Genital Mycoplasma and Chlamydia trachomatis infections in patients with genital tract infections attending a tertiary care hospital of North India.

Limited data are available on the prevalence of genital mycoplasmas and Chlamydia trachomatis (CT) among Indian patients with genital tract infections. The objectives of the study were to determine the prevalence of Ureaplasma urealyticum (UU), Mycoplasma hominis (MH), Mycoplasma genitalium (MG), and CT in patients with genital tract infections. The antimicrobial susceptibilities of UU and MH were also assessed. Endocervical swabs/urethral swabs and first void urine samples of patients (n = 164) were collected. UU and MH were detected by culture and multiplex polymerase chain reaction (PCR). MG and CT were identified by PCR. Ureaplasma isolates were further biotyped and serotyped. Antimicrobial susceptibility was done by microbroth dilution method. UU, MH, MG, and CT were detected in 15.2%, 5.4%, 1.2%, and 6% patients, respectively. Ureaplasma parvum serovar 3/14 was the most prevalent. All isolates of UU and MH were uniformly susceptible to doxycycline and josamycin. Routine screening for these pathogens and antimicrobial susceptibility testing is warranted to prevent sequel of infections and formulate treatment guidelines.

Prevalence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in genital samples collected over 6 years at a Serbian university hospital.

Background: Mycoplasma hominis and Ureaplasma urealyticum are implicated in a wide array of infectious diseases in adults and children. Since some species have innate or acquired resistance to certain types of antibiotics, antibiotic susceptibility testing of mycoplasma isolated from the urogenital tract assumes increasing importance. Aims: To evaluate the prevalence and antibiotic susceptibility of M. hominis and U. urealyticum in genital samples collected between 2007 and 2012. Methods: Three hundred and seventy three patients presenting with symptoms of sexually transmitted diseases, infertility or risky sexual behaviour, who had not taken antibiotics in the previous 6 weeks and had ≥10 WBC per high power fi eld on genital smears were studied. Urethral samples were taken in men and endocervical samples in women. The mycoplasma IST-2 kit was used for organism identifi cation and for testing susceptibility to doxycycline, josamycin, ofloxacin, erythromycin, tetracycline, ciprofl oxacin, azithromycin, clarithromycin and pristinamycin. Results: U. urealyticum was isolated from 42 patients and M. hominis from 11 patients. From 9.8% of isolates, both organisms were grown. All M. hominis isolates were resistant to tetracycline, clarithromycin and erythromycin while U. urealyticum was highly resistant to clarithromycin (94.6%), tetracycline (86.5%), ciprofl oxacin (83.8%) and erythromycin (83.8%). M. hominis was sensitive to doxycycline (83.3%) and ofl oxacin (66.7%) while most U. urealyticum strains were sensitive to doxycycline (94.6%). Limitations: Inability of the commercial kit used in the study to detect other potentially pathogenic urogenital mycoplasmas (Ureaplasma parvum, Mycoplasma genitalium). Conclusion: There is significant resistance of U. urealyticum and M. hominis to tetracycline and macrolides. The most active tetracycline for genital mycoplasmas was found to be doxycycline, which continues to be the drug of first choice.

Genital mycoplasma & Chlamydia trachomatis infections in treatment naïve HIV-1 infected adults.

Background & objectives: Sexually transmitted infections (STIs) enhance the transmission of human immunodeficiency virus (HIV). Thus, screening for STIs is a routine component of primary HIV care. There are limited data for selective screening guidelines for genital mycoplasmas and Chlamydia trachomatis in HIV-infected adults. The aim of the present study was to determine the frequency of genital infections with Ureaplasma spp., Mycoplasma hominis, M. genitalium and C. trachomatis in treatment naïve asymptomatic HIV-1 - infected adults and study their association with CD4+ T-cell count. Methods: First-void urine samples were collected from 100 treatment-naïve HIV-1-infected adults and 50 healthy volunteers. C. trachomatis and M. genitalium were detected by polymerase chain reaction (PCR). Ureaplasma spp. and M. hominis were detected by both culture and PCR. Circulating CD4+ cell counts of HIV-1-infected patients were determined from peripheral blood by flow-cytometry. Results: C. trachomatis was detected in 7 per cent of HIV-1-infected adults compared to none in control population. Ureaplasma spp. and M. hominis showed infection rates of 6 and 1 per cent in the HIV group and 2 and 0 per cent in the control group, respectively. None of the individuals from the patient and control groups was tested positive for M. genitalium. A significant association was found between CD4 cell count and detection of C. trachomatis in HIV-infected adults (P = 0.01). Interpretation & conclusions: Screening of HIV-infected individuals for C. trachomatis infection could be recommended as a routine component of HIV care. The role of mycoplasmas as co-pathogens of the genitourinary tract in HIV-1 infected patients seems to be unlikely. Further longitudinal studies need to be done to confirm these findings.

Association of genital mycoplasmas including Mycoplasma genitalium in HIV infected men with nongonococcal urethritis attending STD & HIV clinics.

Background & objectives: Acute nongonococcal urethritis (NGU) is one of the commonest sexually transmitted infections affecting men. The role of genital mycoplasmas including Mycoplasma genitalium in HIV infected men with NGU is still not known. The aim of this study was to determine the isolation pattern/detection of genital mycoplasma including M. genitalium in HIV infected men with NGU and to compare it with non HIV infected individuals. Methods: One hundred male patients with NGU (70 HIV positive, 30 HIV negative) were included in the study. Urethral swabs and urine samples obtained from patients were subjected to semi-quantitative culture for Mycoplasma hominis and Ureaplasama urealyticum, whereas M. genitalium was detected by PCR from urine. The primers MgPa1 and MgPa3 were selected to identify 289 bp product specific for M. genitalium. Chalmydia trachomatis antigen detection was carried out by ELISA. Results: M. genitalium and M. hominis were detected/isolated in 6 per cent of the cases. M. genitalium was more common amongst HIV positive cases (7.1%) as compared to HIV negative cases (3.3%) but difference was not statistically significant. Co-infection of C. trachomatis and U. urealyticum was found in two HIV positive cases whereas, C. trachomatis and M. hominis were found to be coinfecting only one HIV positive individual. M. genitalium was found to be infecting the patients as the sole pathogen. Interpretation & conclusions: Patients with NGU had almost equal risk of being infected with M. genitalium, U. urealyticum or M. hominis irrespective of their HIV status. M.genitalium constitutes one of the important causes of NGU besides other genital mycoplasmas.

Genital Mycoplasmas in the Newborn Infants: Colonization, Prevalence and Clinical Significance

PURPOSE: The genital mycoplasmas: Ureaplasma urealyticum and Mycoplasma hominis have recently assumed an increasing importance as neonatal pathogens especially in preterm infants. The aim of the present study was to determine the prevalence of infections with these organisms in newborn infants who were admitted in Neonatal Intensive Care Unit(NICU) and who were suspected having infection in newborn nursery METHODS: Sixty four inborns who were hospitalized in the NICU of Seoul National University Children's Hospital and Fourty seven term newborns who were born in Seoul National University Hospital and were evaluated for sepsis in the nursery due to high risk mother and baby's clinical symptoms from May 1994 through August 1994 were included in this study. Blood during the first hour of life and throat swabs during the second hours of life of the baby were collected. Tracheal aspirates were collected in the mechanically ventilated infants during the first day of life. Transport media for genital mycoplasma, urea and mycoplasma broth, and urea agar were used for isolation of genital mycoplasmas. RESULTS: In 64 inborns of NICU included in this study U. urealyticum was isolated in five(11.1%) out of 45 throat swab cultures, one(1.7%) out of 60 blood cultures and one(7.1%) out of 14 tracheal aspirates. M. hominis was isolated in 2 throat cultures. So total 14.3% of these infants harbored genital mycoplasmas. Among 47 term newborns included in this study from nursery, U. urealyticum was isolated 3(8.6%) out of 35 throat swab cultures and one (2.2%) out of 45 blood cultures shortly after birth. M. hominis was not isolated among them. Genital mycoplasma-positive infants in NICU had lesser gestatonal age and lower birth weight than genital mycoplasma- negative infants. Isolation of genital mycoplasmas was also associated with maternal clinical chorioamnionitis. No evidences that neonatal disease such as suspected sepsis, chronic lung disease of prematurity and neonatal outcome such as duration of hospital stay and mortality were related to genital mycoplasmas were noted. Cultures for genital mycoplasmas in amniotic fluid were performed in 26 preterm infants' mothers whose babies hospitalized in NICU and 11 had positve results. Acquisition rate of genital mycoplasmas in their neonates was 54.5%(6/11). One preterm infant who harbored U. urealyticum in the blood exhibited suspected congenital pneumonia. CONCLUSIONS: Our results demonstrate that colonization with genital mycoplasmas is not uncommon in the newborn infants in Korea and genital mycoplasma-positive preterms had lesser gestational age and lower birth weight than genital mycoplasma- negative preterms. Further study about the relation of genital mycoplasmas to neonatal morbidity will be needed.