Prevalence and antibiotic susceptibility of genital Mycoplasma hominis and Ureaplasma urealyticum in a university hospital in Turkey

This study aimed to assess the colonization prevalence and antibiotic susceptibility of genital Ureaplasma urealyticum and Mycoplasma hominis in a teaching hospital, in Turkey. A total of 382 sexually active women with abnormal vaginal discharge were included in the study. Samples that were obtained with cotton swabs were microbiologically analyzed for U. urealyticum and M. hominis, together with antimicrobial susceptibility to doxycycline, ciprofloxacin, ofloxacin, erythromycin, josamycin, pristinamycin, and tetracycline. Ureaplasma urealyticum was detected in 185 (48.4%) cultures, and M. hominis in 17 (4.4%). Eight (2.1%) cultures were positive for both. Resistance of M. hominis to doxycycline, ciprofloxacin, ofloxacin, erytromycin, josamycin, pristinamycin and tetrascycline was 5.9%, 17.6%, 41.2%, 88.2%, 5.9%, 5.9% and 11.8%, respectively. Resistance to doxycycline, ciprofloxacin, ofloxacin, erytromycin, josamycin, pristinamycin and tetrascycline in U. urealyticum isolates was 1.6%, 40.5%, 58.4%, 54.0%, 1.6%, 8.1% and 13.5%, respectively. Both U. urealyticum (94.1%) and M. hominis (96.2) were most sensitive to josamycin, and most resistant to erytromycin (U. urealyticum 54.0%, M. hominis 88.2) and ofloxacin (U. urealyticum 58.4%, M. hominis 41.2%). As a result, the rate of U. urealyticum and M. hominis was found to be 48.4% and 4.4%, respectively. We conclude that doxycycline may be used in empirical treatment of genital tract infections in sexually active women.     

Role of Genital Mycoplasmas in Bacteremia: Should We Be Routinely Culturing for These Organisms?

Objective: The purpose of this study was to examine the role of the genital mycoplasmas Mycoplasma hominis and Ureaplasma urealyticum as causes of bacteremia in a tertiary referral obstetrical, gynecological, and neonatal intensive care facility, over a period of 12 years from 1983 to 1994 inclusively.Methods: All clinically significant blood cultures were reviewed and the percentage of septicemic episodes for genital mycoplasmas was compared to the total isolation rate, including conventional bacteria.Results: The overall positivity rate for all pathogenic organisms isolated from the blood cultures of infants ranged from 4.5% to 7.7% per annum. U. urealyticum represented 0.8% of these positive isolates and M. hominis 0.4%. For adults, the overall positivity rate from blood cultures ranged from 6.5% to 13.5%, with U. urealyticum representing 9.6% of these positive isolates and M. hominis 9.9%.Conclusions: With M. hominis having an established role in such clinical entities as postabortal and postpartum fever and U. urealyticum strongly implicated with chronic lung disease in low birth weight infants, it is appropriate to examine blood cultures for genital mycoplasmas in an obstetric institution.     

Effect on birth weight of erythromycin treatment of pregnant women

To test the hypothesis that treatment with antibiotics prevents low birth weight, pregnant women whose vaginal cultures contained Ureaplasma urealyticum or Mycoplasma hominis (or both) and who gave written informed consent were treated with one of the following: identical looking capsules containing 250 mg of either erythromycin estolate or stearate (active against U urealyticum), or 150 mg of clindamycin hydrochloride (active against M hominis), or placebo, four times daily for six weeks in a randomized double-blind study. Treatment with clindamycin had no effect. Treatment with erythromycin initiated during the second trimester had no effect on mean birth weight or on the frequency of low-birth-weight infants. In contrast, women whose treatment with erythromycin was initiated in the third trimester gave birth to infants with a heavier mean birth weight (3331 g) than infants born to placebo-treated women (3187 g) (P = .042). Similarly, in women whose erythromycin was begun during the third trimester, the birth rate of infants weighing 2500 g or less was 3%, whereas in women treated with placebo, the birth rate for low-birth-weight infants was 12% (P = .047). These data suggest that treatment with erythromycin during the third trimester prevents low birth weight in mycoplasma-colonized pregnant women. Whether the effect is due solely to the action of erythromycin on U urealyticum is uncertain.     

Differential vaginal expression of interleukin-1 system cytokines in the presence of Mycoplasma hominis and Ureaplasma urealyticum in pregnant women

OBJECTIVE: The genital mycoplasmas, Ureaplasma urealyticum and Mycoplasma hominis, are commonly identified in the vagina of healthy pregnant women. However, these microorganisms are the most common isolates from the amniotic fluids of women in preterm labor. The mechanisms responsible for vaginal colonization and ascent to the uterus remain undetermined. We evaluated the association between U. urealyticum and M. hominis vaginal colonization and the presence of pro-inflammatory and anti-inflammatory interleukin-1 system components in asymptomatic pregnant women of different ethnicities. METHODS: Vaginal specimens, obtained from 224 first trimester pregnant women, were assayed for interleukin-1beta (IL-1beta) and IL-1 receptor antagonist (IL-1ra) concentrations by ELISA. U. urealyticum and M. hominis vaginal colonization were identified by polymerase chain reaction (PCR). RESULTS: Vaginal colonization with M. hominis was identified in 37 (16.5%) women, and was more prevalent in black (18.9%) and Hispanic (20.9%) than in white (4.2%) women (p = 0.01). U. urealyticum was present in 84 (37.5%) women and there was no ethnic disparity in its detection. M. hominis colonization was associated with elevated median vaginal IL-1beta concentrations in both black women (p = 0.02) and Hispanic women (p = 0.04), and was unrelated to vaginal IL-1ra concentrations. In marked contrast, U. urealyticum colonization was associated with elevations in vaginal IL-1ra levels, but not with IL-1beta concentrations, in black women (p = 0.02) and Hispanic women (p < 0.0001) and marginally in white women (p = 0.06). CONCLUSION: M. hominis colonization in healthy pregnant women is associated with localized pro-inflammatory immune activation, while U. urealyticum colonization is associated with immune suppression.     

Further studies on genital mycoplasmas in intra-amniotic infection: blood cultures and serologic response

Mycoplasma hominis is recovered significantly more often in amniotic fluid of women with intra-amniotic infection than in matched control women, but Ureaplasma urealyticum is found in 50% of amniotic fluid samples of both groups. To gain further understanding, we performed blood cultures for genital mycoplasmas and measured serologic responses by a micro enzyme-linked immunosorbent assay method in women with intra-amniotic infection and in control subjects. In blood cultures of 81 women with intra-amniotic infection, M. hominis was isolated in two (2.5%) and U. urealyticum in 11 (13.6%). In 44 control blood cultures, M. hominis was not isolated, and U. urealyticum was recovered in eight (18.2%). These differences were not significant. Serologic response was determined in 86 patients. Rise in antibody to M. hominis was significantly more common in women with intra-amniotic infection and M. hominis in the amniotic fluid than in either women with intra-amniotic infection or control patients without M. hominis. For U. urealyticum antibody response was significantly more common in the intra-amniotic infection group than in control subjects, but there was no association between antibody response and isolation of this organism in amniotic fluid. When M. hominis was found in amniotic fluid or maternal blood, patients were nearly always symptomatic. The high likelihood of serologic response in these cases supports a pathogenic role of M. hominis in intra-amniotic infection. The role of U. urealyticum remains unclear.     

Mycoplasma hominis and Ureaplasma urealyticum in midtrimester amniotic fluid: association with amniotic fluid cytokine levels and pregnancy outcome

OBJECTIVE: The association between the detection of Mycoplasma hominis or Ureaplasma urealyticum in midtrimester amniotic fluid and amniotic fluid cytokine concentrations and subsequent pregnancy outcome were examined. STUDY DESIGN: Amniocentesis was performed between 15 and 19 weeks of gestation in 179 asymptomatic women. Aliquots were assayed for M hominis and U urealyticum by polymerase chain reaction coupled to enzyme-linked immunosorbent assay. Intra-amniotic levels of interleukin-1beta, interleukin-1 receptor antagonist, interleukin-4, interleukin-6, and tumor necrosis factor-alpha were determined by enzyme-linked immunosorbent assay. Pregnancy outcomes were obtained after the completion of all testing. RESULTS: U urealyticum was detected in 22 of 172 amniotic fluids (12.8%); M hominis was present in 11 of 179 amniotic fluids (6.1%). There was no relationship between U urealyticum detection and the concentration of any cytokine. Detection of M hominis was associated with elevated intra-amniotic concentrations of interleukin-4 ( P = .01). Preterm premature rupture of membranes that was followed by preterm birth occurred in 5 women (2.8%); 5 women (2.8%) had a spontaneous preterm birth with intact membranes. All 5 of the women with preterm premature rupture of membranes (100%) tested positive for either U urealyticum or M hominis , as opposed to none of the women with spontaneous preterm birth and to 27 of 161 women (16.8%) with a term birth ( P = .0002). CONCLUSION: The detection of M hominis or U urealyticum in midtrimester amniotic fluid by polymerase chain reaction-enzyme-linked immunosorbent assay may be a risk factor for subsequent preterm premature rupture of membranes.     

In vitro activity of clindamycin against strains of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum isolated from pregnant women

Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum are genital agents that are being increasingly implicated in infectious pregnancy complications and abnormal pregnancy outcomes. We measured the in vitro activity of clindamycin against strains of these three agents which were isolated from pregnant women. For 30 strains of C. trachomatis, the median minimal inhibitory concentration was 1.0 microgram/ml (range, 0.25 to 2.0 micrograms/ml). For 27 strains of M. hominis, the median minimal inhibitory concentration was 0.12 microgram/ml (range, 0.06 to 0.25 microgram/ml) and the median minimal bactericidal concentration was 0.5 microgram/ml (range, 0.06 to 2.0 micrograms/ml). For 27 strains of U. urealyticum, the mean minimal inhibitory concentration was 4 micrograms/ml (range, 1.0 to 32.0 micrograms/ml) and the mean minimal bactericidal concentration was 32.0 micrograms/ml (range, 4.0 to 128 micrograms/ml). Thus in vitro clindamycin would appear to be highly active against pregnancy-associated strains of M. hominis, less active against strains of C. trachomatis, and least active against strains of U. urealyticum. Since M. hominis has been strongly linked to postabortal fever and to postpartum fever and endometritis, our results indicate that clindamycin should be evaluated in treatment trials in pregnancy aimed at prevention of M. hominis-induced morbidity as well as in treatment of the complications themselves.     

溶脲脲原体在抗生素临界浓度下药物敏感性研究

目的 :为了研究溶脲脲原体 (UU)在抗生素临界浓度下的药物敏感性情况。方法 :在 UU最小抑菌浓度 (MIC)的质控范围内 ,选择临床上常用抗生素的高度敏感临界值作为 UU培养基的最终浓度 ,通过代谢抑制法 ,观察 6株临床耐药菌株在这些抗生素临界浓度下生长的情况。结果 :在 4.0μg/ m L的四环素族浓度、0 .5μg/ m L的大环内酯类浓度、2 .0μg/ m L氧氟沙星浓度和 1 .0μg/ m L环丙沙星浓度下 ,这些菌株所显示的体外药物敏感性与临床实际回顾性分析的结果有较好的吻合性。结论 :确立 UU的抗生素高度敏感临界值将有助于简化临床上 UU药敏测试的操作程序     

Significance of genital mycoplasmas in pelvic inflammatory disease: innocent bystander!

Objective: Our objective was to determine the role of Mycoplasma hominis and Ureaplasma urealyticum in pelvic inflammatory disease (PID).Methods: The clinical and microbiologic variables in 114 patients with a clinical diagnosis of PID were compared prospectively according to the isolation of M. hominis and U. urealyticum from their endometrial cavities.Results: The groups were epidemiologically well matched. Clinical parameters such as temperature, leukocyte count, erythrocyte count, and C-reactive protein on admission and length of hospital stay were similar in the patients, regardless of their mycoplasma status. A significant percentage of the patients either continued or started to harbor genital mycoplasmas after the resolution of PID without any significant clinical sequelae.Conclusions: The presence of genital mycoplasmas does not change the clinical presentation and course of PID. Both M. hominis and U. urealyticum can persist or colonize the endometrium after complete recovery from PID. Therefore, the genital mycoplasmas do not seem to have a dominant pathogenic role in PID.     

Detection of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum in pregnant Dutch women

A prospective study was performed to determine the prevalence of endocervical infection by Chlamydia trachomatis and vaginal colonization by Mycoplasma hominis and Ureaplasma urealyticum in pregnant women seeking routine obstetrical care in two clinics in the southern part of the Netherlands. C. trachomatis was detected using the direct immunofluorescence staining technique. For the genital mycoplasmata, generally accepted culture methods were used. Evaluable samples were obtained from 691 of 770 women in the first trimester of pregnancy. C. trachomatis was detected in 2.3%, M. hominis in 5.2% and U. urealyticum in 23.9% of the women. The isolation percentages of C. trachomatis and U. urealyticum were almost equally distributed in the different age groups. The prevalence of all three micro-organisms did not seem to be related to parity. Smoking and alcohol consumption seemed to influence the isolation rate of M. hominis and U. urealyticum.     

Diagnosis of sexually transmitted diseases in Chilean pregnant adolescents

We searched in 100 healthy pregnant women by isolation, the presence of Neisseria gonorrhoeae, Herpes simplex, Mycoplasma hominis, Ureaplasma urealyticum and Chlamydia trachomatis. Blood was also taken for examination of specific antibodies to these microorganisms. We studied only for antibodies titled Cytomegalovirus (CMV), Treponema pallidum and Human Immunodeficiency Virus, and Condyloma acuminatum by cervical cytology. In 85 adolescents we found 5 (6%) patients with C. trachomatis, four of these patients had another microorganism added, one with N. gonorrhoeae, M. hominis and U. Urealyticum, one with U. urealyticum and the last two with M. hominis and U. urealyticum, In relation to Mycoplasmas 69 (81%) out of 85 had Mycoplasmas, 4 (5%) had M. hominis, 46 (54%) U. urealyticum and 19 (22%) patients had both. The seropositivity to CMV was 96.25%. We didn't find any other microorganism. We concluded that the rate of STD in chilean pregnant adolescent women is high, especially with no traditional bacteria.     

Genital mycoplasmas

The mycoplasmas frequently isolated in genital tract, and potentially pathogenic, are M. hominis, U. urealyticum and M. genitalium. M. hominis and U. urealyticum are very frequent in the vaginal tract and they can be, according to circumstances, either commensal or pathogenic. M. hominis and/or U. urealyticum, have been considered as responsible for many types of genital infectious diseases (such as cervicitis, pelvis inflammatory disease), for infertility, obstetrical pathologies (premature delivery, premature rupture of membranes, chorio-amniotitis) and neonatal infections. Yet, most of the time, their actual responsibility has not been conclusively proven. Published data lack indisputable conclusions and in many fields, doubts still exist whether these mycoplasmas are pathogens or mere co-factors associated with genital infections. On the other hand, M. genitalium has been much less studied but it seems to be an unquestionable pathogen of genital tract; new studies will be necessary so that one has a better understanding of the pathologies it can induce.     

A randomized placebo-controlled trial of erythromycin for the treatment of Ureaplasma urealyticum to prevent premature delivery. The Vaginal Infections and Prematurity Study Group

Ureaplasma urealyticum has been associated with low birth weight and histologic chorioamnionitis and it is a frequent isolate from the chorioamnion of patients who are delivered prematurely. In prior clinical trials using antibiotics active against U. urealyticum, antibiotic treatment was associated with reduced prematurity and increased mean birth weight. In this multicenter, randomized, double-blind clinical trial, pregnant women with U. urealyticum were treated with 333 mg of erythromycin base or placebo three times daily, starting between 26 and 30 weeks' gestation and continuing through 35 completed weeks of pregnancy. Women with urinary tract infection or Neisseria gonorrhoeae infection were excluded from the trial, and women with Chlamydia trachomatis or group B streptococci were excluded from these analyses. Erythromycin did not eliminate U. urealyticum from the lower genital tract. There were no significant differences between erythromycin- and placebo-treated women in infant birth weight or gestational age at delivery, in frequency of premature rupture of membranes, or in neonatal outcome.     

Mycoplasma infection and infertility.

Attempts were made to isolate mycoplasmas from the uterine cervix of infertile women and normal pregnant and nonpregnant women to investigate the relationship of genital mycoplasma infection to infertility. Ureaplasma urealyticum was demonstrated in 63% of patients with infertility, 68% of normal pregnant women, and 62% of normal nonpregnant women. The incidence of Mycoplasma hominis infection was found to be noticeably lower, with corresponding isolation rates of 10%, 11%, and 6%, respectively. The differences in rate of isolation for U. urealyticum and for M. hominis among the three groups did not reach statistical significance. During a follow-up period of more than 12 months without any treatment for mycoplasma infection in the infertile cases, 11 women (27.5%) became pregnant. These included 7 (28%) of 25 women with positive U. urealyticum cultures. The results demonstrate a fairly high incidence of female genital infection with U. urealyticum which, as the data would indicate, cannot be directly associated with infertility.     

Cervical chlamydia trachomatis and mycoplasmal infections in women with abnormal Papanicolaou smears

In a series of 2,346 Papanicolaou-stained smears from women undergoing routine gynaecological examination, 39 showed cytomorphological signs of inflammation suggesting Chlamydia trachomatis infection (Papanicolaou class II or III). The 39 smears were studied microbiologically by the direct-immunofluorescence test and cell culture to see whether chlamydial infection correlated with the presence of Mycoplasma hominis and Ureaplasma urealyticum. The results were compared with the cytological and colposcopic findings. C. trachomatis was cultured in 56.41% of the 39 smears, and isolated by the direct-immunofluorescence test in 51.28%. M. hominis was detected in 35.89% and U. urealyticum in 25.54%. Though all three organisms coexisted in 10.25% of the smears, C. trachomatis and M. hominis in 15.38%, C. trachomatis and U. urealyticum in 2.56%, no valid conclusions could be drawn from their association. The study did, however, indicate that vacuolated cells and cells with "bubbly" cytoplasm are common also to other infections seen in PAP-test smears and do not necessarily warrant a diagnosis of C. trachomatis, but that Gupta-type intracellular inclusion bodies do.     

Possible role of bacterial and viral infections in miscarriages

OBJECTIVE: To determine the role of infections in miscarriages. Chorionic villi from aborted material were subjected to cytogenetic evaluation and analyzed for the presence of Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, human cytomegalovirus (HCMV), adeno-associated virus (AAV), and human papillomaviruses (HPV). DESIGN: Retrospective study. SETTING: University hospital and academic research institution. MAIN OUTCOME MEASURE(S): Karyotyping and detection of bacterial and viral DNA by means of polymerase chain reaction (PCR) in placenta specimens. RESULT(S): In 54 (50%) of 108 samples the karyotype was normal, in 38 (35%) samples it was abnormal, and in 16 (15%) samples karyotype was undetermined. No U. urealyticum, M. hominis, HCMV, or AAV-2 DNA was detected, while C. trachomatis DNA was detected in one (1%) and HPV DNA in eight (7%) samples. No significant correlation of HPV-positive findings with karyotype status was established. CONCLUSION(S): Our findings do not support a role of C. trachomatis, U. urealyticum, M. hominis, HCMV, or AAV infections in miscarriages during the first trimester of pregnancy. However, further investigation should be made to determine a possible involvement of HPVs in the development of genetic abnormalities of the fetus and in miscarriages.     

Mycoplasmas and in vitro fertilization

Semen samples taken from 135 patients attending an in vitro fertilization clinic were shown to be colonized, 53 with Ureaplasma urealyticum (39%) and 16 with Mycoplasma hominis (12%). An unidentified mycoplasma species was isolated from the sperm of two patients. M. hominis was recovered from all the washed sperm samples taken from colonized semen, whereas washing the sperm eradicated U. urealyticum from 71% of colonized semen. The presence of mycoplasmas in semen made no significant difference to the sperm count, sperm motility, sperm abnormalities, or fertilization of eggs.     

Mycoplasma hominis, ureaplasma urealyticum, and corynebacterium genitalium recovered from the lower genital tracts of adolescent women

The lower genital tracts of 137 adolescent women were examined for the presence of Mycoplasma hominis, Ureaplasma urealyticum, and Corynebacterium genitalium in relation to sexual activity, previous pregnancy, presence of vaginal discharge and oral contraceptive use. None of the sexually inactive and 10% of the sexually active adolescent females were colonized with U. urealyticum. None of the sexually inactive and 4% of the sexually active adolescent females were colonized with C. genitalium. Nineteen percent of the sexually inactive and 36% of the sexually active adolescent females were colonized with M. hominis. The presence of M. hominis in the lower genital tract was not associated with any clinically identifiable vaginal discharge or inflammatory changes in exfoliated cervical and vaginal epithelial cells. The presence of M. hominis in the lower genital tract did not appear to be related to the use of oral contraceptives or antecedent pregnancy. There was no significant difference in the recovery rates of these microorganisms when we compared women who had non-specific vaginitis with those who did not. There is no evidence from this study that any of these microorganisms is responsible for non-specific vaginitis.     

Evidence for an association between Chlamydia trachomatis and cervical intraepithelial neoplasia

Summary. Attempts were made to isolate Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum from women with cervical intraepithelial neoplasia (CIN), from those with microinvasive or invasive cervical cancer, and from a control group of similar women with other gynaecological problems. C. trachomatis was found in a significantly greater proportion of women with CIN (8%) or cervical cancer (18%) than in the control group (1%), whereas M. hominis and U. urealyticum were approximately as common in each group. Histological examination of the cervix in cone biopsies or hysterectomy specimens from 26 women with CIN and from 39 women of similar age with no evidence of CIN showed lymphoid follicles, previously reported to be associated with chlamydial infection, in nine of the specimens with CIN, but in none of the specimens without CIN.     

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.