Clinical role of Ureaplasma parvum and Ureaplasma urealyticum presence in female lower urogenital tract: Is there a place for routine screening and treatment?
Abstract
Sexually transmitted infections represent major health problem in females all over the world if remained undiagnosed and untreated. They can have adverse influence on reproduction and health of a mother and a newborn. The development of molecular methods has permitted the detection of an array of microbes whose pathologic roles in urogenital infections need to be further studied. Ureaplasmas (Ureaplasma spp.), being originally found in 1954 from male urogenital tract, are prokaryotic cells without a cell wall, ranging from 0.1 to 1 μm in length. Fourteen known Ureaplasma serovars have been divided in two species based on their phenotypic and genotypic features, Ureaplasma parvum and Ureaplasma urealyticum detected and identified separately using polymerase chain reaction assays. Both are generally considered as genital tract commensals. U. urealyticum is most probably associated with male urethritis which has not been found for U. parvum. Recent studies with supposedly healthy women reported their detection rate between 18-87 % for U. parvum and 6-10 % for U. urealyticum. Even though they have been found to be associated with chorioamnionitis, preterm birth and perinatal complications more commonly then other commensals in this region the rising question regarding their pathogenic role in females remains unsolved and the guidelines regarding the diagnostic screening and treatment are inconsistent.
The aim of our paper is to review the microbiological characteristics, diagnostic methods and epidemiology of newly differentiated U. parvum and U. urealyticum, and to assess evidence speaking pro and contra their clinical role in causing lower urogenital tract infection in women. Since both bacteria are susceptible to antimicrobials it is of utmost importance for clinicians to decide whether or not to search for one or both of them routinely and treat accordingly in order to prevent ascending upper genital tract infection as well as complications in pregnancy and newborns.
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References
WHO. Sexually transmitted infections. World Health Organization 2013. Dosegljivo 15 Nov 2013 na: http://www.who.int/mediacentre/factsheets/fs110/en/.
Buve A, Gourbin C, Laga M. Gender and sexually transmitted diseses. V: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, et al, eds. Sexually transmitted diseases. 4th ed. New York: McGraw-Hill; 2008. p. 151-64.
Holmes KK, Stamm WE, Sobel JD. Lower genital tract infection syndromes in women. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, et al, eds. Sexually transmitted diseases. 4th ed. New York: McGraw-Hill; 2008. p. 987-1016.
Povlsen K, Bjornelius E, Lidbrink P, Lind I. Relationship of Ureaplasma urealyticum biovar 2 to nongonococcal urethritis. Eur J Clin Microbiol Infect Dis 2002; 21: 97-101.
Deguchi T, Yoshida T, Miyazawa T, Yasuda M, Tamaki M, Ishiko H, et al. Association of Ureaplasma urealyticum (biovar 2) with nongonococcal urethritis. Sex Transm Dis 2004; 31: 192-5.
Couldwell DL, Gidding HF, Freedman EV, McKechnie ML, Biggs K, Sintchenko V, et al. Ureaplasma urealyticum is significantly associated with non-gonococcal urethritis in heterosexual Sydney men. Int J STD AIDS 2010; 21: 337-41.
Ondondo RO, Whittington WL, Astete SG, Totten PA. Differential association of ureaplasma species with non-gonococcal urethritis in heterosexual men. Sex Transm Infect 2010; 86: 271-5.
Maeda S, Deguchi T, Ishiko H, Matsumoto T, Naito S, Kumon H, et al. Detection of Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in patients with non-gonococcal urethritis using polymerase chain reaction-microtiter plate hybridization. Int J Urol 2004; 11: 750-4.
Shepard MC. The recovery of pleuropneumonia-like organisms from Negro men with and without nongonococcal urethritis. Am J Syph Gonorrhea Vener Dis 1954; 38: 113-24.
Shepard MC, Lunceford CD, Ford DK, Purcell RH, Taylor-Robinson D, Razin S, et al. Ureaplasma urealyticum gen. nov. sp. nov.: proposed nomenclature for the human T (T-strain) mycoplasmas. Int J Syst Bacteriol 1974; 24: 160-71.
Waites KB, Katz B, Schelonka RL. Mycoplasmas and ureaplasmas as neonatal pathogens. Clin Microbiol Rev 2005; 18: 757-89.
Robertson JA, Stemke GW, Davis JW, Jr., Harasawa R, Thirkell D, Kong F, et al. Proposal of Ureaplasma parvum sp. nov. and emended description of Ureaplasma urealyticum (Shepard et al. 1974) Robertson et al. 2001. Int J Syst Evol Microbiol 2002; 52: 587-97.
Waites KB, Taylor-Robinson D. Mycoplasma and Ureaplasma. In: Versalovic J, ed. Manual of Clinical Microbiology. 10th ed. Washington DC: ASM Press; 2011. p. 970-85.
Glass JI, Lefkowitz EJ, Glass JS, Heiner CR, Chen EY, Cassell GH. The complete sequence of the mucosal pathogen Ureaplasma urealyticum. Nature 2000; 407: 757-62.
Saada AB, Terespolski Y, Adoni A, Kahane I. Adherence of Ureaplasma urealyticum to human erythrocytes. Infect Immun 1991; 59: 467-9.
Busolo F, Zanchetta R, Bertoloni G. Mycoplasmic localization patterns on spermatozoa from infertile men. Fertil Steril 1984; 42: 412-7.
Shepard MC, Masover GK. Special features of ureaplasmas. In: Barile MF, Razin S, eds. The mycoplasmas. Vol 1. New York, N. Y.: Academic Press; 1979. p. 451-94.
Taylor-Robinson D, Furr PM, Webster AD. Ureaplasma urealyticum in the immunocompromised host. Pediatr Infect Dis 1986; 5: S236-8.
Xiao L, Paralanov V, Glass JI, Duffy LB, Robertson JA, Cassell GH, et al. Extensive horizontal gene transfer in ureaplasmas from humans questions the utility of serotyping for diagnostic purposes. J Clin Microbiol 2011; 49: 2818-26.
Waites KB, Xiao L, Paralanov V, Viscardi RM, Glass JI. Molecular methods for the detection of Mycoplasma and ureaplasma infections in humans: a paper from the 2011 William Beaumont Hospital Symposium on molecular pathology. J Mol Diagn 2012; 14: 437-50.
Xiao L, Glass JI, Paralanov V, Yooseph S, Cassell GH, Duffy LB, et al. Detection and characterization of human Ureaplasma species and serovars by real-time PCR. J Clin Microbiol 2010; 48: 2715-23.
McKechnie ML, Hillman RJ, Jones R, Lowe PC, Couldwell DL, Davies SC, et al. The prevalence of urogenital micro-organisms detected by a multiplex PCR-reverse line blot assay in women attending three sexual health clinics in Sydney, Australia. J Med Microbiol 2011; 60: 1010-6.
Cassell GH, Waites KB, Watson HL, Crouse DT, Harasawa R. Ureaplasma urealyticum intrauterine infection: role in prematurity and disease in newborns. Clin Microbiol Rev 1993; 6: 69-87.
Iwasaka T, Wada T, Kidera Y, Sugimori H. Hormonal status and mycoplasma colonization in the female genital tract. Obstet Gynecol 1986; 68: 263-6.
McIver CJ, Rismanto N, Smith C, Naing ZW, Rayner B, Lusk MJ, et al. Multiplex PCR testing detection of higher-than-expected rates of cervical mycoplasma, ureaplasma, and trichomonas and viral agent infections in sexually active australian women. J Clin Microbiol 2009; 47: 1358-63.
Kong F, Ma Z, James G, Gordon S, Gilbert GL. Species identification and subtyping of Ureaplasma parvum and Ureaplasma urealyticum using PCR-based assays. J Clin Microbiol 2000; 38: 1175-9.
Kataoka S, Yamada T, Chou K, Nishida R, Morikawa M, Minami M, et al. Association between preterm birth and vaginal colonization by mycoplasmas in early pregnancy. J Clin Microbiol 2006; 44: 51-5.
Yamazaki T, Matsumoto M, Matsuo J, Abe K, Minami K, Yamaguchi H. Frequency of Chlamydia trachomatis in Ureaplasma-positive healthy women attending their first prenatal visit in a community hospital in Sapporo, Japan. BMC Infect Dis 2012; 12: 82.
Cao X, Wang Y, Hu X, Qing H, Wang H. Real-time TaqMan polymerase chain reaction assays for quantitative detection and differentiation of Ureaplasma urealyticum and Ureaplasma parvum. Diagn Microbiol Infect Dis 2007; 57: 373-8.
Ekiel AM, Friedek DA, Romanik MK, Jozwiak J, Martirosian G. Occurrence of Ureaplasma parvum and Ureaplasma urealyticum in women with cervical dysplasia in Katowice, Poland. J Korean Med Sci 2009; 24: 1177-81.
Schlicht MJ, Lovrich SD, Sartin JS, Karpinsky P, Callister SM, Agger WA. High prevalence of genital mycoplasmas among sexually active young adults with urethritis or cervicitis symptoms in La Crosse, Wisconsin. J Clin Microbiol 2004; 42: 4636-40.
De Francesco MA, Negrini R, Pinsi G, Peroni L, Manca N. Detection of Ureaplasma biovars and polymerase chain reaction-based subtyping of Ureaplasma parvum in women with or without symptoms of genital infections. Eur J Clin Microbiol Infect Dis 2009; 28: 641-6.
Hunjak B, Sabol I, Vojnovic G, Fistonic I, Erceg AB, Persic Z, et al. Ureaplasma urealyticum and Ureaplasma parvum in women of reproductive age. Arch Gynecol Obstet 2013. In press. Dosegljivo $ Avg 2013 na: http://link.springer.com/article/10.1007/s00404-013-2980-z.
Paavonen J, Critchlow CW, DeRouen T, Stevens CE, Kiviat N, Brunham RC, et al. Etiology of cervical inflammation. Am J Obstet Gynecol 1986; 154: 556-64.
Totten PA, Taylor-Robinson D, Jensen JS. Genital Mycoplasmas. V: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, et al, eds. Sexually transmitted diseases. 4th ed. New York: McGraw-Hill; 2008. p. 709-36.
Povlsen K, Thorsen P, Lind I. Relationship of Ureaplasma urealyticum biovars to the presence or absence of bacterial vaginosis in pregnant women and to the time of delivery. Eur J Clin Microbiol Infect Dis 2001; 20: 65-7.
Haggerty CL, Totten PA, Ferris M, Martin DH, Hoferka S, Astete SG, et al. Clinical characteristics of bacterial vaginosis among women testing positive for fastidious bacteria. Sex Transm Infect 2009; 85: 242-8.
Waites KB, Schelonka RL, Xiao L, Grigsby PL, Novy MJ. Congenital and opportunistic infections: Ureaplasma species and Mycoplasma hominis. Semin Fetal Neonatal Med 2009; 14: 190-9.
Gray DJ, Robinson HB, Malone J, Thomson RB, Jr. Adverse outcome in pregnancy following amniotic fluid isolation of Ureaplasma urealyticum. Prenat Diagn 1992; 12: 111-7.
Horowitz S, Mazor M, Romero R, Horowitz J, Glezerman M. Infection of the amniotic cavity with Ureaplasma urealyticum in the midtrimester of pregnancy. J Reprod Med 1995; 40: 375-9.
Gardella C, Riley DE, Hitti J, Agnew K, Krieger JN, Eschenbach D. Identification and sequencing of bacterial rDNAs in culture-negative amniotic fluid from women in premature labor. Am J Perinatol 2004; 21: 319-23.
Beeton ML, Chalker VJ, Maxwell NC, Kotecha S, Spiller OB. Concurrent titration and determination of antibiotic resistance in ureaplasma species with identification of novel point mutations in genes associated with resistance. Antimicrob Agents Chemother 2009; 53: 2020-7.
Bebear CM, Renaudin H, Charron A, Clerc M, Pereyre S, Bebear C. DNA gyrase and topoisomerase IV mutations in clinical isolates of Ureaplasma spp. and Mycoplasma hominis resistant to fluoroquinolones. Antimicrob Agents Chemother 2003; 47: 3323-5.
Duffy L, Glass J, Hall G, Avery R, Rackley R, Peterson S, et al. Fluoroquinolone resistance in Ureaplasma parvum in the United States. J Clin Microbiol 2006; 44: 1590-1.
Povlsen K, Jensen JS, Lind I. Detection of Ureaplasma urealyticum by PCR and biovar determination by liquid hybridization. J Clin Microbiol 1998; 36: 3211-6.
Reyes L, Reinhard M, Brown MB. Different inflammatory responses are associated with Ureaplasma parvum-induced UTI and urolith formation. BMC Infect Dis 2009; 9: 9.
von Chamier M, Allam A, Brown MB, Reinhard MK, Reyes L. Host genetic background impacts disease outcome during intrauterine infection with Ureaplasma parvum. PloS One 2012; 7: e44047.
Spelman DW, Bradford D. Intraurethral immunoglobulin in the treatment of non-specific urethritis. Br J Vener Dis 1984; 60: 58-9.
Taylor-Robinson D, Furr PM, Webster AD. Ureaplasma urealyticum causing persistent urethritis in a patient with hypogammaglobulinaemia. Genitourin Med 1985; 61: 404-8.
Paralanov V, Lu J, Duffy LB, Crabb DM, Shrivastava S, Methe BA, et al. Comparative genome analysis of 19 Ureaplasma urealyticum and Ureaplasma parvum strains. BMC Microbiol 2012; 12: 88.
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