Prevalence of Ureaplasma Urealyticum in Infertility Assessments in An Eastern Algerian Region

Nedjoua Sekhri-Arafa ^1*, Rihab Traikia^2*,  Zaarour Douaa^2*

Understanding the prevalence of Ureaplasma urealyticum in infertility assessments can enhance diagnosis and treatment, improving reproductive health outcomes.

Abstract

Background: Infertility is a global concern, with sexually transmitted infections (STIs) being a potential cause. Ureaplasma urealyticum, a prevalent urogenital bacterium, has implications for fertility. This study focuses on the prevalence of U. urealyticum in infertility cases, investigating its role in both men and women. Methods: A prospective and retrospective analysis (2020-2023) was conducted on 480 samples collected from patients at a private medical laboratory in Constantine, Algeria. Samples were obtained through endocervical and urethral swabs, as well as semen collection. Detection and analysis utilized the MYCOFAST RevolutioN ATB+ kit. Results: The prevalence of U. urealyticum was notable, accounting for 99.41% of infections, with only 0.59% attributable to Mycoplasma hominis. Notably, men exhibited a higher infection rate than women, with an overall male/female ratio of 1.2. Age distribution revealed that the most affected age group was 34-44 years. Despite the lower prevalence of positive cases (35.62%), vigilance regarding STIs is crucial. U. urealyticum emerged as the predominant species responsible for urogenital infections, particularly among men. Conclusion: The study underscores the importance of STI monitoring and preventive measures, even in regions with relatively lower prevalence. The MYCOFAST RevolutioN ATB+ kit facilitated efficient detection and has implications for etiological and epidemiological investigations. Continued research is vital for a comprehensive understanding of Ureaplasma infections and their impact on reproductive health.

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

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.  Mycoplasme and Chlamydia. Ed Elsevier Masson. Paris 2002, 145 p.

Bharat, A., Cunningham, S. A., Scott Budinger, G. R., Kreisel, D., DeWet, C. J., Gelman, A. E., ... Schmidt, T. M. (2015). Disseminated Ureaplasma infection as a cause of fatal hyperammonemia in humans. Science Translational Medicine, 7(284), 284re3. https://doi.org/10.1126/scitranslmed.3010636

Canada.ca. (2012). Pathogen Safety Data Sheets: Infectious Substances – Ureaplasma urealyticum. Retrieved from [link]

Diarra, D. (2000). Lower genital infections in the outpatient clinic at the Gabriel Touré Hospital about 200 observations [In French]. Doctoral dissertation, Université de Bamako.

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. https://doi.org/10.7883/yoken.JJID.2015.258

Fernandez Molina, C., et al. (2007). Diagnosis of Mycoplasma hominis, Ureaplasma parvum y 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. (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, 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. https://doi.org/10.1007/s10815-007-9192-z

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

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., Stenzel, 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), 921e9–929.

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 M. C. François, D. Ploy, C. H. Martin, É. Bingen, & R. Quentin (Eds.), Medical bacteriology [In French] (pp. 229-236). 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.

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. Revue Médicale de Liège, 61(5-6), 433-441.

World Health Organization. (2023). Infertility. 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. (2008). 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.