Prevalence and Impact of Ureaplasma urealyticum on Infertility

Nedjoua Sekhri-Arafa^1*, Rihab Traïkia², Douaa Zaarour²

Infertility is a global concern linked to STIs like Ureaplasma urealyticum, necessitating ongoing research to improve reproductive health outcomes.

Abstract

Background: Infertility is a significant global health issue, with sexually transmitted infections (STIs) identified as potential contributing factors. Ureaplasma urealyticum, a common urogenital bacterium, is implicated in various reproductive complications. This study investigates the prevalence and impact of U. urealyticum in infertility cases in Constantine, Algeria, focusing on both male and female patients. Methods: A combined prospective and retrospective analysis was conducted from 2020 to 2023, encompassing 480 samples from patients at a private medical laboratory. Samples were collected through endocervical and urethral swabs, as well as semen collection. The MYCOFAST RevolutioN ATB+ kit was utilized for the detection and analysis of U. urealyticum and Mycoplasma hominis. Results: U. urealyticum was found to be the predominant pathogen, responsible for 99.41% of infections, while M. hominis accounted for only 0.59%. The infection rate was higher in men compared to women, with a male/female ratio of 1.2. The most affected age group was 34-44 years. Despite the overall lower prevalence of positive cases (35.62%), the study highlights the necessity for continued vigilance and preventive measures against STIs. Conclusion: The study identifies U. urealyticum as the primary species responsible for urogenital infections in both men and women in the studied population. The findings underscore the importance of STI monitoring and preventive strategies, even in regions with relatively lower prevalence rates. The use of the MYCOFAST RevolutioN ATB+ kit proved effective in the rapid detection of these pathogens, facilitating further etiological and epidemiological research. Ongoing research is essential to enhance understanding and develop interventions to mitigate the impact of Ureaplasma infections on reproductive health.

Keywords: Infertility, Sexually transmitted infections, Mycoplasmas, Ureaplasma urealyticum

References

Andrade-Rocha, F. T. (2003). Ureaplasma urealyticum and Mycoplasma hominis in men participating in routine semen analysis [In French]. Urologia Internationalis, 71(4), 377–381.

Anwar, S., & Anwar, A. (2016). Infertility: A review on causes, treatment and management. Women’s Health & Gynecology, 2(6), 1-5.

Bébéar, C. (2002). Mycoplasma and Chlamydia. Paris: Ed Elsevier Masson.

Bharat, A., Cunningham, S. A., Scott Budinger, G. R., Kreisel, D., DeWet, C. J., Gelman, A. E., ... & Lynch, J. P. (2015). Disseminated Ureaplasma infection as a cause of fatal hyperammonemia in humans. Science Translational Medicine, 7(284), 284re3.

Diarra, D. (2000). Lower genital infections in the outpatient clinic at the Gabriel TOURE hospital about 200 observations [In French]. (Doctoral dissertation, Doctoral Thesis).

Esen, B., Gozalan, A., Sevindi, D. F., Demirbas, A., Onde, U., Erkayran, U., ... & Adiloglu, A. K. (2017). Ureaplasma urealyticum: Presence among sexually transmitted diseases. Japanese Journal of Infectious Diseases, 70(1), 75-79. doi: 10.7883/yoken.JJID.2015.258.

Fernandez Molina, C., et al. (2007). Diagnosis of Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum in patients with bacterial vaginosis. Revista Cubana de Medicina Tropical, 59(2).

Gimenes, F., Souza, R. P., Bento, J. C., Teixeira, J. J., Maria-Engler, S. S., Bonini, M. G., ... & Consolaro, M. E. (2014). Male infertility: A public health issue caused by sexually transmitted pathogens. Nature Reviews Urology, 11(12), 672–687.

Gu, X., Liu, S., Guo, X., Weng, R., & Zhong, Z. (2019). Epidemiological investigation and antimicrobial susceptibility analysis of mycoplasma in patients with genital manifestations. Journal of Clinical Laboratory Analysis.

Gupta, A., Gupta, S., Mittal, A., Chandra, P., & Gill, A. K. (2009). Correlation of mycoplasma with unexplained infertility. Archives of Gynecology and Obstetrics, 280(6), 981–985.

He, M., Xie, Y., Zhang, R., Gao, S., Xu, G., Zhang, L., & Wu, S. (2016). Prevalence and antimicrobial resistance of mycoplasma and chlamydia in patients with genital tract infections in Shanghai, China [In French]. Journal of Infection and Chemotherapy, 22(8), 548–552.

Imudia, A. N., Detti, L., Puscheck, E. E., Yelian, F. D., & Diamond, M. P. (2008). The prevalence of Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis, and Neisseria gonorrhoeae infections, and the rubella status of patients undergoing an initial infertility evaluation. Journal of Assisted Reproduction and Genetics, 25(1), 43–46. doi: 10.1007/s10815-007-9192-z.

Judlin, P. (2007). Chlamydiae and mycoplasma screening… And bitter? Excerpt from Updates in Medical Gynecology [In French]. CNOOF, Paris, 21p.

Kissinger, P. (2015). Trichomonas vaginalis: A review of epidemiological, clinical and treatment issues [In French]. BMC Infectious Diseases, 15(1).

Knox, C. L., Allan, J. A., Allan, J. M., Edirisinghe, W. R., Stenze, D. L., Lawrence, F. L., ... & Timms, P. (2003). Ureaplasma parvum and Ureaplasma urealyticum are detected in semen after washing before assisted reproductive technology procedures. Fertility and Sterility, 80(4), 921e9–92929.

Ling, Y., Wu, T., Hou, Y., Cheng, X., Zhu, C., Liu, J., & Dong, L. (2012). Prevalence and antimicrobial susceptibility of Ureaplasma urealyticum and Mycoplasma hominis in Chinese women with genital infectious diseases. Indian Journal of Dermatology, Venereology, and Leprology, 78(3), 406.

Maktit, A. (2014). Epidemiology of lower urogenital infections with Chlamydia trachomatis and cultivable mycoplasma in the military hospital of Meknes [In French]. (Doctoral dissertation).

Mereghetti, L., Lanotte, P., & Quentin, R. (2011). Male genital samples. In François, D., Ploy, M. C., Martin, C. H., Bingen, É, & Quentin, R. (Eds.), Medical bacteriology: Usual techniques (pp. 229-236). Paris: Elsevier Masson.

Peeling, R. W., & Embree, J. (2005). Screening for sexually transmitted infection pathogens in semen samples. Canadian Journal of Infectious Diseases and Medical Microbiology, 16(2), 73-76.

Public Health Agency of Canada. (2012). Pathogen Safety Data Sheets: Infectious Substances – Ureaplasma urealyticum. Retrieved April 13, 2023, from Canada.ca.

Ruan, Z., Yang, T., Shi, X., Kong, Y., Xie, X., & Zhang, J. (2017). Clonality and distribution of clinical Ureaplasma isolates recovered from male patients and infertile couples in China [In French]. PLOS ONE, 12(8), e0183947.

Sellors, J., Mahony, J., Jang, D., Pickard, L., Castriciano, S., Landis, S., & Chernesky, M. (1991). Rapid, on-site diagnosis of Chlamydia urethritis in men by detection of antigens in urethral swabs and urine. Journal of Clinical Microbiology, 29(2), 407-409.

Song, T., Ye, A., Xie, X., Huang, J., Ruan, Z., Kong, Y., & Zhang, J. (2014). Epidemiological investigation and antimicrobial susceptibility analysis of ureaplasma species and Mycoplasma hominis in outpatients with genital manifestations. Journal of Clinical Pathology, 67(9), 817–820.

Szamatowicz, M., & Szamatowicz, J. (2020). Proven and unproven methods for the diagnosis and treatment of infertility [In French]. Advances in Medical Science, 65(1), 93.

Taylor-Robinson, D. (1996). Infections due to species of Mycoplasma and Ureaplasma: An update. Clinical Infectious Diseases, 23(4), 671–684.

Van Den Brule, F., Freyens, A., & Gaspard, U. (2006). Management of Chlamydia trachomatis pelvic infection. Rev Med Liege, 61(5-6), 433-41.

World Health Organization. (2023). Infertility. In International Classification of Diseases, 11th Revision (ICD-11). Geneva: World Health Organization.

Zdrodowska-Stefanow, B., Klosowska, W. M., Ostaszewska-Puchalska, I., Bulhak-Koziol, V., & Kotowicz, B. (2006). Ureaplasma urealyticum and Mycoplasma hominis infection in women with urogenital diseases. Advances in Medical Sciences, 51, 250-253.

Zheng, W. W., Zhang, W. J., Cui, D., Nie, Z. C., Ding, B. S., Cheng, J. H., & Mei, C. Z. (2020). Examination of Ureaplasma urealyticum and Mycoplasma hominis in 4082 Chinese patients. Brazilian Journal of Medical and Biological Research, 54(2), e10099.

Zhou, Y. H., Ma, H. X., Shi, X. X., & Liu, Y. (2018). Ureaplasma spp. in male infertility and its relationship with semen quality and seminal plasma components. Journal of Microbiology, Immunology and Infection, 51(6), 778–783.