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| Year : 1985 | Volume
: 31
| Issue : 2 | Page : 112-4,suppl114A |
Mycoplasmas in female genital tract.
Bhatt MM, Deodhar LP, Gogate AA, Vaidya PR, Patel MV
How to cite this article:
Bhatt M M, Deodhar L P, Gogate A A, Vaidya P R, Patel M V. Mycoplasmas in female genital tract. J Postgrad Med 1985;31:112-4,suppl114A |
Organisms of the genus Ureaplasma urealyticum referred to as ureaplasmas (earlier called T. strain mycoplasmas) and less frequently Mycoplasma hominis (large colony mycoplasma) have been suggested as a cause of a wide range of diseases of the female genital tract.[5] These include salpingitis, vaginitis, cervicitis, pelvic inflammatory diseases (PID) and infertility. The mycoplasmas and ureaplasmas can be isolated from urine and swabs taken from the cervix, vagina, urethra etc.
This study was undertaken to find out the incidence of infection due to these micro-organisms in female patients attending the gynaecology outpatient department of the municipal hospital, Bombay. Control cases were also studied for comparing the isolation rates of M. hominis and U. urealyticum with the study group.
Urine samples and two swabs from the cervix or vagina of female patients attending the hospital for various complaints such as leucorrhoea, burning micturition, dysuria etc., were collected. Stuart's transport medium was used whenever necessary. When the samples were brought to the laboratory, the following procedures were carried out:
1) Urine sediments and fresh cervical/vaginal swabs were examined microscopically for T. vaginalis and Candida.
2) Giemsa staining was done to detect inclusions of Chlamydia trachomatis.
3) Gram's staining was done to detect Gram negative, intracellular diplococci, candida and other species.
4) Urine sediments and swabs were cultured on the following media: (a) chocolate agar, (b) blood agar and MacConkey's agar, (c) Sabouraud's agar (S.A.), (d) PPLO agar/broth supplemented with arginine (for M. hominis), at pH = 7.07.5 and (e) PPLO agar/broth supplemented with urea (for U. urealyticum) at pH=6.5.
The first three media were incubated at 37°C for 24-48 hours and examined. Sabouraud's agar was examined for one week to see the growth of Candida. The PPLO agar and PPLO broth were kept in Mac Intosh and Fildes' jar in a gaseous environment of 95% N2 and 5% CO2. Colonies and colour change in the media were observed after 5 days. The presence of Ureaplasmas was indicated by a colour change from yellow to pink. Identification of various micro-organisms was carried out by using standard tests as recommended by Kenny.[3] Cultural studies of chlamydia were not done.
One hundred and twenty-six patients with genital tract infection were investigated. Of these, 102 had vaginitis, 14 had cervicitis, 9 had repeated abortions and one patient had pelvic inflammatory disease. Fifty five control cases (patients without genital tract infection) were also studied for comparison. The results of bacteriological studies are shown in [Table - 1].
In 34 cases of the study group, M. hominis or U. urealyticum were isolated whereas U. urealyticum was isolated only in 3 cases of the control group. Identification of the Ureaplasma organisms was confirmed only when the samples cultured simultaneously on MacConkey's medium did not show any growth of urease-producing bacteria like Proteus and Klebsiella. Colonies of Ureaplasma on PPLO agar were confirmed by using Shepard's reagent.[3] Mycoplasma hominis showed typical fried egg colonies [Fig. 1] and were confirmed by Diene's stain and showed inability to revert to bacterial forms in penicillin-free medium. A few cultures of M. hominis and U. urealyticum were confirmed by FAO/WHO collaborating centre, Aarhus.
Candida albicans were isolated from 14 cases and their pathogencity and significance were confirmed by repeated isolation, pseudogerm tube and chlamydospore formation.
Microbial flora of the female genital tract presents as extensive and diversified spectrum of pathogenic and non-pathogenic organisms as any other human tissue system.[1] An increased rate of endogenous infection due to micro-organisms like bacteriodes, mycoplasmas etc., has been recorded in the last few decades. This can be partly attributed to greatly improved laboratory techniques resulting in increased isolation of these organisms with relative ease.
In the present study, in 34 cases (27%), Ureaplasmas and Mycoplasmas were isolated from patients with various clinical conditions. In all these cases, the organisms were isolated and identified from the urine as well as from the vaginal swabs. In two cases, there was a mixed infection [Table - 1]. Malik[4] from Aligarh has reported an isolation rate of 34.1% and 53.7% of large colony Mycoplasma and U. urealyticum respectively from vaginitis/cervicitis patients. Kapur et al[2] and Gupta et al[1] have reported recovery of U. urealyticum in 21.4% and 10% respectively of patients suffering from vaginal discharge. The results in the present studies are low as compared to above studies due to different types of populations. Young et al[7] have reported an incidence of 78% of Ureaplasma in women attending a clinic for sexually transmitted diseases. According to these authors,[7] conditions in the female genitourinary tract are much more favourable for the proliferation of ureaplasmas. With the result, infants become colonised with genital mycoplasmas usually during passage through the birth canal; mycoplasmas, mainly ureaplasmas have been isolated from the nose, throat, conjunctiva etc. of upto 15% of infants of both sexes.[6]
The present study shows that ureaplasma and mycoplasma infections are common in women with genital tract infections and can be diagnosed in the routine laboratory. Difference in the isolation rate of these infections in the study group as well as in the control group was also significant.
We thank the Dean, L.T.M.M.C. Sion, for allowing us to utilize the hospital data. We are extremely grateful to the Research Society, L.T.M.M.C. Sion, for the research grant sanctioned for this project. Our thanks are also due to Dr. B. N. Ganguli, Hoechst Pharmaceuticals Ltd., Bombay, for his help and advice.
| 1. | Gupta, U., Oumachigui, A. and Hingorani, V.: Microbial flora of the vagina with special reference to anaerobic bacteria and mycoplasma. Ind. J. Med. Res., 61: 1600-1603, 1973.  |
| 2. | Kapur, T. R., Gupta, U., Bhutani, L. K., Singh, O. P., Kandhari, K. C. and Hingorani, U.: Isolation of 'T' Mycoplasma in vaginal discharge. Obstet. and Gynaec. Ind., 26: 879-883, 1976. |
| 3. | Kenny, G. E.: Mycoplasma: Chapter 81, In, "Gradwohl's Clinical Laboratory Methods and Diagnosis." Editors: A. D. Sonnenwirth and L. Jarrett, C. V. Mosby and Company, Saint Louis, 1980, Pp. 1870-1875. |
| 4. | Malik, A.: Isolation of mycoplasma from female genital tract infections. In, "Proceedings of the All India symposium on Mycoplasma Diseases", 1982, pp. 5561. |
| 5. | Munday, P. E., Furr, P. M. and Taylor Robinson, D.: The prevalence of Ureaplasma urealyticum and Mycoplasma hominis in the cervix and anal canal of women. J. Infect., 3: 253-257, 1981. |
| 6. | Taylor-Robinson, D. and Csonka, G. W.: Laboratory and clinical aspects of mycoplasmal infections of the human genitourinary tract. Chapter If, In, "Recent Advances in Sexually Transmitted Diseases". Editor: J. R. W. Harris, Churchill Livingstone, Edinburgh, 1981, pp. 151186. |
| 7. | Young, H., Tuach, S. and Bain, S. R. S.: Incidence of Ureaplasma urealyticum infection in women attending a clinic for sexually transmitted diseases. J. Infect., 3: 258-265, 1981. |
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