Genital Mycoplasmas Research Articles

Maternal Origins of Neonatal Infections: What Do Obstetrician–Gynecologist Should/Could Do?

Neonatal infections are responsible for 20% of neonatal deaths yearly. In this review, we focused on the origins of the commoner neonatal infections, and we define the role of obstetricians. Regarding group B Streptococcus, a key measure for the prevention of neonatal infection is the vaginal-rectal culture screening at term pregnancy. Intravenous penicillin is the first-line prophylaxis at the start of labor, with intravenous ampicillin as an alternative. First-generation cephalosporins or clindamycin are recommended in case of penicillin allergy. Concerning urinary tract infections (UTIs), guidelines recommend complete urinalysis and urine culture in the first trimester of pregnancy for the screening of asymptomatic bacteriuria. For lower UTIs, guidelines recommend nitrofurantoin as first-choice antibiotic. Amoxicillin or cefalexin are second-line antibiotics. For upper UTIs, guidelines recommend cephalexin per os as first line. Candida spp. colonization affects 20% of pregnant women; however, congenital fetal candidosis and Candida amnionitis are rare. First-line treatment in case of symptomatic vaginitis during pregnancy or asymptomatic colonization during the third trimester is vaginal clotrimazole. Fluconazole is not approved in pregnancy, especially during the first trimester. Genital mycoplasmas colonization during pregnancy is usually asymptomatic and associated with bacterial vaginosis. Colonization is related to neonatal respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), pneumonia, chorioamnionitis, and sepsis. Macrolides are the first-line treatment along with lactobacillus supplementation. In cases of preterm premature rupture of membranes or preterm labor, ceftriaxone, clarithromycin, and metronidazole are required to prevent intra-amniotic infection. Intra-amniotic infection affects 1 to 5% of deliveries at term and one-third of preterm ones and is associated with perinatal death, early-onset neonatal sepsis, RDS, BPD, pneumonia, meningitis, and prematurity-related diseases. Guidelines recommend a combination of ampicillin and gentamicin, and in case of caesarean section, an additional dose of clindamycin or metronidazole is required. In conclusion, obstetricians should be aware that the treatment of maternal infection during pregnancy can prevent potentially lethal infections in the newborn. KEY POINTS: · Part of neonatal infections starts from maternal infections that must be treated during pregnancy.. · Streptococcus group B and asymptomatic bacteriuria should be investigated in pregnancy and treated.. · Mycoplasma and ureaplasma vaginal colonization during pregnancy is related to negative neonatal outcomes..

Prevalence of selected sexually transmitted infectious agents in a cohort of asymptomatic soldiers in Austria

BackgroundAccording to the World Health Organization (WHO), more than one million sexually transmitted infections (STIs) are acquired every day worldwide. Although STIs may be asymptomatic in many cases, they can cause severe symptoms and can also lead to adverse pregnancy outcomes and both male and female infertility. Asymptomatic carriers seem to play an important role in terms of the distribution of STIs; however, studies revealing the prevalence of STIs in asymptomatic individuals are rare.MethodsIn the current study, 654 leftovers of standard urine samples from healthy, asymptomatic Austrian soldiers were investigated for the prevalence of Trichomonas vaginalis, Chlamydia trachomatis, and genital mycoplasmas (Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum, and Candidatus Mycoplasma girerdii) by specific PCRs.ResultsWe detected T. vaginalis, M. hominis, U. urealyticum, U. parvum, and C. trachomatis in the investigated samples with prevalence of 7.6%, 4%, 2.4%, 5.4%, and 3.2%, respectively; neither M. genitalium nor Ca. Mycoplasma girerdii was found in our sample collection.ConclusionsOur study introduces data on STIs of a mainly male cohort, which are scarce because most of the available information on sexually transmitted infectious agents arises from fertility clinics (mainly women) or symptomatic patients.Graphical abstract

The prevalence of Mycoplasma hominis in Outpatients at a Tertiary Care Hospital in East India.

Introduction Mycoplasma hominis (M. hominis) is the first Mycoplasma isolated from humans in the year 1937. Though regarded as a commensal of the urogenital tract, it has been implicated in various genital and extra-genital infections namely bacterial vaginosis, cervicitis, pelvic inflammatory diseases, pyelonephritis, premature rupture of the membrane in pregnancy, infertility, sepsis in newborns, etc. The pathogenesis, prevalence, and epidemiology of genital mycoplasmas in general and M. hominis in particular in Indian women have been studied very minimally. This study aimed to study the prevalence of M. hominis carriage among symptomatic and asymptomatic sexually active women attending to the outpatient department of a tertiary care hospital in East India with or without clinically suspected genitourinary infections and to compare the detection of M. hominis by polymerase chain reaction (PCR) as compared to that of culture. Methods In this observational study, sterile Dacron swabs were used to collect two samples each from the genitourinary tract of 110 sexually active women aged 15-45 years (80 cases and 30 control). One sample was inoculated in mycoplasma broth for culture. The other was used for PCRto detect the presence of theM. hominis gene. Results Culture positivity for mycoplasma was seen in 4/80 (5%) patients clinically suspected of genitourinary infection (cases) based on their presenting signs and symptoms. In those without such suspicion (control), all cultures were negative (p=0.021). PCR was positive for M. hominis in 22 (20%) samples. Considering the PCR as the gold standard the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of culture are found to be 18.18%, 100%, 100%, and 88.25% respectively. The highest prevalence of M. hominis was in the age group 20-24 years (9/24) and 50% of all detections (11/22) were among 25-29 years. Detections were more frequent among patients with multiparity, multiple sexual partners, intrauterine contraceptive devices, lower socioeconomic status, and lower educational status. Conclusion Our study results showed that the presence of M. hominis is significantly higher in cases than in the control group. The study also indicates the need for continued research on this bacterium both in patients with genital symptoms and in asymptomatic patients.

CHARACTERISTICS OF THE VAGINAL BIOCENOSE OF WOMEN OF EARLY REPRODUCTIVE AGE WITH ENDOCERVICOSIS

Purpose. To study the state of the vaginal ecosystem in nulliparous women with endocervicosis by improving diagnostic methods.
 Materials and methods. The contingent of the study was 142 women of early reproductive age (20-24 years old), who did not give birth, 112 with a histologically established diagnosis of endocervicosis. In all 142 examined women, the determination of vaginal biocenosis was carried out by means of bacterioscopy of smears with determination of the degree of purity and bacteriological examination of discharge, determination of HPV of high carcinogenic risk.
 The proposed comprehensive approach to the treatment of young women with endocervicosis who did not give birth consisted of the following. Destruction of the pathological focus was carried out by the method of argon plasma coagulation (APC) of tissues using the Fotek-EA 142 apparatus. In the postoperative period, vaginal suppositories were prescribed for this group of patients on the 10th day after the procedure, once a day for 10 days. One suppository contains two active substances: dexpanthenol 100 mg, chlorhexidine bigluconate - 16 mg and a polyethylene oxide base. Dexpanthenol normalizes cell metabolism, stimulates the regeneration of mucous membranes, increases the strength of collagen fibers and accelerates mitosis. In addition, an antiseptic was prescribed, which shows activity against gram-positive and gramnegative bacteria.In order to treat the human papillomavirus in this group, together with the interferon drug, the drug tyloron was prescribed in the generally accepted dosage.
 Research results. Sexually transmitted infections play an important role in the occurrence and progression of background cervical pathology. When conducting an in-depth analysis of vaginal microbiocenosis with the help of bacteriological research in patients with endocervicosis, in significant concentrations, an increase in the quantitative indicators of contamination of the vagina with conditionally pathogenic microorganisms was established relative to the diagnostic level. A high degree of infection with chlamydia, genital mycoplasmas, pathogenic strains of ureaplasma, trichomonads, herpes virus infections creates a risk group upon occurrence and the development of infertility, miscarriage and other perinatal pathology in patients with endocervicosis who did not give birth. Clinically significant and, especially, high viral load in HPV-infected young women with endocervicosis occurs in a significant percentage of cases. The results of the cytological characteristics of smears of the exo- and endocervix indicate that 12 women (21.82%) of the I group and 10 women (17 .54%) of the II group during the cytological diagnosis changes characteristic of the IIa class were established. In 32.73% of cases of group I and 33.33% of group II, cytograms show varieties of pathological keratinization, namely hyperkeratosis, parakeratosis, dyskeratosis. In 38.18% of patients of the I group and in 40.35% of the II group, cells with characteristic manifestations of damage by the human papilloma virus are found in cytological preparations.
 Conclusion. Thus, women with endocervicosis who have not given birth need more careful observation and effective treatment.

Modeling ascending Ureaplasma parvum infection through the female reproductive tract using vagina-cervix-decidua-organ-on-a-chip and feto-maternal interface-organ-on-a-chip.

Genital mycoplasmas can break the cervical barrier and cause intraamniotic infection and preterm birth. This study developed a six-chamber vagina-cervix-decidua-organ-on-a-chip (VCD-OOC) that recapitulates the female reproductive tract during pregnancy with culture chambers populated by vaginal epithelial cells, cervical epithelial and stromal cells, and decidual cells. Cells cultured in VCD-OOC were characterized by morphology and immunostaining for cell-specific markers. We transferred the media from the decidual cell chamber of the VCD-OOC to decidual cell chamber in feto-maternal interface organ-on-a-chip (FMi-OOC), which contains the fetal membrane layers. An ascending Ureaplasma parvum infection was created in VCD-OOC. U. parvum was monitored for 48 h post-infection with their cytotoxicity (LDH assay) and inflammatory effects (multiplex cytokine assay) in the cells tested. An ascending U. parvum infection model of PTB was developed using CD-1 mice. The cell morphology and expression of cell-specific markers in the VCD-OOC mimicked those seen in lower genital tract tissues. U. parvum reached the cervical epithelial cells and decidua within 48 h and did not cause cell death in VCD-OOC or FMi-OOC cells. U. parvum infection promoted minimal inflammation, while the combination of U. parvum and LPS promoted massive inflammation in the VCD-OOC and FMi-OOC cells. In the animal model, U. parvum vaginal inoculation of low-dose U. parvum did not result in PTB, and even a high dose had only some effects on PTB (20%). However, intra-amniotic injection of U. parvum resulted in 67% PTB. We report the colonization of U. parvum in various cell types; however, inconsistent, and low-grade inflammation across multiple cell types suggests poor immunogenicity induced by U. parvum.

Detection of Ureaplasma urealyticum by Catalytic Hairpin Assembly Combined with a Lateral Flow Immunoassay Strip.

Ureaplasma urealyticum is a common genital mycoplasma in men and women, which can cause reproductive tract infection and infertility, and is also related to adverse pregnancy outcomes and neonatal diseases. Pathogen culture and polymerase chain reaction (PCR) are the main methods for the diagnosis of U. urealyticum. However, pathogen culture takes too long, and PCR requires professional personnel and sophisticated instruments. Here, we report a simple, convenient, sensitive, and specific detection method, which combines catalytic hairpin assembly with a lateral flow immunoassay strip. Only a water bath and a fluorescence reader are needed to detect the results in 30 min. We can realize the point-of-care testing of U. urealyticum by this method. To verify this method, we selected 10 clinical samples for testing, and the test results were exactly the same as the clinical report.

Maternal mortality: The role of Mycoplasma hominis and its impact on neonatal health

Maternal mortality remains a public health challenge. Every day, approximately 800 women die worldwide from causes related to pregnancy and childbirth that can be prevented. Maternal mortality continues to be prevalent in developed countries and developing countries with infections being one of the major causes of this canker, these include genital mycoplasma infections. Mycoplasma hominis (M. hominis) is a facultative human pathogen that is mostly detected in the lower urogenital tract in sexually active healthy men and women. It is known to have adverse effects on the outcome of pregnancy. M. hominis has been identified in women from family planning and prenatal clinics much more frequently and it has been associated with pyelonephritis, pelvic inflammatory disease, postpartum septicemia, endometritis, and preterm birth. M. hominis also affects neonatal health leading to respiratory distress, neonatal meningitis, and congenital pneumonia. This review provides an overview of the current knowledge on Mycoplasma hominis , the dangers it poses to maternal and neonatal health, and its detection and treatment.

Adverse pregnancy and birth outcomes associated with Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum: a systematic review and meta-analysis

ObjectivesMycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum (genital mycoplasmas) commonly colonise the urogenital tract in pregnant women. This systematic review aims to investigate their role in adverse pregnancy and birth...

The role of intraamniotic inflammation in threatened midtrimester miscarriage

The assessment and management of patients with threatened midtrimester miscarriage is a clinical challenge because the etiology of this condition is poorly understood. This study aimed to examine the frequency of intraamniotic infection or inflammation and the effect of antibiotics in patients presenting with regular uterine contractions and intact membranes before 20 weeks of gestation. This retrospective study comprised patients who met the following criteria: (1) singleton gestation, (2) gestational age before 20 weeks, (3) the presence of regular uterine contractions confirmed by a tocodynamometer (8 or more contractions in 60 minutes), (4) intact amniotic membranes, and (5) transabdominal amniocentesis performed for the evaluation of the microbiologic and inflammatory status of the amniotic cavity. Samples of amniotic fluid were cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and polymerase chain reaction was performed to detect Ureaplasma species. Amniotic fluid was tested for white blood cell counts and matrix metalloproteinase-8 concentrations to diagnose intraamniotic inflammation. Patients with intraamniotic inflammation, or intraamniotic infection, were treated with antibiotics (a combination of ceftriaxone, clarithromycin, and metronidazole). Treatment success was defined as the resolution of intraamniotic infection/inflammation at the follow-up amniocentesis or delivery after 34 weeks of gestation. 1) Intraamniotic inflammation was present in 88% (15/17) of patients, whereas infection was detectable in only 2 cases; 2) objective evidence of resolution of intraamniotic inflammation after antibiotic treatment was demonstrated in 100% (4/4) of patients who underwent a follow-up amniocentesis; 3) 30% (5/15) of women receiving antibiotics delivered after 34 weeks of gestation (3 of the 5 patients had a negative follow-up amniocentesis, and 2 of the women were without a follow-up amniocentesis); 4) the overall treatment success of antibiotics was 40% (6/15; 4 cases of objective evidence of resolution of intra-amniotic inflammation and 5 cases of delivery after 34 weeks of gestation). The prevalence of intraamniotic inflammation in patients who presented with a threatened midtrimester miscarriage was 88% (15/17), and, in most cases, microorganisms could not be detected. Antibiotic treatment, administered to patients with intraamniotic inflammation, was associated with either objective resolution of intraamniotic inflammation or delivery after 34 weeks of gestation in 40% (6/15) of the cases.

Molecular Basis of the Slow Growth of Mycoplasma hominis on Different Energy Sources.

Mycoplasma hominis is an opportunistic urogenital pathogen in vertebrates. It is a non-glycolytic species that produces energy via arginine degradation. Among genital mycoplasmas, M. hominis is the most commonly reported to play a role in systemic infections and can persist in the host for a long time. However, it is unclear how M. hominis proceeds under arginine limitation. The recent metabolic reconstruction of M. hominis has demonstrated its ability to catabolize deoxyribose phosphate to produce ATP. In this study, we cultivated M. hominis on two different energy sources (arginine and thymidine) and demonstrated the differences in growth rate, antibiotic sensitivity, and biofilm formation. Using label-free quantitative proteomics, we compared the proteome of M. hominis under these conditions. A total of 466 proteins were identified from M. hominis, representing approximately 85% of the predicted proteome, while the levels of 94 proteins changed significantly. As expected, we observed changes in the levels of metabolic enzymes. The energy source strongly affects the synthesis of enzymes related to RNA modifications and ribosome assembly. The translocation of lipoproteins and other membrane-associated proteins was also impaired. Our study, the first global characterization of the proteomic switching of M. hominis in arginine-deficiency media, illustrates energy source-dependent control of pathogenicity factors and can help to determine the mechanisms underlying the interaction between the growth rate and fitness of genome-reduced bacteria.

Evaluation of a Multiplex Real-Time PCR Assay for Detecting Chlamydia trachomatis in Vaginal Samples.

Chlamydia trachomatis is an important cause of sexually transmitted infections (STI) in Western countries. It is often asymptomatic, and thus, left untreated, and can have severe negative consequences, such as tubal infertility or adverse pregnancy outcomes. Other sexually transmitted microorganisms, such as Neisseria gonorrhoeae and Trichomonas vaginalis, as well as normal residents of the vaginal flora, such as genital mycoplasmas, also negatively impact human sexual and reproductive health. We evaluated the reliability of the Seegene Allplex STI Essential Assay for C. trachomatis detection using the real-time qPCR routinely used in our diagnostic laboratories as the gold standard. The Seegene assay displayed a sensitivity of 97.8% and a specificity of 98.9%. As this assay can also detect six other urogenital pathogens, we applied it to 404 samples from women who attended Lausanne University Maternity Hospital and obtained the following prevalence rates: 2.5% for C. trachomatis, 3.5% for Mycoplasma hominis, 6.3% for Ureaplasma urealyticum, and 27.7% for Ureaplasma parvum. Two samples were positive for Trichomonas vaginalis, and one sample was positive for Mycoplasma genitalium. Bacterial vaginosis was present in 4.5% of the cases and was strongly associated with M. hominis. Finally, we confirmed the association between C. trachomatis infection and pre-term birth (p = 0.03) but could not detect any association of this condition with other urogenital pathogens (Mycoplasma/Ureaplasma). In conclusion, given its high sensitivity and specificity for C. trachomatis DNA detection as well as its multiplex format, which simultaneously provides results for six other urogenital pathogens, the Seegene Allplex™ STI Essential Assay represents an appealing diagnostic tool in modern microbiology laboratories.

Lamellar body count: Marker for foetal lung maturation promoted by intra-amniotic infection and/or inflammation

ObjectiveThere is evidence indicating that the risk of respiratory distress syndrome is reduced in preterm neonates exposed to intra-amniotic infection and/or inflammation. We hypothesised that foetal lung maturation promoted by intra-amniotic infection and/or inflammation results in elevated lamellar body count (LBC) in amniotic fluid (AF). This study aimed to determine the relationship between LBC in AF and intra-amniotic infection and/or inflammation in patients with threatened preterm birth. Study designThis was a retrospective cohort study of patients with threatened preterm birth. A total of 104 consecutive pregnant women underwent amniocentesis in the early preterm period [gestational age < 34 weeks] to evaluate intra-amniotic infection and/or inflammation and foetal lung maturity. Intra-amniotic infection was confirmed by positive AF culture results for aerobic/anaerobic bacteria, fungi, and genital mycoplasma. Intra-amniotic inflammation was defined as a positive AF matrix metalloproteinase-8 rapid test. Outcomes of the study population were compared according to LBC in AF using a cut-off of 15,000/mm3. ResultsThe rates of elevated LBC and intra-amniotic infection and/or inflammation were 23% (24/104) and 52% (54/104), respectively. The median LBC was significantly higher in patients with intra-amniotic infection and/or inflammation than in those without [median LBC, 9,000/mm3 (interquartile range, IQR: 3,000–39,000) vs. 3,000/mm3 (IQR: 2,750–5,000), p < 0.001]. Intra-amniotic infection and/or inflammation was observed in 96% (23/24) of patients with elevated LBC and 39% (31/80) of patients without elevated LBC (p < 0.001). On multivariable analysis, the presence of intra-amniotic infection and/or inflammation was significantly associated with elevated LBC with an odds ratio (OR) of 66.0 [95% confidence interval (CI) 6.6–664.4, p < 0.001], even after accounting for gestational age at amniocentesis being a significantly related factor for predicting elevated LBC with an OR of 1.5 (95% CI 1.1–2.0, p = 0.004). ConclusionLBC elevation was independently associated with the presence of intra-amniotic infection and/or inflammation in women with early threatened preterm birth (gestational age < 34 weeks). This finding may support the view that an intra-amniotic inflammatory response promotes foetal lung maturation that can be detected by elevated LBC in AF.

Bacteriospermia and its association with seminal fluid parameters and infertility in infertile men, Kerman, Iran: A cross-sectional study.

BackgroundThe role of genital Ureaplasma species, genital Mycoplasma (M) species, and Chlamydia (C.) trachomatis, the most prevalent sexually transmitted bacteria, in male infertility are still not clear. Different reports about the impact of these bacteria on semen quality are controversial.ObjectiveThis study was proposed to determine the frequency of bacteriospermia in men and investigate the relationship between the presence of these bacteria and semen quality using molecular assay.Materials and MethodsIn this cross-sectional study, 200 semen samples obtained from men attending the research and clinical centers for fertility in Kerman, Iran, between July and December 2019 were analyzed for semen volume, progressive motility, non-progressive motility, total progressive motility, and viability according to the World Health Organization guidelines. The polymerase chain reaction was used for the detection of related bacteria.ResultsThe mean values of volume, progressive motility, non-progressive motility, total progressive motility, and viability were significantly lower in infertile men (p 0.001). Statistically significant correlations were observed between the presence of M. genitalium and progressive sperm motility, M. hominis and semen volume, Ureaplasma parvum and the sperm normal form, and C. trachomatis and the sperm progressive motility and viability. Logistic regression analysis showed that M. genitalium (OR = 8.06, p 0.001) and C. trachomatis (OR = 16, p = 0.01) were significantly associated with male infertility.ConclusionDuring the infertility assessment, clinicians should consider of role C. trachomatis and M. genitalium in male infertility. Screening test particularly for asymptomatic individuals is recommended.

Determination of the prevalence of Mycoplasma hominis and Ureaplasma species in Bacterial vaginosis patients in association with antibiotic resistance profile in Franceville, Gabon

BackgroundGenital mycoplasma are only considered pathogenic at a certain level and are often associated with other pathological situations such as bacterial vaginosis (BV). They may lead to infertility as well as other gynaeco-obstetrical and neonatal problems. Despite numerous reported resistances, macrolides are required to treat pregnant women while non-pregnant women are managed with tetracyclines and fluoroquinolones. This study aimed to establish the prevalence and resistance rates of Mycoplasma hominis (Mh) and Ureaplasma spp. (Uu) in BV positive (BV+) women. Material and methodsVaginal secretions were collected from women aged 14–56 years consulting for a cytobacteriological examination of the vaginal swab associated with a simultaneous search for genital mycoplasma in the medical analysis laboratory of the Research and Medical Analysis Unit (URAM) of CIRMF in Franceville, Gabon. BV was diagnosed using the Nugent score while genital mycoplasma identification and antibiotic susceptibility testing were performed using the Mycoplasma IST 2 kit. ResultsOf the 462 women included in this study, 60.18% (278/462, p = 0.00002) were both BV+ and genital mycoplasma carriers, including 5.19% (24/462) pregnant women. Overall mycoplasma carriage was 33.12% (153/462) for Uu, 1.95% for Mh and 25.11% (116/462) for mixed infections (Uu + Mh). The BV + patients most affected by mycoplasma were those whose age varied from 25 to 35 years with 27.49% (127/462, p = 0.980), those not using condoms with 39.40% (182/462, p = 0.014, OR = 2.35), those non-pregnant but capable of bearing children with 53.90% (249/462, p = 0.967, OR = 1.02). In the overall population, 83.66% and 51.63% of Uu strains were highly resistant to Ciprofloxacin and Azithromycin respectively; 100% and 55.56% of Mh strains were resistant to Azithromycin and Tetracycline respectively; while strong resistance has been observed in mixed infections to Ciprofloxacin (97.41%), Azithromycin (81.90%), Ofloxacin (69.83%) and Tetracycline (68.97%). ConclusionThe prevalence of genital mycoplasma infections is very high in women with bacterial vaginosis. Given the numerous emerging resistance rates to most classes of antibiotics available for the treatment of genital mycoplasma infections in our study, it would be advisable for therapeutic prescriptions to be made based on laboratory results.

Genital Mycoplasmas and Biomarkers of Inflammation and Their Association With Spontaneous Preterm Birth and Preterm Prelabor Rupture of Membranes: A Systematic Review and Meta-Analysis.

Genital mycoplasmas (GM), such as Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma parvum, and Ureaplasma urealyticum are commonly associated with spontaneous preterm labor (SPTL), spontaneous preterm birth (PTB), and preterm prelabor rupture of membranes (PPROM). This study determined the association between GM and such adverse pregnancy outcomes. We searched for studies published 1980–2019 in MEDLINE, EMBASE, and Web of Science. Studies were eligible when GM was detected during pregnancy. We included 93 and 51 studies in determining the prevalence and the inflammatory biomarkers associated with GM, respectively, using the “metafor” package within R. The protocol was registered with PROSPERO (registration no. CRD42016047297). Women with the studied adverse pregnancy outcomes had significantly higher odds of presence with GM compared to women who delivered at term. For PTB, the odds ratios were: M. hominis (OR: 2.25; CI: 1.35–3.75; I2: 44%), M. genitalium (OR: 2.04; CIL 1.18–3.53; I2: 20%), U. parvum (OR: 1.75; CI: 1.47–2.07; I2: 0%), U. urealyticum (OR: 1.50; CI: 1.08–2.07; I2: 58%). SPTL had significantly higher odds with M. hominis (OR: 1.96; CI: 1.19–3.23; I2: 1%) or U. urealyticum (OR: 2.37; CI: 1.20–4.70; I2: 76%) compared to women without SPTL. Women with PPROM had significantly higher odds with M. hominis (OR: 2.09; CI: 1.42–3.08; I2: 0%) than women without PPROM. However, our subgroup analysis based on the diagnostic test and the sample used for detecting GM showed a higher prevalence of GM in maternal samples than in fetal samples. GM presence of the cervix and vagina was associated with lower odds of PTB and preterm labor (PTL). In contrast, GM presence in the AF, fetal membrane, and placenta was associated with increased odds of PTB and PTL. However, genital mycoplasmas may not elicit the massive inflammation required to trigger PTB. In conclusion, GM presence in the fetal tissues was associated with significantly increased odds of PTB and PTL.

Characterization of amniotic fluid sludge in preterm and term gestations

Objective To describe the characteristics of amniotic fluid sludge obtained from patients in term and preterm gestations. Methods This cross-sectional study included patients with dense aggregates of particulate matter detected in amniotic fluid, observed with transvaginal sonography. All patients were in labor and had an impending delivery, either preterm or at term. Echogenic material contained within amniotic fluid was retrieved transvaginally by needle amniotomy under direct visualization. The amniotic fluid analysis consisted of a Gram stain, cultures for aerobic/anaerobic bacteria and genital mycoplasmas, and a white blood cell count. Results Twenty-five patients ranging from 18 to 41 weeks of gestation were included in the study. We observed the following: (1) the appearance of amniotic fluid was consistent with pus-like material, vernix, or meconium by naked eye examination; (2) samples collected before 33 weeks of gestation (n = 13) had a pus-like appearance; however, after this gestational age, most of the samples [83% (10/12)] appeared to be consistent with vernix; (3) amniotic fluid cultures were positive for microorganisms in 13 patients, of which 10 were preterm gestations before 33 weeks; (4) the most frequent microorganisms retrieved by culture were genital mycoplasmas (Ureaplasma urealyticum [46% (6/13)]), followed by Mycoplasma hominis [31% (4/13)] and Candida albicans [15% (2/13)]; and (5) patients with sonographic particulate matter in preterm gestations frequently presented acute histologic chorioamnionitis and funisitis, but these conditions were rare in patients at term. Conclusion The nature of amniotic fluid particulate material varies as a function of gestational age. The material obtained in preterm gestations is frequently related to an inflammatory process, while that obtained at term is often consistent with vernix and appears to represent a maturational process.

Prevalence of Genital Mycoplasma in Pregnancies with Shortened Cervix

Objective: To determine whether colonization with genital Mycoplasma species (spp.) in patients presenting with a shortened cervix before 34th week of pregnancy is associated with preterm birth. Methods: The collective of this retrospective study consisted of 100 pregnant women who presented to a German Tertiary Perinatal Center between 2017 and 2020 due to a shortened cervix defined as a cervical length of 25mm or shorter measured by transvaginal ultrasound before 34 weeks of gestation. At the time of admission gestational age ranged from 18+4 and 33+3 weeks of pregnancy. All patients underwent urine Polymerase Chain Reaction (PCR) for genital Mycoplasma (Ureaplasma (U.) urealyticum, U. parvum, M. hominis or M. genitalium). Patients who were tested positive underwent a therapy with macrolides (azithromycin or clarithromycin). Results: 37% of the patients were positive for Ureaplasma spp. whereas 5% (5 patients) were Mycoplasma spp positive. All the latter were simultaneously colonized with Ureaplasma spp. Ureaplasma positive patients were significantly younger than those who were tested negative. Median maternal age at examination was 30 years (a) versus 31a (p=0.04). There was no difference between Ureaplasma positive and negative patients regarding median maternal body-mass-index (BMI) (kg/m²) (23.4 versus 22.3, p=0.41), cervical length at admission (mm) (15 versus 17, p=0.17), gestational age at examination (days, d) (198 versus 197, p=0.97) or gestational age at birth (d) (250 versus 257, p=0.33), respectively. Comparing U. parvum positive and U. urealyticum positive patients, there was some weak indication that U. parvum positive patients may get a shortening of the cervix earlier in pregnancy, as the median gestational age at examination was 196d versus 215d (p=0.06). Regarding Mycoplasma positive and negative patients, there was no difference in all examined parameters. Conclusions: Overall, one third of all women in our study with a shortened cervix before 34th week of pregnancy were colonized with genital Mycoplasma spp. We were able to show that pregnant women, who were treated with antibiotics when tested-positive for genital Mycoplasma, gave birth at the same gestational age as patients with a shortened cervix without detected Mycoplasma. This raises the question of whether routine testing and early antibiotic treatment should be established in prenatal care.

Genital mycoplasma and preterm birth: a difficult puzzle to solve

Genital mycoplasma and preterm birth: a difficult puzzle to solve

The Role of Genital Mycoplasmas in Preterm Labor.

Background:Growth of Mycoplasma in genital tract can cause problems such as infertility, pelvic inflammatory disease (PID), and preterm labor. This study was designed to evaluate the role of these bacteria in preterm labor among individuals in Gorgan city which is located in north of Iran.Methods:The study included 100 women with complaints of pain in preterm labor before 37 weeks of pregnancy (case group) and 100 women with term labor (control group) who were referred to Shahid Sayyad Shirazi Teaching Hospital in Gorgan city, north of Iran. Vaginal swabs, collected from all of these women, were evaluated for genital Mycoplasma sp. by molecular method using specific primers with polymerization chain reaction (PCR). The comparison of results was done by conducting X 2 and p<0.05 was considered significant.Results:Genital Mycoplasma was detected in 78 cases (39%) of 200 vaginal samples. Genital Mycoplasma colonization rates in the preterm and term samples were 60% and 18%, respectively, with relative risk of 2.05 (1.78–2.37) (p=0.001). The proportion of Ureaplasma parvum (44% and 15%), Ureaplasma urealyticum (11%, 3%), and Mycoplasma homins (5%, 0%) was significantly higher in women with preterm birth (PTB) than term labor. No cases of Mycoplasma genitalum were detected in this study.Conclusion:There is a significant relationship between presence of genital Mycoplasma in vaginal secretion and the risk of preterm labor.

Evaluation of Antibacterial Activity of Selected Edible Herbs Against Genital Mycoplasmas Among University Students in Enugu State, Nigeria

<i>The prevalence rates of Mycoplasma hominis and Ureaplasma Spp</i> and the evaluation of edible herbs against genital mycoplasmas were determined among university students in Enugu state, Nigeria. Specimens from 2400 subjects comprising of 1200 male and female subjects were tested for <i>Mycoplasma hominis</i> and <i>Ureaplasma Spp</i>. Cultures were done on Mycoplasma agar, A7agar and urea-arginine LYO2 broth. Antimicrobial susceptibility pattern was determined by Mycoplasma IST2 kit. Preliminary qualitative phytochemical analysis was done using standard methods to reveal the presence of basic phytochemicals. Rizomes of <i>Curcuma longa</i>, garlic and ginger, cloves and seeds of <i>Garcina kola</i> were extracted with water, methanol and ethanol sequentially and reconstituted with dimethyl -sulfoxide to concentrations (mg/ml) of 200, 100, 50, 25, 12.5, 6.25, 3.125 and 1.56. Mycoplasma isolates were screened for sensitivity to the extracts using agar well diffusion and broth diffusion methods. <i>Mycoplasma hominis</i> occurred more in women at (81.6%) while <i>Ureaplasma Spp</i> occurred more in men at (88%). <i>Mycoplasma hominis</i> (98%) and <i>Ureaplasma Spp</i> (91.6%) showed high sensitivityto ciprofloxacin. The test plants all showed presence of alkaloids, tannis, flavonoids, terpenoids, saponins, phenols and cardiac glycosides. At 200mg/ml <i>Garcina kola</i> and <i>Curcurma longa</i> showed higher zones of inhibition at 35mm on <i>Mycoplasma hominis</i> and <i>ureaplasma Spp</i>. Syngestic activities of ethanolic extracts of Curcuma longa and garlic showed high zones of inhibition at 45mm on <i>Mycoplasma hominis</i> while at 200mg/ml <i>Garcina kola</i> and cloves showed zones of inhibition at 45mm on <i>ureaplasma spp</i>. The minimum inhibitory concentration (MIC) results of the syngestic plants were 1.56mg/ml on all the isolates. The Results from the study showed that there is high prevalence of <i>Mycoplasma hominis</i> in women while <i>Ureaplasma Spp</i> while <i>Ureaplasma Spp</i> occurred more in men in the study area. The synergistic activities of selected edible plants showed higher efficacy on resistant isolates and suggest its use in the treatment of genital Mycoplasmas.