Mycoplasma/Ureaplasma infection in pregnancy: to screen or not to screen

Abstract

Mycoplasmata have been linked to pregnancy complications and neonatal risk. While formerly a limited number of species could be discovered by cultures, molecular biology nowadays discovers both lower quantities and more diverse species, making us realize that mycoplasmata are ubiquitous in the vaginal milieu and do not always pose a danger for pregnant women. As the meaning of mycoplasmata in pregnancy is not clear to many clinicians, we summarized the current knowledge about the meaning of different kinds of mycoplasmata in pregnancy and discuss the potential benefits and disadvantages of treatment. Currently, there is no general rule to screen and treat for mycoplasmata in pregnancy. New techniques seem to indicate that Ureaplasma parvum (Up), which now can be distinguished from U. urealyticum (Uu), may pose an increased risk for preterm birth and bronchopulmonary disease in the preterm neonate. Mycoplasma hominis (Mh) is related to early miscarriages and midtrimester abortions, especially in the presence of abnormal vaginal flora. Mycoplasma genitalium (Mg) is now recognized as a sexually transmitted infection (STI) that is involved in the causation of cervicitis, pelvic inflammatory disease (PID) in non-pregnant, and preterm birth and miscarriages in pregnant women, irrespective of the presence of concurrent other STIs, like Chlamydia or gonorrhoea. Proper studies to test for efficacy and improved pregnancy outcome are scarce and inconclusive. Azythromycin is the standard treatment now, although, for Mg, this may not be sufficient. The role of clarithromycin in clinical practice still has to be established. There is a stringent need for new studies based on molecular diagnostic techniques and randomized treatment protocols with promising and safe antimicrobials.

Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? – a position statement from the European STI Guidelines Editorial Board

“…To avoid some of the confounding factors, we focused on international peer‐reviewed papers using molecular diagnostics and appropriate species differentiation. Relevance of these bacteria in pregnancy or in neonates was not addressed, because this has been reviewed recently elsewhere …”

Emerging role for Ureaplasma parvum serovar 3: Active infection in women with silent high‐risk human papillomavirus and in women with idiopathic infertility

“…This microenvironment seemed to increase both the susceptibility of the vaginal mucosa and a low cell‐mediated immunity favoring the coinfection with other ST pathogens (Camporiondo et al, ; Denks et al, ; Magaña‐Contreras et al, ). On the basis of these data, it has been suggested the hypothesis that the finding of a specific proinflammatory profile might represent a surrogate marker of U. parvum infection (Donders, Ruban, Bellen, & Petricevic, ).…”

Evaluation of In Vitro Antimicrobial Susceptibility in Ureaplasma urealyticum and Mycoplasma hominis Strains Isolated from Genitourinary Tract Samples

“…Literatürde yer alan çalışmaların bulguları ile uyumlu olarak, üremelerin cinsel aktif yaşlar olan 20-49 yaş aralığında daha sık olduğu ve bu yaş aralığında ise en yüksek oranın 20-29 yaş grubunda olduğu görülmüştür (1,3,(6)(7)(8)11,13,(20)(21)(22)(23)26,32) . Araştırmamızın bulguları vajinal sürüntü örneklerinin % 37.5'inde ve servikal sürüntü örneklerinin % 28.6'sında U.urealyticum ve/veya M.hominis üremesi olduğunu göstermiştir.…”

“…Ancak U.urealyticum'un PİH patogenezindeki rolü kesin değildir (11) . Bunların yanı sıra gebe kadınların tüm mikoplazma türlerini taşıyabildiği ve mikoplazmaların koriyoamniyonit, erken doğum ya da düşük doğum ağırlıklı bebek ve çeşitli perinatal komplikasyonlarla ilişki-li olduğu bilinmektedir (7,18) . Ureaplasma tür-leri ile ilişkili infeksiyonlarda spontan abortus oranları oldukça yüksek iken, kolonizasyon olan olgularda göreceli risk bildirilmiştir.…”

“…Ayrıca intraamniyotik infeksiyonlarda en sık saptanan tür U.urealyticum'dur (27) . Gebelerde inflamatuvar belirteçler ile kombine olarak M.hominis'in prenatal taranması faydalı bulunurken, U.urealyticum açısından taramanın perinatal komplikasyonları ön görmede katkısı olmadığı görülmüştür (7) . Yardımcı üreme teknikleri kullanılan olgularda, tekrarlayan düşüklerde, erken doğumlarda ve düşük doğum ağırlıklı yeni doğanlarda antibiyotik tedavisi ve gebelerde makrolidler için antibiyotik duyarlılık testlerinin yapılması önerilmektedir (27) .…”