Colonization of the lower urogenital tract with Ureaplasma parvum can cause asymptomatic infection of the upper reproductive system in women: a preliminary study.

PURPOSE: Genital ureaplasmas are considered opportunistic pathogens of human genitourinary tract involved in adverse pregnancy sequelae and infertility. While association of Ureaplasma urealyticum with urogenital tract infections is well established, the role of Ureaplasma parvum in these infections is still insufficient. In the study, we compared how often cervicovaginal colonization with U. parvum is associated with the presence of these microorganisms in the upper genitourinary tract of fertile and infertile women. METHODS: We used PCR assay to determine the prevalence of U. parvum and U. urealyticum in pairs of specimens, i.e., vaginal swabs and Douglas' pouch fluid samples from consecutive 40 women with no symptoms of genital tract infection. RESULTS: In total, 19 (47.5 %) of the 40 samples were positive for ureaplasmas. U. parvum was simultaneously detected in pairs of samples in five (55.5 %) of the nine (47.4 %) women positive in PCR assay. As many as 5 (18.5 %) of the 27 infertile women and 1 (7.7 %) of the 13 fertile women showed infection of the upper genital tract with U. parvum. CONCLUSION: The results of the study demonstrated that colonization of the lower genital tract with U. parvum can produce asymptomatic infection of the upper reproductive system in women. These findings also imply that U. parvum may be present in the upper genital tract at the time of conception and might be involved in adverse pregnancy outcomes.

Association of cervical infection of Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis with peritoneum colonisation in pregnancy.

This study investigated the prevalence of Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis infections in the cervices and peritoneum of pregnant women and compared them with non-pregnant controls. A total of 96 pregnant women who planned to deliver by caesarean section, and 124 non-pregnant women were screened for cervical Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis infections by polymerase chain reaction analysis. If cervical infection was present, peritoneal infection was searched from the Pouch of Douglas during caesarean section in the pregnant group and was searched by culdocentesis in the control group. Chlamydia trachomatis infection was present in 7.3% of pregnant women and 2.4% of the non-pregnant controls. Ureaplasma urealyticum infection was present in 26% of pregnant women and 15.3% of the non-pregnant controls. The incidence of Chlamydia trachomatis and Ureaplasma urealyticum infection was significantly higher in pregnancy. Mycoplasma hominis infection was present less frequently compared with Chlamydia trachomatis and Ureaplasma urealyticum in both groups. Intraperitoneal colonisation by Chlamydia trachomatis was present in only one pregnant woman and in one non-pregnant control. No intraperitoneal infection was detected for Ureaplasma urealyticum and Mycoplasma hominis. Cervical Ureaplasma urealyticum and Chlamydia trachomatis infections were more frequently seen in pregnant Turkish women.

Colovesical fistulae in the sigmoid diverticulitis.

In most cases Colovesical fistulae are complications of diverticular disease and representing the most common kind of colodigestive fistula; less common are colovaginal, colocutaneous, coloenteric and colouterine fistula. In this article we review the literature concerning colovesical fistulae in colorectal surgery for sigmoid diverticulitis and report on two cases that required a surgical treatment, one elective and the other in emergency. In both cases we performed a sigmoid resection with a primary anastomosis and small vesical window-ectomy placing a Foley catheter for about 10 days.

[Frequency of detection of Ureaplasma urealyticum and Mycoplasma hominis in cervical canal and the Douglas pouch of infertile and fertile women]. / Czestosc wykrywania Ureaplasma urealyticum i Mycoplasma hominis w kanale szyjki macicy i jamie otrzewnej u plodnych i nieplodnych kobiet.

The group of organisms commonly referred to as genital mycoplasmas comprise species most often found in genitourinary tract of sexually active adults as common commensal inhabitants, or pathogens which can possibly cause many different pathologies like: non-gonococcal urethritis, bacterial vaginosis, cervicitis, endometritis or pelvic inflammatory disease. The problem of their morbidity and the possible influence they have on human fertility is still not clear. The aim of this study was to find out whether two investigated species- Ureaplasma urealyticum and Mycoplasma hominis can be detect more often in a group of infertile women. 74 women participated in the study and were assigned to one of 2 groups of patients: infertile women and fertile women without any sign of genital tract infection. Swabs from the cervical canal of the uterus and the fluid from the Douglas pouch were taken during the gynecological examination and laparoscopic procedure. Two diagnostic methods were used: biochemical method- commercial diagnostic kit- Mycoplasma IST 2 and PCR method. The results showed that Ureaplasma urealyticum and Mycoplasma hominis were detected among both fertile and infertile women with nearly the same frequency, much more often in cervical canal than in the Douglas pouch. Ureaplasma urealyticum was more common pathogen than Mycoplasma hominis in both groups and locations. The achieved results point out that the role of genital mycoplasmas in human infertility is still unclear and require further investigations.

Prevalance of Chlamydia trochomatis, Ureaplasma urealyticum and Mycoplasma hominis infections in the unexplained infertile women.

OBJECTIVE: To prospectively investigate the prevalence of Chlamydia trachomatis (CT), Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU) in the cervical canal and pouch of Douglas in unexplained infertile women and compare it to healthy controls in the Turkish population. MATERIALS AND METHODS: A total of 31 women presenting with a history of infertility [n = 24 (77%) primary infertility, n = 7 (23%) secondary infertility] between 20 and 38 years of age and 31 women willing to have tubal ligation between 30 and 41 years of age were consecutively included into this study. Specimens were taken from intra-abdominal washings and from the cervical canal. CT, MH and UU were detected with polymerase chain reaction (PCR). RESULTS: Results of 62 women were analyzed. None of the participants met the criteria for salpingitis during laparoscopy. The most common infection in the cervical canal in both groups was UU, which was detected in 13 cases of infertile patients and 11 controls (P = 0.602). Cervical chlamydial and mycoplasmic infection was detected in one case each in infertile and control patients. Neither MH nor UU were obtained from the pouch of Douglas in both groups. Only CT was present in peritoneal fluid of an infertile woman who had also a concomitant chlamydial infection in the cervical canal. CONCLUSION: Demonstration of cervical colonization of CT by PCR may be a promising method for the detection of asymptomatic pelvic infection in patients with unexplained infertility. However, screening for MH and UU is not cost-effective due to similar low rates of detection.

Improved diagnostic value of PCR in the diagnosis of female genital tuberculosis leading to infertility.

Histopathological and mycobacteriological examinations have limited utility in the diagnosis of genital tuberculosis. In this double-blind study, 61 samples, consisting of endometrial aspirates (EAs), endometrial biopsies (EBs) and fluid from the pouch of Douglas (POD), from 25 women suffering from infertility were investigated for the presence of the mpt64 gene of Mycobacterium tuberculosis by PCR and correlated with laparoscopic findings. PCR demonstrated M. tuberculosis DNA in 14 out of 25 patients (56.0 %), compared to one smear with acid-fast bacilli (1.6 %) and two culture-positive samples (3.2 %). The presence of M. tuberculosis DNA was observed in 53.3 % of EBs, 47.6 % of EAs and 16.0 % of POD fluid samples. All patients with laparoscopy suggestive of tuberculosis, 60 % of those with a probable diagnosis and 33 % of those with incidental findings were positive by PCR. However, one EA sample from an infertile patient with normal laparoscopy was also positive. Multiple sampling from different sites and amplification of the mpt64 gene segment by PCR offered increased sensitivity in determining tuberculous aetiology in female infertility.

[Abdomino-pelvic actinomycosis: a case report]. / Actinomycose abdomino-pelvienne: à propos d'un cas.

The actinomycosis is a chronic suppurative granulomatosis disease. It is owed to a bacillus gram positive; actinomycès israelli. The cervical and thoracic localizations are most frequent. The digestive localization represents 20% of cases. It interest very rarely the pelvis and the genital tracts. We bring back the observation of a patient old of 30 years admitted for mass abdominal. To the exam, the patient had a sensibility of the left hypochondriac area and we found a mass of 6 cm of diameter. To the rectal touch, we found a mass in the bag of Douglas. The echography and the computed tomography revealed a collection under the spleen and a pelvic collection. A rectotomy is performed. The bacteriological study isolates actinomycès israelli. The collection under the spleen is drained under radiological control. Actinomycès israelli is also recovered in the pus brought back by the puncture. The patient is treated by Penicillin. The patient had a favourable evolution. No etiology is found at this patient. For this observation, the collection was accessible to a drainage permitting the diagnosis and the treatment of the actinomycosis while avoiding a mutilated surgery.

[Mycoplasma hominis and Ureaplasma urealyticum of cervical canal and in the pouch of Douglas in infertile women: a preliminary report]. / Mycoplasma hominis i Ureaplasma urealyticum w kanale szyjki macicy i w zatoce Douglasa u nieplodnych kobiet-doniesienie wstepne.

Detection of Mycoplasma hominis and Ureaplasma urealyticum in the samples obtained from the cervical canal of the uterus and from the pouch of Douglas in 71 women in whom underwent diagnostic and operative laparoscopy is presented. Ureaplasma urealyticum in 33 cases diagnosed for infertility was present in 6 (18.2%) patients. In cervical canal and the pouch of Douglas in 5 and 2 women respectively. In 1 (3.0%) woman Ureaplasma urealyticum was present in both places. In the women from the control group U. urealyticum was detected in 6 (15.5%) cases only in cervical canal. Mycoplasma hominis was present only in cervical canal more frequently in the control group 4 (cases) than among infertile women 1 (3.0%).

[Chlamydia trachomatis in cervical canal and in the pouch of Douglas in infertile women]. / Chlamydia trachomatis w kanale szyjki macicy i w zatoce Douglasa u nieplodnych kobiet.

The results of microbiological examination of samples from cervical canal of the uterus and from pouch of Douglas in 71 women who underwent diagnostic and operative laparoscopy is presented. In 33 cases diagnosed because of infertility Chlamydia trachomatis was present in 2 (6.1%) women and in one woman both in cervical canal and pouch of Douglas. In second woman only in cervical canal Chlamydia trachomatis was present. There was not statistically significant correlation between control and study groups.

Anaerobic and aerobic microflora of pouch of Douglas aspirate v/s high vaginal swab in cases of pelvic inflammatory disease.

The anaerobic and aerobic bacterial flora in pouch of Douglas (POD) aspirate and high vaginal swabs (HVS) was studied in 43 cases of pelvic inflammatory disease (PID) using standard techniques. High vaginal swabs from 20 healthy women were included as controls. Anaerobic and aerobic bacteria were isolated from 37 (86%) HVS and 31 (72%) POD aspirates from these 43 women. A total of 100 aerobic and 10 anaerobic bacterial strains were recovered from both the sites. Coagulase negative staphylococci (28), Escherichia coli (23) and Streptococcus faecalis (14) were predominant aerobic bacteria. Of the anaerobes, peptostreptococci species and Bacteroides species were more common, polymicrobial flora (more than one type of organism) was present in a total of 27 specimens. However mixture of anaerobic and aerobic bacteria were seen in only 5 specimens. Of the 20 control specimens, ten were positive for organisms. Ten aerobic and 3 anaerobic bacterial strains were recovered.

PIP: Anaerobic and aerobic bacteria were isolated from the vagina and pouch of Douglas (POD) in 43 women who presented with pelvic inflammatory disease (PID) to the University College of Medical Sciences and Guru Tegh Bahadur Hospital in Shahdara, Delhi, India. In addition, high vaginal swabs were taken from 20 healthy controls. In the PID group, a positive culture was achieved in 42 of 43 cases. Anaerobic and aerobic bacteria were isolated from 37 (86%) high vaginal swab and 31 (72%) POD specimens. Of the 26 PID cases in which both vaginal swab and POD specimens were positive, 18 (72%) had different microflora at the two sites. In 5 additional cases, high vaginal swabs were negative for organisms detected by POD aspiration. A total of 100 aerobic and 10 anaerobic bacterial strains were recovered from both the sites. Coagulase negative staphylococci, Escherichia coli, and Streptococcus faecalis predominated. Polymicrobial flora were detected in 27 specimens from women with PID, but only 5 of these contained a mix of anaerobes and aerobes. Among controls, a total of 10 aerobic and 3 anaerobic strains were recovered from 10 specimens. These findings confirm that POD aspiration provides a more accurate picture of the microbial population of the fallopian tubes than high vaginal swab and has a definite role in the management of PID patients.

False-positive cultures of the cul-de-sac associated with culdocentesis in patients undergoing elective laparoscopy.

We studied 21 women undergoing elective laparoscopy to determine whether positive bacterial cultures obtained by culdocentesis were contaminants from the vaginal mucosa. Cultures for aerobic and anaerobic microorganisms were prepared from swabs of the posterior vaginal fornix, laparoscopic cul-de-sac aspirates, culdocentesis aspirates, and repeat laparoscopic aspirates of the cul-de-sac. Cultures were positive from the vaginal fornix in all cases. All cultures from the cul-de-sac before culdocentesis were negative. Five of seven cultures (71.4%) from culdocentesis specimens and seven of nine cultures (77.8%) from repeat laparoscopic cul-de-sac aspirates were positive in women without povidone-iodine vaginal preparation. Five of 12 cultures (41.7%) from culdocentesis specimens and three of 12 cultures (25%) from repeat laparoscopic cul-de-sac aspirates were positive in the women with vaginal preparation. Both aerobic and anaerobic bacteria were recovered. We conclude that false-positive culdocentesis cultures occur and that bacterial contamination of the cul-de-sac following culdocentesis may lead to false-positive cultures of specimens obtained during subsequent laparoscopy.

[Incidence and significance of pathogen detection in Douglas fluid in non-inflammatory genital diseases]. / Häufigkeit und Bedeutung des Keimnachweises in der Douglasflüssigkeit bei nichtentzündlichen Genitalerkrankungen.

Between 1976 and 1986 the secretions from the pouch of Douglas of 1,219 patients with non-inflammatory genital diseases were microbiologically studied. Microorganisms were detected in 3.4%. In the majority of cases they were physiological skin organisms, with a count of less than 10 per ml of Douglas fluid. These findings support the view, that secondary contamination of the specimens occurred during removal, transportation, or laboratory processing.

Correlation of ultrasonography and bacteriology of the endocervix and posterior cul-de-sac of patients with severe pelvic inflammatory disease.

We evaluated 30 patients admitted with a diagnosis of pelvic inflammatory disease (PID) by culdocentesis and ultrasonography to determine the severity of disease in relation to endocervical and culdocentesis bacteriology. Specimens from the endocervix were cultured for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum. In addition, culdocentesis fluid was cultured for aerobes and anaerobes. Patients with N. gonorrhoeae or C. trachomatis had significantly milder disease (P less than 0.05) compared with patients whose specimens were negative for those organisms. Furthermore, those patients with ultrasound confirmation of a tubo-ovarian complex had significantly (P less than 0.0001) greater recovery of aerobes and anaerobes from culdocentesis fluid than did patients with milder disease.

Impact of diverging anaerobic technology on cul-de-sac isolates from patients with endometritis-salpingitis-peritonitis.

The probability of obtaining accurate identification of bacteria present in the cul-de-sac in cases of polymicrobial bacterial endometritis-salpingitis-peritonitis (ESP) was analyzed on the basis of a comparison of bacteriologic data derived from the hospital laboratory and those engendered by a research anaerobic laboratory. Two sets of paired cul-de-sac specimens from 20 cases of ESP were analyzed at two different laboratories whose anaerobic technology differed from that of the reference laboratory. At University Hospital (Jacksonville, Florida), 22 of 36 (61%) aerobic bacterial isolates were correctly identified, in contrast to only eight of 52 (15.4%) anaerobic isolates. The clinical facility of the University of Florida College of Medicine (Gainesville, Florida) identified 28 of 32 (86.5%) aerobic and 16 of 34 (47.9%) anaerobic isolates. The probability of accurately delineating the anaerobic bacteria present in polymicrobial peritonitis which may develop in patients with acute salpingitis was directly related to the degree of sophistication in anaerobiology. Since most institutions cannot provide sophisticated anaerobiology, the authors contend that therapy cannot be contingent upon microbiologic data and that the clinician must rely primarily on clinical and biophysical parameters to monitor the effectiveness of therapy.

Microbiology and pathogenesis of acute salpingitis as determined by laparoscopy: what is the appropriate site to sample?

Acute salpingitis is a polymicrobial disease. Neisseria gonorrhoeae and anaerobic gram-positive cocci were the predominant microorganisms isolated from the fallopian tubes of salpingitis patients. Gonococci were isolated from the fallopian tubes in eight of 35 (23%) patients; anaerobic bacteria were recovered from 10 of 35 (28.5%). Although Chlamydia trachomatis was not recovered from the fallopian tube exudate, there was abundant serologic evidence of chlamydial infection in the salpingitis patients. Twenty-three percent of patients with paired sera had a fourfold rise in IgM and IgG titer, which was consistent with systemic chlamydial infection. Comparison of cultures obtained via laparoscopy and culdocentesis suggested that culdocentesis is not an accurate reflection of the microbial milieu in the fallopian tube.

[Douglas' pouch swab for detection of anaerobic asporous micro-organisms (author's transl)]. / Zum Nachweis von obligat anaeroben sporenlosen Mikroorganismen in Douglas-Abstrichen.

Bacteriological diagnosis was applied to Douglas' pouch swabs taken off 119 patients, most of them with non-inflammatory genital diseases. Purely anaerobic cultures were recorded from 11.8 per cent, mixed anaerobic-aerobic cultures from 8.4 per cent, and purely aerobic cultures from 56.3 per cent. Cultures remained sterile in 23.5 per cent of all cases. Forty-six of those patients were afflicted with uterine myomatosis, a group from which the following results were obtained: purely anaerobic cultures in 21.7 per cent of all cases, mixed anaerobic-aerobic cultures in 6,5 per cent, purely aerobic cultures in 54.4 per cent, and sterile cultures in 17.4 per cent. The importance of such sited flora to both genesis and kinetics of pelvic inflammations is discussed.

Cul-de-sac isolates from patients with endometritis-salpingitis-peritonitis and gonococcal endocervicitis.

Neisseria gonorrhoeae was cultured from the cul-de-sac in 11 of 17 patients with bacteriologically documented gonococcal endometritis-salpingitis and identified by Gram stain in one other instance. In five, N. gonorrhoeae was the only isolate. In six other patients, the presence of other aerobic (two) and anaerobic bacteria (three), as well as N. gonorrhoeae, was documented. In the remaining six patients, only aerobic and anaerobic organisms were isolated. The data are interpreted as supporting the concept of anaerobic superinfections following initial infection with N. gonorrhoeae late in the course of this disease entity.

PIP: Bacteriologic observations derived by culdocentesis in 17 women with gonococcal endometritis-salpingitis from whom 1 or more bacteria were isolated are reported. Neisseria gonorrhoeae was cultured from the cul-de-sac in 11 cases and identified by Gram stain in 1 additional case. N. gonorrhoeae was the only isolate in 5 of these patients. Concomitantly with N. gonorrhoeae, aerobic bacteria were recovered in 2 cases and multiple anaerobic bacteria in 4 cases. In the remaining 6 cases, only aerobic and anaerobic organisms were isolated. Analysis of the Gram stain of the endocervix revealed the presence of intracellular gram-negative diplococci in 10 of 11 smears where N. gonorrhoeae was isolated. Diplococci were not demonstrated when N. gonorrhoeae was absent from the culdocentesis fluid. The data tend to refute the concept of a polymicrobial etiology for pelvic inflammatory disease, suggesting instead progressive anaerobic superinfection with nonrecovery and probable elimination of N. gonorrhoeae. The presence of aerobic/facultative anaerobes with obligatory anaerobes argues against an end-stage anaerobic environment.