Urethral inflammatory response to ureaplasma is significantly lower than to Mycoplasma genitalium and Chlamydia trachomatis

Abstract

A non-syndromic approach to treatment of people with non-gonococcal urethritis (NGU) requires identification of pathogens and understanding of the role of those pathogens in causing disease. The most commonly detected and isolated micro-organisms in the male urethral tract are bacteria belonging to the family of Mycoplasmataceae, in particular Ureaplasma urealyticum and Ureaplasma parvum. To better understand the role of these Ureaplasma species in NGU, we have performed a prospective analysis of male patients voluntarily attending a drop in STI clinic in Oslo. Of 362 male patients who were tested for NGU using microscopy of urethral smears, we found the following sexually transmissible micro-organisms: 16% Chlamydia trachomatis, 5% Mycoplasma genitalium, 14% U. urealyticum, 14% U. parvum and 5% Mycoplasma hominis. We found a high concordance in detecting in turn U. urealyticum and U. parvum using 16s rRNA gene and ureD gene as targets for nucleic acid amplification testing (NAAT). Whilst there was a strong association between microscopic signs of NGU and C. trachomatis infection, association of M. genitalium and U. urealyticum infections in turn were found only in patients with severe NGU (>30 polymorphonuclear leucocytes, PMNL/high powered fields, HPF). U. parvum was found to colonise a high percentage of patients with no or mild signs of NGU (0-9 PMNL/HPF). We conclude that urethral inflammatory response to ureaplasmas is less severe than to C. trachomatis and M. genitalium in most patients and that testing and treatment of ureaplasma-positive patients should only be considered when other STIs have been ruled out.

Detection of ureaplasmas and bacterial vaginosis associated bacteria and their association with non-gonococcal urethritis in men

“…The role of U . urealyticum in male NGU is still not settled, as studies have shown diverging results [5, 6, 36, 37] and the present study did not find any correlation.…”

Roles ofUreaplasmaSpecies in Idiopathic Chronic Prostatitis: A Case-Control Study

“…N. gonorrhea and C. trachomatis microbes can induce male urethritis or CP, therefore they are eradicated by administering specific antimicrobials [5915]. However, urethral inflammatory response after Ureaplasma infections is significantly lower than that of Mycoplasma genitalium or C. trachomatis [16]. In other words, clinical symptoms or signs such as urethral discharge and increased WBC counts in voided urine samples are usually inconsistent following Ureaplasma infections [9].…”

The Role of Polymorphonuclear Leukocyte Counts from Urethra, Cervix, and Vaginal Wet Mount in Diagnosis of Nongonococcal Lower Genital Tract Infection

“…In addition, 10-20 ml of first void urine was collected. DNA was isolated from 200 μ l of medium from the cervical swab (Roche Molecular system) and from 200 μ l of first void urine (FVU) [ 7 ]. NAAT was performed for each of these microorganisms from FVU, as well as from a cervical/vaginal swab.…”