Vaginosis Bacteriana – Actualización y novedad terapéutica

La vaginosis bacteriana es la causa del flujo vaginal anormal más común en mujeres en edad reproductiva. Esta patología se presenta en la mayoría de los casos de forma asintomática y cuenta con una alta tasa de recurrencia. Desde la perspectiva fisiopatológica, la vaginosis bacteriana se causa por un desequilibrio bacteriano vaginal. Este desequilibro genera un desplazamiento de la flora vaginal normal y como consecuencia ésta se coloniza principalmente por bacterias anaerobias como: Gardenerella vaginalis, Prevotella, Peptostreptoccocus, Ureaplasma urealyticum, porphyromonas y mycoplasma hominis. Las pacientes pueden presentar clínicamente un flujo blanquecino o grisáceo, en ocasiones espumoso que puede ser mal oliente. Estas pacientes aparte de la clínica o sintomatología genital también podrían presentar un estrés psicológico que podría llevar al desarrollo de patologías de índole psiquiátrica. El tratamiento de la patología se realiza con antibióticos, de primera elección, dentro de los cuales se encuentra el metronidazol o clindamicina vaginal u oral y como segunda línea se utiliza el tinidazol o el secnidazol, ambos por vía oral. De igual forma, recientemente se han desarrollado nuevas terapias que ayudan a evitar el alto porcentaje de recurrencia de la patología, como colonias de Lactobaciillus depositadas directamente en la vagina.

On the clinical significance of biovars ureaplasma urealyticum

Developing of chronic salpingoophoritis, non-specific bacterial vaginitis and specific candidamytotic vaginitis ought to be associated with complicated obstetric anamnesis and presence of biovar Parvo ureaplasmas predominantly found in womens genital tracts. The correlation may be seen between identifying biovar Parvo ureaplasmas in men and arising of torpid and chronic infectious urethritis, that may testify to its more intensive pathogenic effect comparing with biovar T- 9GO. Detection of biovar T-960 in urogenital system in men and women doesnt exclude the possibility of inflammation, that implies adequate complex therapy identical to that in case of biovar Parvo.

Laboratory diagnostics of urogenital mycoplasma colonization and infection

The paper presents data on the possibilities of determining urogenital mycoplasmas (Mycoplasma hominis and Ureaplasma urealyticum) using some variants of culture and PCR methods. The scheme of cultural studies in full is given, with the help of which high specificity and sensitivity indicators are achieved. The proposed research algorithm for detecting Mycoplasma hominis and Ureaplasma urealyticum, based on the use of culture and PCR methods as complementary.

Epidemiological, clinical and laboratory differences between male urethral infections due to Haemophilus spp. and those due to Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Ureaplasma urealyticum: A descriptive study

Objective: To describe the epidemiological, clinical and laboratory characteristics of male patients diagnosed with Haemophilus spp. urethral infection and to compare them with the characteristics of male patients diagnosed with N. gonorrhoeae, C. trachomatis, M. genitalium and U. urealyticum urethral infection. Over the past 2 years, an increase in urethral infections due to Haemophilus spp. was observed. Materials and methods: All male patients who attended our Department of Sexually Transmitted Infections between January 2018 and February 2019 were retrospectively studied; they underwent conventional bacteriological and multiplex PCR studies in the urethra at the same time. Results: Of the 86 patients studied, a unique microorganism was detected in 76 cases, N. gonorrhoeae in 24, Haemophilus spp. in 21 (16 H. parainfluenzae and 5 H. influenzae), C. trachomatis in 19, M. genitalium in 8 and U. urealyticum in 4; 10 cases presented more than one microorganism. In case of multiple aetiological agents, sexual partnership was multiple. In the Haemophilus group, 81% reported only unprotected oral insertive sex; symptoms lasted for more than one week in 62% of the patients. Conclusions: Haemophilus is an aetiological agent of non-gonococcal urethritis whose incidence is clearly increasing; the main route of transmission is oral sex. The most common reason for consultation is dysuria and testicular pain, while urethral discharge was predominant for the other causes of urethral infection. Due to the high frequency of antibiotic resistance in the Haemophilus group, it is necessary to confirm eradication by performing a test of cure.

Sequence analysis reveals asymptomatic infection with Mycoplasma hominis and Ureaplasma urealyticum possibly leads to infertility in females: A cross-sectional study

Background: Genetic evidence of asymptomatic Mycoplasma hominis (M. hominis) and Ureaplasma urealyticum (U. urealyticum) infection associated with infertility among females is lacking because suitable high throughput molecular methods have not been applied. Objective: This study aimed to explore the occurrence of M. hominis and U. urealyticum in the genital tract of females with asymptomatic infection and infertility as well as determine their genetic relatedness. Materials and Methods: The study group included 100 asymptomatic females and 31 females diagnosed with infertility. Sequencing of the 16S rRNA gene following DNA extraction was performed directly from endo-cervical swabs. Phylogenetic analysis established the genetic linkage between the isolates from both groups. Results: In asymptomatic females, M. hominis and U. urealyticum were detected with a prevalence of 8% and 2% respectively. Among females with infertility, the prevalence was 6.45% and 3.23% for M. hominis and U. urealyticum respectively. In both groups, M. hominis occurred significantly more frequently. Phylogenetic analysis revealed three distinct clusters in both groups: two with already characterized M. hominis and Ureaplasma species (28.6% of the overall Mycoplasma spp.) and one distinct cluster matched with U. urealyticum. Furthermore, all M. hominis from asymptomatic females clustered significantly with infertility contrary to U. urealyticum. The M. hominis cluster was significantly linked to two strains from China. Conclusion: The sequence analysis of Mycoplasma and Ureaplasma in the genital tract of asymptomatic and infertile females showed significant association; therefore, it is paramount to consider them as possible etiologic agents of infertility and genital infection, especially when the etiology of infertility is unknown. Key words: Mycoplasma hominis, Ureaplasma urealyticum, Genetic linkage, Asymptomatic infections, Infertility.

Screening for Vaginal and Endocervical Infections in the First Trimester of Pregnancy? A Study That Ignites an Old Debate

Objectives: Vaginal and endocervical infections are considered a global health problem, especially after recent evidence of their association with preterm delivery and other adverse obstetric outcomes. Still, there is no consensus on the efficacy of a screening strategy for these infections in the first trimester of pregnancy. This study evaluated their prevalence and whether screening and treatment resulted as effective in reducing pregnancy and perinatal complications. Methods: A single-center prospective observational study was designed; a sample size of 400 first-trimester pregnant women was established and they were recruited between March 2016–October 2019 at the Puerta de Hierro University Hospital (Spain). They were screened for vaginal and endocervical infections and treated in case of abnormal flora. Pregnancy and delivery outcomes were compared between abnormal and normal flora groups by univariate analysis. Results: 109 patients had an abnormal flora result (27.2%). The most frequently detected infection was Ureaplasma urealyticum (12.3%), followed by Candida spp. (11.8%), bacterial vaginosis (5%), Mycoplasma hominis (1.2%) and Trichomonas vaginalis (0.8%). Patients with abnormal flora had a 5-fold increased risk of preterm premature rupture of membranes (5.3% vs. 1.1% of patients with normal flora, Odds Ratio 5.11, 95% Confidence Interval 1.20–21.71, p = 0.028). No significant differences were observed regarding preterm delivery or neonatal morbidity. Conclusions: Considering the morbimortality related to prematurity and that the results of our study suggest that the early treatment of abnormal flora could improve perinatal outcomes, the implementation of a screening program during the first trimester should be considered.

Analysis of the Clinical Features of Intrauterine Ureaplasma urealyticum Infection in Preterm Infants: A Case-Control Study

Objective: To analyze the clinical characteristics of intrauterine Ureaplasma urealyticum (UU) infection in premature infants.Method: In this single-center retrospective case-control study, 291 preterm infants born in our hospital and hospitalized in our department and gestational age no more than 32 weeks, birth weight no more than 2000 g were included from January 2019 to January 2021. Lower respiratory tract secretion, gastric fluid and urine were collected for UU RNA detection within 48 h after birth. Intrauterine UU infection is defined by at least one positive UU-PCR test of secreta or excreta of preterm infants after birth. The UU infection group included 86 preterm infants and the non-UU infection group included 205 preterm infants. We compared their clinical features, hemogram changes and disease outcomes using statistical analyses.Results: The clinical characteristics of premature infants such as the duration of oxygen use and ventilator use in hospital were significantly prolonged in the UU infection group (P < 0.05). The levels of leukocytes, platelet and procalcitonin in the UU infection group were significantly higher than in the non-UU infection group (P < 0.05). In terms of preterm complications, only the incidences of bronchopulmonary dysplasia, retinopathy of prematurity and metabolic bone disease in premature infants in the UU infection group were significantly higher than those in the non-UU infection group (P < 0.05). The mode of delivery, maternal premature rupture of membranes, and postnatal leukocyte level were independent risk factors for UU infection, while gestational hypertension was a protective factor for UU infection. The level of leukocytes in postnatal hemogram of premature infants could be used as a diagnostic index of UU infection, but the diagnostic accuracy was poor.Conclusion: In our study, UU infection can increase the incidence of bronchopulmonary dysplasia, retinopathy of prematurity and metabolic bone disease in preterm infants, but have no effect on the incidence of necrotizing enterocolitis, intracranial hemorrhage, white matter damage and other diseases in preterm infants. For high-risk premature infants, UU should be detected as soon as possible after birth, early intervention and drug treatment necessarily can improve the prognosis as much as possible.

DnaJ, A Promising Vaccine Candidate Against Ureaplasma Urealyticum Infection

Background: Ureaplasma urealyticum (Uu) is an important sexually transmitted pathogen that is responsible for diseases such as non-gonococcal urethritis, chorioamnionitis and neonatal respiratory diseases. The rapid emergence of multidrug-resistant bacteria threatens the effective treatment of U. urealyticum infections. Considering this, vaccination could be an efficacious medical intervention to prevent U. urealyticum infection and disease. As a highly conserved molecular chaperone, DnaJ is expressed and upregulated by pathogens soon after infection. Here, we assessed the potential of recombinant DnaJ vaccine in a mouse model and dendritic cells (DCs). Results: The results showed that intramuscular administration of recombinant DnaJ induced robust humoral- and T helper (Th) 1 cell-mediated immune responses and protected against cervical infection, inflammation, and the pathologic sequelae after U. urealyticum infection. Importantly, DnaJ also induced the maturation of mouse bone marrow-derived DCs (BMDCs), ultimately promoting naïve T-cell differentiation towards the Th1 phenotype. In addition, adoptive immunisation of DnaJ-pulsed BMDCs elicited antigen-specific immunoglobulin G2 antibodies as well as a Th1-biased cellular response in mice. Conclusion: We concluded that DnaJ can be a promising vaccine candidate to control U. urealyticum infections.

Recent Efforts in the Discovery of Urease Inhibitor Identifications

: Urease is an attractive drug target for designing anti-infective agents against pathogens such as Helicobacter pylori, Proteus mirabilis, and Ureaplasma urealyticum. In the past century, hundreds of medicinal chemists focused their efforts on explorations of urease inhibitors. Despite the FDA’s approval of acetohydroxamic acid as a urease inhibitor for the treatment of struvite nephrolithiasis and the widespread use of N-(n-butyl)thiophosphoric triamide as a soil urease inhibitor as nitrogen fertilizer synergists in agriculture, urease inhibitors with high potency and safety are urgently needed. Exploration of novel urease inhibitors has therefore become a hot research topic recently. Herein, inhibitors identified worldwide from 2016 to 2021 have been reviewed. They structurally belong to more than 20 classes of compounds such as urea/thioure analogues, hydroxamic acids, sulfonamides, metal complexes, and triazoles. Some inhibitors showed excellent potency with IC50 values lower than 10 nM, having 10000-fold higher potency than the positive control thiourea.