine test results should only take about three to four days. If using Testing.com, you can access your results when you log into your account.
Interpreting test results
Significant concentrations of M. pneumoniae IgM and/or a fourfold increase in IgG levels between the initial sample and the convalescent sample indicate an active or recent M. pneumoniae infection. Increases in IgG, without IgM, can also be seen with reinfection.
If neither IgM or IgG are present in detectable concentrations, you either do not have an active infection, have not had a recent or past mycoplasma infection, or your immune system has not produced antibodies in response to the microbe.
The detection of one of the mycoplasmas or U. urealyticum in a cultured sample may indicate that you have a mycoplasma infection, particularly if the sample is from a body site that is normally sterile, such as joint fluid or blood.
But if the sample is from the respiratory or genital tract, a positive culture may also mean that the mycoplasma is present as part of your normal flora. For example, U. urealyticum is present in the genital tract of about 60% of healthy women and M. hominis is present in about 20%.
If mycoplasma is not detected in a culture, then it may mean that you are not infected by that microbe or that the organism was not present in sufficient quantity to be detected in the sample tested.
With DNA testing for M. pneumoniae, if the mycoplasma is present in the sample, then you may have M. pneumoniae or may be colonized by the organism. If it is not detected, then you may not have a M. pneumoniae infection or the microbe was present in numbers too low to be detected.
Whenever you receive test results, especially for a less common test like mycoplasma, speak to your physician and ask questions. Some things to ask may include:
- Are these results conclusive or is follow-up testing needed?
- What treatment is available if the test detects mycoplasma in my body?
- Should other testing be done along with the mycoplasma test?
