The role of genital mycoplasma infection in female infertility: A systematic review and meta-analysis.

PROBLEM: Recent studies show that lower genital tract infection with genital mycoplasma may be associated with the pathology of female infertility. However, this association remains controversial due to the variable prevalence, sample sizes, and different methods used to diagnose genital mycoplasma infection. The aim of the present meta-analysis was to gain better understanding of the specific impact of genital mycoplasma on female infertility. METHOD OF STUDY: A systematic review of literature on the association of genital mycoplasma (Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum) infection and female infertility was performed using three electronic databases: PubMed, Scopus, and CINAHL, from January 2000 to January 2020. Pooled odds ratio (OR) and 95% confidence intervals for genital mycoplasma infection and female infertility were derived from a fixed effects model. RESULTS: This meta-analysis included eight studies conducted in six countries. Based on the results, women with infertility had a statistically higher odds of having any genital mycoplasma infection (p < .0001) compared to the control group. The pooled OR of all the included studies was 3.82 (95% CI: 2.55, 5.72). There was an unremarkable heterogeneity in all the studies included in this meta-analysis (I2  = 0%, p = .48). A subgroup analysis also showed that M. genitalium, M. hominis, and U. urealyticum infections are significantly associated with female infertility. CONCLUSION: Our meta-analysis showed a significant association between M. genitalium, M. hominis, and U. urealyticum infections and female infertility. This evidence supports the development of guidelines for the diagnosis and treatment of genital mycoplasma infections to prevent female infertility.

The prevalence of six species of Mycoplasmataceae in an HIV/AIDS population in Jiangsu Province, China.

This study employed culture and polymerase chain reaction (PCR) to examine the prevalence of Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Mycoplasma fermentans, Mycoplasma penetrans and Mycoplasma pirum in 210 HIV/AIDS patients, 455 sexually transmitted infection (STI) clinic attendees and 245 healthy volunteers from first-void urine specimens for men and endocervical swabs for women. U. urealyticum and M. hominis were detected in 107 (51.0%) and 69 (32.9%) patients in the HIV/AIDS group. At least one of the other four organisms was detected in 34 (16.2%) HIV/AIDS patients, 29 (6.4%) STI clinic attendees and six (2.5%) healthy volunteers. This study showed that U. urealyticum, M. hominis and M. fermentans were significantly more prevalent in HIV/AIDS patients, as were other mycoplasmas. Our results suggest a possible role for co-infection.

Relevant prevalence of Mycoplasma hominis and Ureaplasma urealyticum serogroups in HIV-1 infected men without urethritis symptoms.

M. hominis and U. urealyticum are the better-known mycoplasma species pathogenic to the human genitourinary tract, causing mainly urethritis, bacterial vaginosis and pregnancy complications. In HIV-infected patients, the prevalence and role of these species is still not well known. The aim of this work was to determinate the prevalence of these species in this group of male patients (HIV group), in comparison to a group of men with clinical symptoms of urethritis (STD group). M. hominis was isolated from 7.5% patients (8/106) and U. urealyticum from 18.9% patients (20/106) from the HIV group, being among these 62.5% and 85% in significant concentrations, respectively. In the STD group these rates were 0.9% (1/110) for M. hominis and 13.6% (15/110) for U. urealyticum, being 100% and 93.3% in significant concentrations, respectively. We could demonstrate infection rates by these mycoplasma species in the HIV group as high as the one found in the STD one, what may indicate the occurrence of opportunistic infections in our population. This fact is discussed here because in immunosuppressed patients, specially M. hominis has been reported causing severe infections, even systemically.

Relevant prevalence of Mycoplasma hominis and Ureaplasma urealyticum serogroups in HIV-1 infected men without urethritis symptoms

M. hominis and U. urealyticum are the better-known mycoplasma species pathogenic to the human genitourinary tract, causing mainly urethritis, bacterial vaginosis and pregnancy complications. In HIV-infected patients, the prevalence and role of these species is still not well known. The aim of this work was to determinate the prevalence of these species in this group of male patients (HIV group), in comparison to a group of men with clinical symptoms of urethritis (STD group). M. hominis was isolated from 7.5 per cent patients (8/106) and U. urealyticum from 18.9 per cent patients (20/106) from the HIV group, being among these 62.5 per cent and 85 per cent in significant concentrations, respectively. In the STD group these rates were 0.9 per cent (1/110) for M. hominis and 13.6 per cent (15/110) for U. urealyticum, being 100 per cent and 93.3 per cent in significant concentrations, respectively. We could demonstrate infection rates by these mycoplasma species in the HIV group as high as the one found in the STD one, what may indicate the occurrence of opportunistic infections in our population. This fact is discussed here because in immunosuppressed patients, specially M. hominis has been reported causing severe infections, even systemically.

Sexually transmitted diseases in homosexual males in Seville, Spain.

BACKGROUND AND METHODS: The absence of any official statistics on the prevalence of STD in homosexual men in Spain induced us to carry out a prospective study of new homosexual patients who consulted the STD Clinic of the School of Medicine in Seville, between January 1988 and December 1989. The aim of the study was to determine the prevalence of symptomatic and asymptomatic infections in this group of patients. RESULTS: 1805 patients were seen during the study period; 318 patients were homosexual of whom 309 agreed to participate in the study. Of the 309 homosexual men, 108 (35%) had symptoms and the remaining 201 (65%) were asymptomatic. In the symptomatic group the diagnoses were: syphilis 28 (25.9%); urethritis 40 (37%) (of these 40, 11 had Neisseria gonorrhoeae, five had Chlamydia trachomatis, five had Ureaplasma urealyticum, one had Herpes simplex virus and in 18 no pathogen was detected); genital herpes seven (6.4%). Eleven (10%) had concomitant infections. The following infections were found in the asymptomatic group: syphilis 23 (11.4%), N gonorrhoeae six (3%), C trachomatis two (1%), Herpes simplex virus one (0.5%). Antibodies against HIV were detected in 30 (9.6%) of the total group. CONCLUSIONS: Sexually transmitted diseases are common amongst homosexual men in Seville and many of these are asymptomatic.

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections in women. Prevalence, risks and management at a South African infertility clinic.

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections not only jeopardize fertility but also pose a risk for infertility treatment and resulting pregnancies. Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of these organisms. We studied the wives in 40 consecutive infertile couples. Monoclonal direct immunofluorescence (DIF) for C trachomatis was performed on fixed smears from endocervical swabs. M hominis and U urealyticum were isolated by inoculation of Hayflick (HF) medium, HF broth and Ureaplasma A7 agar with endocervical swabs. Using DIF, 11 (27.5%) specimens were positive, 25 (62.5%) were negative, and 4 (10.0%) were equivocal. DIF was repeated on smears from three of the last four patients; all three were positive for C trachomatis. One patient was lost to follow-up and excluded from the study. For the total 39 specimens the final results were 14 (35.9%) positive and 25 (64.1%) negative. M hominis was isolated from 3 (7.5%) endocervical swabs. None of the endocervical swabs yielded a culture positive for U urealyticum. Statistical analysis showed no correlation between the clinical history and presence of infection with any of the three organisms. The prevalence of 35.9% for C trachomatis was surprisingly high for an infertile population and, if supported by culture confirmation, justifies routine screening. The potential adverse effects of these organisms on the success rate of highly specialized infertility treatments are essentially unresolved. Since our analysis of cost effectiveness as applicable to our unit, all new infertile couples are treated empirically with lymecycline.

[Infections by Mycoplasma hominis and Ureaplasma urealytycum in vaginal discharge. Incidence and treatment]. / Infections à Mycoplasmes hominis et Ureaplasma urealytycum dans les écoulements vaginaux. Fréquence et traitements.

This report summarizes the studies carried out on 100 patients who were examined for vaginal discharge. The following observations were made: Mycoplasma hominis in 13.59% of the cases, Ureaplasma urealytycum in 8.73% of the cases, that is, the presence of at least one of these microorganisms in 22.32 of the cases. All these infections were treated by tetracyclines administered in appropriate doses.

Mycoplasmas among clients attending a family planning clinic in Zaria, Nigeria.

The effect of contraception in the incidence of genital tract mycoplasma infection was studied in 150 women practicing contraception and another 50 women attending a gynecological clinic, using no contraception. Using the chi-squared method, there was no statistically significant difference between total mycoplasma recovery in family planning clients versus the controls. The only statistically significant difference was between total positive mycoplasma in the oral contraceptive group versus IUD users.

Serological survey of the Iriomote cat (Felis iriomotensis) in Japan.

The Iriomote cat (Felis iriomotensis) was first discovered on Iriomote Island in the Yaeyama Islands of Japan in 1965. Ten male and 11 female adult cats were captured during the 6 yr period from 1983 to 1988. These were examined for evidence of viral and mycoplasmal infections. Neither Mycoplasma sp. nor Ureaplasma sp. were detected in swab samples of oropharyngeal and urogenital regions. A foamy virus was isolated from the oropharyngeal swab of a female cat examined in 1988. Feline leukemia virus was not detected in any of the cats. All cats were negative for serum antibodies to feline panleukopenia virus, feline herpesvirus, feline immunodeficiency virus and rotavirus. Eleven of 19 (58%), 14 of 17 (82%) and 6 of 17 cats (35%) had serum antibodies against feline calicivirus, coronavirus and feline syncytium forming virus, respectively.

Etiology of urethritis in Thai men.

The etiology of urethritis was determined for 303 Thai men with urethral discharge containing 5 or more polymorphonuclear cells (PMN)/high power field (hpf) and 132 men with a discharge containing less than 5 PMN/hpf. Neisseria gonorrhoeae was isolated significantly more often from men with greater than or equal to 5 PMN/hpf than from men with less than 5 PMN/hpf (42% vs 1%, P less than .0001). Chlamydia trachomatis was also isolated more often from patients with greater than or equal to 5 PMN/hpf than from men with less than 5 PMN/hpf (16% vs 8%, P less than .03). Ureaplasma urealyticum was isolated with nearly equal frequency from both groups of patients (45% vs 37%). Among men with a urethral exudate containing greater than or equal to 5 PMN/hpf, N. gonorrhoeae was isolated as the only pathogen from 19% and in combination with C. trachomatis or U. urealyticum in 23% of these men. C. trachomatis or U. urealyticum, but not N. gonorrhoeae, was isolated from 30%, and no pathogen was isolated from 28% of these men. Among men with urethral exudate containing less than 5 PMN/hpf, N. gonorrhoeae was isolated from only 1%, C. trachomatis or U. urealyticum from 41%, and no pathogen from 58%. These findings suggest that all Thai men with urethral discharge containing greater than or equal to 5 PMN/hpf should be treated for non-gonococcal urethritis and for gonococcal urethritis if gram-negative diplococci are demonstrated on gram stain of the urethral discharge. Men with urethritis with less than 5 PMN/hpf should be treated for only non-gonococcal urethritis.

Mycoplasma hominis and Ureaplasma urealyticum. Comparison of media for isolation and prevalence among patients with nongonococcal nonchlamydial genital infections.

One hundred and twelve genital specimens were cultured for Mycoplasma hominis and Ureaplasma urealyticum using a conventional system and the Mycotrim GU biphasic culture system. Both systems gave the same percentage of recovery (60%) of Mycoplasma hominis, while the recovery rates of Ureaplasma urealyticum were 95% with the conventional system and 83% with the Mycotrim GU. The media contamination was similar for both systems. The average time for Mycoplasma isolation and identification was shorter with the Mycotrim GU in comparison with the conventional system. The prevalence of Mycoplasma hominis in 91 patients with nongonococcal nonchlamydial urethritis and/or cervicitis was 8%, that of Ureaplasma urealyticum was 31%.

[Microbiological and serological study in cases of infertility with or without sterility with particular emphasis on the etiological role of Chlamydia trachomatis]. / Indagini microbiologiche e sierologiche in casi di infertilita' e/o sterilita' con particolare riguardo al ruolo svolto in essi da Chlamydia trachomatis.

Microbiological investigations were carried out on two groups of men and women--a) with genital non gonococcal pathology and--b) in infertile/sterile people of the same sex and age (mean age 28.4 y) with the aim to document in them the prevalence of various microorganisms particularly of Mycoplasma/Ureaplasma and Chlamydia trachomatis as aetiological agent of their pathology. Serum antibodies to Chlamydia trachomatis were also studied by microimmunofluorescence, immunoperoxidase and ELISA methods in the same population in comparison with apparently healthy blood donors of the same sex and age as control. Finally, 56 infertile/sterile couples were included in this study to investigate the possible role of Chl. trachomatis. Various microorganisms were isolated more frequently from women of the group b) (45.5%-22.9% respectively p less than 0.01). Mycoplasma/Ureaplasma in comparison with Chl. trachomatis were prevalent in all groups investigated (p less than 0.01). Infertile/sterile women had higher anti Chl. trachomatis antibodies than did women with genital non gonococcal pathology or women of the control group (p less than 0.01). Mycoplasma/Ureaplasma strains were isolated from infertile/sterile couples more frequently than Chl. trachomatis but the women of these couples had high titres (greater than 128) of anti Chl. trachomatis antibodies. Finally, IgA as well as IgG anti Chl. trachomatis antibodies were demonstrated in two out of nine peritoneal fluid samples obtained from women affected by PID. In one case, a pregnancy underwent after an ad hoc therapy of the two partners from whom two Ureaplasma strains were isolated.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation of mycoplasmas from bovine semen in Northern Ireland.

In a survey of 332 fresh and 137 processed bovine semen samples and 25 preputial washes, mycoplasmas and, or, ureaplasmas were isolated from 46 per cent, 31 per cent and 80 per cent, respectively. Intermittent isolation from different semen collections from the same bull indicated that at least three collections per bull were necessary to determine whether infection was present. When stored processed samples were examined Mycoplasma canadense and M bovigenitalium were isolated from straws taken as long ago as 1975. Addition of lincomycin and spectinomycin to the semen extender eliminated the isolation of mycoplasmas and reduced the rate of isolation of ureaplasmas.

Colonization with genital mycoplasmas in pregnant women and their neonates and birth weight.

The colonization by genital mycoplasmas of mothers and their newborn infants was examined in 114 pregnant women and their 84 neonates. Urine and cervical swabs were taken from the pregnant women in the last trimester, and urine from the neonates within six days after birth. Ureaplasma urealyticum was found in 73.7% of the pregnant women and in 17.9% of the neonates. Mycoplasma hominis was isolated in 8.8% of the material from the pregnant women and in 1.2% of that from the neonates. The isolation rate of U. urealyticum from newborn girls was significantly higher than that from newborn boys (p less than 0.01). There was no correlation between the germ density in the urine of the pregnant women and that of the neonates. The urine of the neonates harboured as many U. urealyticum as that of the adults. The frequency of colonization by mycoplasmas in the pregnant women or the neonates was not related to the duration of gestation or the babies' birth weight.

Cervical colonization with Ureaplasma urealyticum and pregnancy outcome: prospective studies.

We have investigated the prevalence of endocervical Ureaplasma urealyticum and its association with abnormal pregnancy outcomes in two large unselected cohorts of pregnant women. The overall prevalences of infection in the two groups were 72.5 and 81.2%, respectively. In univariate analysis endocervical U. urealyticum was not associated with spontaneous abortion or preterm low birth weight. It was also not associated with low birth weight or postpartum endometritis/fever, either in univariate analysis or by conditional logistic regression. Endocervical colonization is not in itself a risk factor for ascending prepartum infection and abnormal outcome. For methodologic reasons prospective studies and treatment trials will not be helpful unless subgroups of infected women in whom the infection is a risk for adverse outcome can be clearly defined.

Screening for Ureaplasma urealyticum infections in the neonate and the association with prematurity.

Ureaplasma urealyticum has been implicated in gynaecological, obstetrical and neonatal pathology. Increased levels of C-reactive protein and total IgM concentrations in cord blood have often been used as a screening method for infectious disease in the fetus and the newborn. Analysis of the isolation rate of U. urealyticum in function of the concentrations of these two parameters in cord blood showed that U. urealyticum was significantly (P less than 0.05) more frequently isolated when CRP was above normal in cord blood. No correlation between the IgM level in the newborn and the presence of U. urealyticum could be established. A significant relationship was found (P less than 0.01) between Ureaplasma isolation in the urine of mother and child on the one hand and gestational age on the other hand, which supports the hypothesis that U. urealyticum may play a role in preterm delivery.

Prevalence of Chlamydia trachomatis and genital mycoplasmas in asymptomatic women.

To establish the prevalence of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum in women attending a family planning and a prenatal clinic in Halifax, cervical swabs were obtained at the time of the first visit from 491 women who had no symptoms of genital infection. Among the women attending the family planning clinic M. hominis occurred in combination with C. trachomatis more frequently than expected (p less than 0.05). It occurred in the absence of U. urealyticum in only a few cases (13% of the occurrences in the family planning clinic and 6% of those in the prenatal clinic). C. trachomatis was significantly more prevalent in women under 25 years of age (p less than 0.04). However, mycoplasmas were as prevalent in women over 30 years as in those under 30. There were no significant differences in the infection rates of the organisms by trimester among pregnant women. More research is necessary for a proper understanding of the role of M. hominis and U. urealyticum in genitourinary infections and pregnancy outcomes.