Increasing the evaluation of Mycoplasma and Ureaplasma infections in primary care: A quality improvement project

BACKGROUND: Mycoplasma and Ureaplasma infections are frequently underdiagnosed and undertreated in primary care, contributing to adverse reproductive and genitourinary outcomes. Limited routine screening, diagnostic complexity, and variable provider awareness contribute to gaps in care. LOCAL PROBLEM: In an academic primary care setting, patients presenting with genitourinary symptoms were infrequently evaluated for Mycoplasma and Ureaplasma. METHODS: This quality improvement project was conducted in two academic family medicine clinics. Pre- and postintervention retrospective chart reviews assessed rates of testing and diagnosis among adult patients presenting with urethral or vaginal discharge, pelvic pain, and/or dysuria. Provider education and standardized evaluation and treatment algorithms were implemented. INTERVENTIONS: An educational session was delivered and supported with emailed materials. Standardized algorithms outlining indications for testing and recommended treatments were integrated into clinical workflow. RESULTS: During the study period, 519 patients presented with genitourinary symptoms. Recurrent symptoms consistent with Mycoplasma or Ureaplasma infection were identified in 205 patients (39.5%); however, 133 (64.9%) were not screened. Among the 72 patients (35.1%) who underwent diagnostic testing, 46 (63.9%) tested positive. Overall, 45 patients were diagnosed with Mycoplasma or Ureaplasma infections, including Mycoplasma hominis (26.7%), Ureaplasma parvum (31.1%), Ureaplasma urealyticum (20.0%), and Mycoplasma genitalium (20.0%). Most patients received guideline-concordant antimicrobial therapy, primarily doxycycline, azithromycin, or levofloxacin, with referral for specialty evaluation in cases of persistent infection. These primary care-based interventions reduced underdiagnosis and improved reproductive and genitourinary health outcomes. CONCLUSION: Targeted provider education and streamlined diagnostic protocols improved evaluation and screening for Mycoplasma and Ureaplasma in primary care.