Authors: Kasprzykowska Urszula Elias Joanna Elias Marek Mączyńska Beata Sobieszczańska Beata Magdalena
Publish Date: 2013/12/07
Volume: 289, Issue: 5, Pages: 1129-1134
Abstract
Genital ureaplasmas are considered opportunistic pathogens of human genitourinary tract involved in adverse pregnancy sequelae and infertility While association of Ureaplasma urealyticum with urogenital tract infections is well established the role of Ureaplasma parvum in these infections is still insufficient In the study we compared how often cervicovaginal colonization with U parvum is associated with the presence of these microorganisms in the upper genitourinary tract of fertile and infertile womenIn total 19 475 of the 40 samples were positive for ureaplasmas U parvum was simultaneously detected in pairs of samples in five 555 of the nine 474 women positive in PCR assay As many as 5 185 of the 27 infertile women and 1 77 of the 13 fertile women showed infection of the upper genital tract with U parvumThe results of the study demonstrated that colonization of the lower genital tract with U parvum can produce asymptomatic infection of the upper reproductive system in women These findings also imply that U parvum may be present in the upper genital tract at the time of conception and might be involved in adverse pregnancy outcomesMycoplasmataceae family comprises pleomorphic cell wall deficient bacteria of Mycoplasma and Ureaplasma genera referred to collectively as mycoplasmas 1 2 Genital ureaplasmas ie U urealyticum biovar 2 comprising serotypes 2 4 5 7 and from 7 to 13 and U parvum biovar 1 serotypes 1 3 6 and 14 are considered natural inhabitants of the lower urogenital tract of humans as they are often isolated from healthy individuals 3 4 On the other hand ureaplasmas are involved in a variety of infections in humans There are several reports confirming the association of U urealyticum with nongonococcal urethritis infertility postpartum endometriosis chorioamnionitis spontaneous abortion stillbirth premature birth and perinatal morbidity and mortality 1 2 5 While association of U urealyticum with urogenital tract infections is well established the role of U parvum in these infections is still insufficient and underestimated mostly because of lack of ureaplasma species differentiation Nevertheless the isolation of U parvum from subjects with genitourinary tract infections as well as findings of studies on laboratory animals seems to confirm the pathogenicity of the species 6 De Francesco et al 7 have found U parvum serovar 3/14 in 86 of women with symptomatic genital tract infections Similarly Kong et al 8 have identified U parvum in vaginal swabs of 87 pregnant women U parvum has also been linked with adverse pregnancy outcomes such as late abortion and early preterm birth 9 Kacerovsky et al 10 identified U parvum in 57 of healthy nonpregnant women and the organism was far more prevalent than any of the other genital mycoplasmas Chlamydia spp or virusesThe pathomechanism of infections caused by genital ureaplasmas is not fully elucidatedhowever several virulence factors ie IgA protease phospholipases A and C as well as hemolytic activity and attachment to the host cell have been described in Ureaplasma species Moreover it has been showed that longlasting colonization of mucosal membranes of the lower urogenital tract and immune response to ureaplasmal antigens stimulated inflammation demonstrated by elevated levels of proinflammatory cytokines eg interleukin6 IL6 and IL8 5 11Most studies linking ureaplasmas with genital tract infections adverse pregnancy outcomes or infertility are limited to sampling the lower genital tract thus yielding inconclusive results and complicating an understanding the potential role of U parvum in the reproductive tract infections The study was undertaken to elucidate whether the colonization of the lower urogenital tract with U parvum can produce ascending asymptomatic infection of the upper genital tract in nonpregnant fertile and infertile women In the study PCR assay was used to determine the prevalence of U parvum and U urealyticum in pairs of specimens ie vaginal swabs and Douglas’ pouch fluid samples obtained from consecutive 40 women with no symptoms of infection of the urogenital tract that were subjected to diagnostic laparoscopy
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