Is Mycoplasma hominis a vaginal pathogen?

OBJECTIVE: To evaluate the role of Mycoplasma hominis as a vaginal pathogen. DESIGN: Prospective study comprising detailed history, clinical examination, sexually transmitted infection (STI) and bacterial vaginosis screen, vaginal swabs for mycoplasmas and other organisms, follow up of bacterial vaginosis patients, and analysis of results using SPSS package. SETTING: Genitourinary medicine clinic, Royal Liverpool University Hospital. PARTICIPANTS: 1200 consecutive unselected new patients who had not received an antimicrobial in the preceding 3 weeks, and seen by the principal author, between June 1987 and May 1995. MAIN OUTCOME MEASURES: Relation of M. hominis isolation rate and colony count to: (a) vaginal symptoms and with the number of polymorphonuclear leucocytes (PMN) per high power field in the Gram stained vaginal smear in patients with a single condition--that is, candidiasis, bacterial vaginosis, genital warts, chlamydial infection, or trichomoniasis, as well as in patients with no genital infection; (b) epidemiological characteristics of bacterial vaginosis. RESULTS: 1568 diagnoses were made (the numbers with single condition are in parenthesis). These included 291 (154) cases of candidiasis, 208 (123) cases of bacterial vaginosis, 240 (93) with genital warts, 140 (42) chlamydial infections, 54 (29) cases of trichomoniasis, and 249 women with no condition requiring treatment. M. hominis was found in the vagina in 341 women, but its isolation rates and colony counts among those with symptoms were not significantly different from those without symptoms in the single condition categories. There was no association between M. hominis and the number of PMN in Gram stained vaginal smears whether M. hominis was present alone or in combination with another single condition. M. hominis had no impact on epidemiological characteristics of bacterial vaginosis. CONCLUSION: This study shows no evidence that M. hominis is a vaginal pathogen in adults.

Ureaplasma urealyticum and chronic lung disease.

Neonatal lower respiratory tract colonisation with mycoplasma organisms was examined for an association with chronic lung disease. Ureaplasma urealyticum colonised 9/70 (13%) infants less than 1500 g. Seven (78%) colonised and 33 (54%) non-colonised infants developed chronic lung disease. Logistic regression analyses revealed early gestation, but not mycoplasma colonisation, was independently associated with chronic lung disease.

Ophthalmia neonatorum in Bangkok: the significance of Chlamydia trachomatis.

In a prospective 2-month case-controlled study, 17 cases of neonatal conjunctivitis were diagnosed. A statistically significant association between neonatal conjunctivitis and the presence of Chlamydia trachomatis (five cases) and Staphylococcus aureus (five cases) was shown. No cases of gonococcal conjunctivitis were found, perhaps because of the routine use of silver nitrate (1%) drops. C. trachomatis conjunctivitis could not be diagnosed on clinical grounds, nor was examination of Giemsa-stained conjunctival scrapes sufficiently sensitive to detect all cases. In order to prevent the long-term morbidity of C. trachomatis infection in both mother and child, specific aetiological diagnosis using immunodiagnostic or cultural procedures is required.

PIP: All 1033 children under 1 month of age attending the ophthalmology clinic at the Children's Hospital, Mahidol University, over the 2-month period July to August 1991 were entered in the study of ophthalmia neonatorum [ON]. Control neonates had either neonatal jaundice or mild respiratory distress but no signs of conjunctivitis. 2 controls matched for age and sex were chosen for each neonate with conjunctivitis. Demographic, social, medical, and obstetric histories were obtained from the mothers by direct questioning. 17 children (1.6%) had neonatal conjunctivitis. 5 neonates (30%) vs. none of the control neonates were infected by C. trachomatis as confirmed by ELISA and immunofluorescence. 5 (30%) of those with ON and significantly ( .03) fewer (6%) controls were infected with S. aureus. Coagulase-negative staphylococci, Acinetobacter anitratus, Pseudomonas spp., and diphteroids were isolated as or more frequently from control neonates. Chlamydial ophthalmia presented between 5 and 10 days after delivery. Of the neonates infected with S. aureus, 1 presented at less than 5 days of age, 2 presented at 5-10 days, and 2 at over 10 days; all of them were boys. Pus cells were on Gram-stained smears in all of the 15 patients tested and in 4 (12%) of the controls. 11 (64%) of the 15 patients had more than 5 pus cells per high power field, whereas only 1 ((3%) of the controls had similar numbers. Bacteria were seen in smears from 8 (53%) of the 15 patients tested and in 8 (23%) of the controls. Giemsa-stained smears of scrapes were available from 14 of the patients. Intracytoplasmic inclusions were seen in the conjunctival epithelial cells of 5 (35%) patients with ON, 3 of which were shown to contain C. trachomatis by ELISA and immunofluorescence. Of the various risk factors studied, only those women with a vaginal discharge during pregnancy (odds ration 6.7, 0.007), and those using non-barrier-type contraceptives (odds ratio 29.3, p 0.0002) were more likely to produce a child with ophthalmia neonatorum.

Mycoplasma hominis as a respiratory pathogen in X-linked hypogammaglobulinaemia.

We report a case of lower respiratory tract infection with Mycoplasma hominis in a patient with X-linked hypogammaglobulinaemia.

In vitro activity of florphenicol.

Florphenicol was active at a lower concentration than chloramphenicol against over half of 234 recent clinical bacterial isolates. The majority (98%) of the isolates were inhibited by florphenicol at a concentration of 8 mg/l or less. Florphenicol was particularly effective against chloramphenicol resistant strains of Haemophilus influenzae. Klebsiella aerogenes and Bacteroides spp. Florphenicol was bacteristatic for salmonellae and Escherichia coli but bactericidal for Haemophilus influenzae. Florphenicol was slightly more active than chloramphenicol against Chlamydia trachomatis, Mycoplasma hominis and Mycoplasma pneumoniae but less active against Ureaplasma urealyticum.

Incidence of Ureaplasma urealyticum in endourethral swabs compared with first voided urine from men.

The incidence of Ureaplasma urealyticum in endourethral swabs was compared with that in first voided urine specimens from 171 male patients. The organism was isolated from the urethras of 72 (42%) and from the urine of 66 (39%). The interval since last voiding urine did not significantly influence the incidence of infection or ureaplasma counts in either type of specimen. Urethritis was strongly associated with ureaplasma counts of greater than or equal to 5 x 10(5) colour changing units (ccu)/ml in the urethra and greater than or equal to 5 x 10(3) ccu/ml in urine.

Ciprofloxacin treatment of chlamydial infections of urogenital tracts of women.

Ciprofloxacin was evaluated in chlamydial infections of the urogenital tracts of women treated with a dosage regimen of 500 mg orally twice a day for seven days. Of the 40 women evaluated, 30 were infected with Chlamydia trachomatis only, two were infected with Neisseria gonorrhoeae only, and a further eight had combined gonococcal and chlamydial infections. Ten were found to be harbouring Chlamydia trachomatis in the urethra as well as the cervix. Neisseria gonorrhoeae was eradicated from all patients with or without concomitant chlamydial infection. The overall chlamydial reisolation rates were 14% (5/35) four weeks after treatment and 23% (6/26) 11 weeks after treatment. The organism was not reisolated from the urethra of any of the patients after treatment. Ciprofloxacin was effective against Mycoplasma hominis, but almost completely ineffective against Ureaplasma urealyticum.

Morbidity after termination of pregnancy in first trimester.

The outcome of termination of pregnancy was observed in relation to the preoperative clinical and microbiological findings in 167 women attending a day care abortion unit in Liverpool. Before termination, Chlamydia trachomatis was isolated from the cervix of 19 (11%) of the patients and high counts (greater than 10(4) colour changing units (ccu) per ml of specimen) of mycoplasmas were found in 30 (18%). Coexistent infections with chlamydiae and high counts of mycoplasmas occurred in only seven (4%) women. Trichomonas vaginalis, yeasts, or pathogenic bacteria were found in vaginal swabs from 30 (18%) women. After undergoing termination, seven (4%) women developed pelvic inflammatory disease (PID), five (71%) of whom had yielded C trachomatis before undergoing termination. A further 13 (8%) patients developed minor morbidity of the upper genital tract; high count mycoplasmal infection had been found in seven (54%) and chlamydial infection in three (23%) of these women before termination. In contrast, C trachomatis had been isolated from only 11 (8%) and high counts of mycoplasmas from 23 (16%) of the 147 women who had uneventful recoveries after undergoing termination. No correlation was apparent between the presence of vaginal pathogens before termination and the development of untoward sequelae postoperatively. Neither the history nor clinical examination before termination would have indicated that chlamydial or mycoplasmal infections were present, or that postoperative complications were likely to occur. Abnormal cervical cytology, however, was found in 86 (52%) of women overall, including 15 (79%) of the 19 women with chlamydial infection.

Persistent urethritis due to Ureaplasma urealyticum in conjugal or stable partnerships.

A study of four conjugal partnerships is described in which the male partners presented with persistent or recurrent non-gonococcal, non-chlamydial, but ureaplasma positive urethritis. Resolution of symptoms and signs in the male partners was achieved only after treatment to eliminate Ureaplasma urealyticum from both partners.

Evaluation of ciprofloxacin 500 mg twice daily for one week in treating uncomplicated gonococcal chlamydial, and non-specific urethritis in men.

Ciprofloxacin, a quinolone antibacterial, was evaluated in the treatment of gonococcal, chlamydial, gonococcal and chlamydial, and non-gonococcal non-chlamydial urethritis. The dosage regimen used was 500 mg orally twice a day for seven days. Of the 56 patients evaluated 22 had gonococcal infection only, 13 were infected with Chlamydia trachomatis only, seven had combined infection, and 14 were harbouring neither of these organisms. Neisseria gonorrhoeae was cleared in all the 29 patients with or without chlamydial infection. Of those who denied having sexual intercourse during the follow-up period, post gonococcal urethritis (PGU) developed in 12 (63%) out of 19, C trachomatis was isolated again from 11 (78%) out of 14, and urethritis recurred in five (55%) out of nine patients with non-gonococcal non-chlamydial infection. There was also evidence that the dosage regimen used was only partially effective against Ureaplasma urealyticum.

Differentiation of ectromelia virus haemagglutinin from haemagglutinins of other poxviruses.

The use of mouse erythrocytes in haemagglutinin titrations allows ectromelia virus haemagglutinin (EHA) to be differentiated from the haemagglutinins produced by other members of the variola/vaccinia subgroup of poxviruses.