Symptomatic Genital Mycoplasmal Infections Among Ante-Natal Women In An Urban Community Of Northern Nigeria And The Need To Possibly Widen The Scope Of Present Laboratory Investigations

摘要

Aim To establish the incidence of symptomatic genital Mycoplasma infections among antenatal women in Jos, Nigeria.Methods High vaginal and Endocervical swabs (HVS/ECS) samples were obtained consecutively from 283 antenatal women that volunteered to enroll in the study. Samples were processed using standard laboratory procedures for the isolation of Mycoplasma species while information such as age, marital status, occupation and other clinical data were obtained using a questionnaire. The results obtained were analysed using SPSS 11.0 statistical methods and P values ≤0.05 were considered significant.Results The overall incidence of genital Mycoplasma infection among the 283 antenetal subjects was found to be 32.5% (n=92); M. hominis was 12.7% (n=36), U. urealyticum 16.6% (n=47), other Mycoplasmas 3.5% (n=9), and mixed M. hominis and U. urealyticum 7.4% (n=21). There was no significant age difference and occupation with the rate of isolation of genital Mycoplasmas among the subjects (P> 0.05); however, there was a significant association of recovery of genital Mycoplasmas with a positive history of vaginal discharge while majority (>95%) of the non specific bacteria (Escherichia coli, Klebsiella spp., Proteus mirabilis and Enterococcus spp.) were recovered from women with background Mycoplasma infections (p<.05).Conclusion Genital Mycoplasmas have been shown to be among the agents that cause, or influence symptomatic genitourinary infections among antenatal women; hence efforts should be made for their recovery especially on persistent isolation of non specific bacteria from genital specimens. Introduction The commonest species of Mycoplasma causing genital tract infections are Mycoplasma hominis, Ureaplasma urealyticum and Mycoplasma genitalium 1,2 . This tissue and organ specificity has been linked with a set of closely related genetically defined factors responsible for tissue specificity of these Mycoplasmas 3,4 . It is this same genetic disposition that has also been attributed to the association of Mycoplasma pneumoniae with the respiratory tract; although of recent M. genitalium has been isolated from the respiratory tract and M. pneumoniae from the genital tract; these are few exceptions 5,6,7 . Bacterial endometrialis which is a sub-clinical bacteria of the endometrium, which in most cases is due to prior bacterial vaginosis has been linked with several obstetric and gynaecological disorders of Mycoplasma has played a significant role; these include: recurrent abortion, dysfunctional uterine bleeding, pelvic pain, premenstrual syndrome, premature labor, placental insufficiency and pre-eclampsia 8,9,10 . Mycoplasmas have been implicated in several cases of unexplained infertility; usually establishing such a diagnosis is not easy due to the level of skillful procedures required, and hence, plasma cells, which are evidence of chronic infection and foci of lymphocytes in the endometrium may be the sole clue of Mycoplasma endometritis 11,12,13 . Koren and Spigland14 (Koren, & Spigland, 1978) found out that: endometrial washings taken from 59 women with unexplained infertility showed 16 patients (27%) to prove positive for Mycoplasma, and five (31%) of these conceived within few months of the 7-day course of the antibiotic, doxycycline. Bercovici et al 15 found out that, Mycoplasma was isolated from 18% of infertile women, though patients with evidence of Mycoplasma in the endometrium had no specific histologic feature. In another study, Idriss et al 16 conducted on 161 consecutive infertility patients and 67 controls for U. urealyticum; of the patients with unexplained infertility, 55% had a positive culture from the endocervix compared with 32% of the controls. In the tropical and sub-tropical parts of the world, little requests are often made by clinicians for the isolation of Mycoplasma in the investigation of nongonococcal urethritis/ cervicitis in general 17,18,19 . Similarly, specific laboratory investigations for is