Article

Prevalence of Ureaplasma urealyticum and Mycoplasma hominis infection in unselected infertile men

Section of Microbiology, Department of Bio-medical Sciences, University of Catania, Italy.
Journal of chemotherapy (Florence, Italy) (Impact Factor: 1.6). 04/2012; 24(2):81-6. DOI: 10.1179/1120009X12Z.00000000021
Source: PubMed

ABSTRACT

In this study, we investigated the prevalence of Ureaplasma urealyticum and Mycoplasma hominis infection among 250 unselected infertile men, the presence of urogenital symptoms in infected men and the effects of these microorganisms on the conventional sperm parameters. Urethral samples were obtained using a swab inserted 3-4 cm into the urethral meatus. Ureaplasma urealyticum and Mycoplasma hominis were detected by the kit Mycofast R evolution 3 Elitech Microbiology (Elitech Microbiology, Signes, France). Ureaplasma urealyticum was detected in 15.6% of the cases and Mycoplasma hominis in 3.6%. One patients had a co-infection with both pathogens. About 41% of the infertile patients with mycoplasma infection had urogenital symptoms. A lower number of patients with mycoplasma infection had normal sperm parameters compared with non-infected infertile men, but this frequency showed only a trend compared to non-infected patients (Chi-square=3.61; P=0.057), and a significantly higher percentage of patients with oligo-astheno-teratozoospermia (Chi-square=127.3; P<0.0001), or asthenozoospermia alone (Chi-square=5.74; P<0.05) compared to non-infected infertile patients. In conclusion, this study showed an elevated prevalence of Ureaplasma urealyticum and Mycoplasma hominis infection in unselected men attending an infertility outpatient clinic and that the presence of these microorganisms is associated with a higher percentage of patients with abnormal sperm parameters.

Full-text

Available from: Aldo E. Calogero, Jan 26, 2016
Prevalence of Ureaplasma urealyticum and
Mycoplasma hominis infection in unselected
infertile men
Mario Salmeri
1
, Daniela Valenti
2
, Sandro La Vignera
2
, Salvatore Bellanca
3
,
Angela Morello
1
, M. Antonietta Toscano
1
, Silvana Mastrojeni
1
,
Aldo E. Calogero
2
1
Section of Microbiology, Department of Bio-medical Sciences, University of Catania, Italy,
2
Section of
Endocrinology, Andrology and Internal Medicine and Master in Andrological and Human Reproduction Sciences,
Department of Internal Medicine and Systemic Diseases, University of Catania, Italy,
3
Department Maternal
Infant and Radiological Science, University of Catania, Italy
In this study, we investigated the prevalence of Ureaplasma urealyticum and Mycoplasma hominis infection
among 250 unselecte d infertile men, the presence of urogenital symptoms in infected men and the effects
of these microorganisms on the conventional sperm parameters. Urethral samples were obtained using a
swab inserted 3–4 cm into the urethral meatus. Ureaplasma urealyticum and Mycoplasma hominis were
detected by the kit Mycofast R evolution 3 Elitech Microbiology (Elitech Microbiology, Signes, France).
Ureaplasma urealyticum was detected in 15.6% of the cases and Mycoplasma hominis in 3.6%. One
patients had a co-infection with both pathogens. About 41% of the infertile patients with mycoplasma
infection had urogenital symptoms. A lower number of patients with mycoplasma infection had normal
sperm parameters compared with non-infected infertile men, but this frequency showed only a trend
compared to non-infected patients (Chi-square53.61; P50.057), and a significantly higher percentage of
patients with oligo-astheno-teratozoospermia (Chi-square5127.3; P,0.0001), or asthenozoospermia alone
(Chi-square55.74; P ,0.05) compared to non-infected infertile patients. In conclusion, thi s study showed
an elevated prevalence of ureaplasma urealyticum and mycoplasma hominis infection in unselected men
attending an infertility outpatient clinic and that the presence of these microorganisms is associated with a
higher percentage of patients with abnormal sperm parameters.
Keywords: Ureaplasma urealyticum, Mycoplasma hominis, Infertility, Infection, Sperm parameters, Urethral swab, Urogenital symptoms
Introduction
Infertility affects about 15–20% of the couples in
their reproductive age in industrialized countries.
1,2
Approximately 35% of these cases relate to a male
factor
3
and it is estimated that 8–35% of male
infertility is due to an infection of the genital tract.
4
Microbial agents impair fertility by causing an ob-
struction of the male reproductive system, a testicular
damage affecting the whole spermatogenesis, sperm
cell function impairment, and/or agglutination of
motile spermatozoa.
5,6
Ureaplasma urealyticum and
Mycoplasma hominis are among the most common
pathogens. The prevalence of U. urealyticum has been
reported to range from 5% to 42% in the semen
samples of infertile men.
7–11
Mycoplasmas are the smallest free living and self-
replicating organisms with the smallest genome size
and cells measuring 0.3–0.8 mm. They belong to the
Mollicutes class and to the Mycoplasmataceae
family. Seventeen different species of mycoplasmas
have been isolated in humans. They are prokaryotes
which lack of cell wall, a characteristic feature that
distinguishes them from other bacteria. M. pneumo-
nia is a well-established pathogen which colonizes the
respiratory or oropharynx tract. Several mycoplas-
mas have been isolated from the urogenital tract and
are natural inhabitants of male urethra contaminat-
ing the semen during ejaculation. They can cause
infections via sexual contacts and for this reason
they are often referred as ‘sexual mycoplasmas’.
12,13
Newly-identified mycoplasma species, such as M.
penetrans and M. pirum, have pathological effect
evident in patients with AIDS. Sexual mycoplasmas
are U. ureal yticum and M. hominis, which are the
Correspondence to: A E Calogero, Sezione di Endocrinologia, Andrologia
e Medicina Interna, Dipartimento di Medicina Interna e Patologie
Sistemiche, Universita` di Catania, Policlinico ‘G. Rodolico’, Via S. Sofia
78, Blgd 4, Rm 2C19, 95123 Catania, Italy. Email: acaloger@unict.it
ß
2012 Edizioni Scientifiche per l’Informazione su Farmaci e Terapia
DOI 10. 1179/1120009X12Z .0000000002 1
Journal of Chemotherapy 2012 VOL.24 NO.2 81
Page 1
most common, and M. genitalium, M. fermentans, M.
spermatophilum, and M. prim atum, which are rare.
The importance of mycoplasmas infections is
obscured by the presence of many asymptomatic
carriers, but the microorganisms, characterized by a
silent nature, are potentially pathogenic and may play
a role in genital infection and on male’s fertile
capability.
14
There is no doubt that they can cause
non-gonococcal urethritis (NGU) in both men and
women; they are also associated with pyelonephritis,
pelvic inflammatory disease and post-partum fevers,
prostatitis, and epididymitis.
6,11,15–17
Their patho-
genicity is associated with the ability to the adhere to
epithelial cells of the genitourinary tract, to sperma-
tozoa, and erythrocytes.
12
Although mycoplasmas have been described since
1898 and many studies have examined their impact on
men fertility, their possible influence on sperm quality
is still controversial. Therefore, the purpose of this
study was to evaluate: (1) the frequency of myco-
plasma infections in unselected infertile men; (2) the
presence of urogenital symptoms in men with myco-
plasma infection; and (3) the effects of the infection on
the conventional sperm parameters in vivo.
Patients and Methods
Patient enrolment
The study was conducted in 250 unselected subfertile
men who attending our Centre of Andrology from
October 2005 to November 2010. All men under-
went a careful andrological evaluations, semen sam-
ple analysis, sperm culture, and urethral swab.
Sperm parameters
Semen samples were obtained by masturbation after
3–5 days of sexual abstinence. All samples were pro-
duced on site and collected in sterile nontoxic reci-
pients. Patients were not taking antibiotics for at least
2 weeks before semen analysis. Before collecting the
sample, they were asked to wash their hands and
genital area with water and soap carefully. After
liquefaction at room temperature, semen samples were
analyzed for sperm concentration, seminal volume,
viability, progressive motility, non-progressive moti-
lity, morphology, sperm vitality, and leukocyte con-
centration, according to the criteria outlined by the
World Health Organization (WHO, 1999).
According to these criteria, oligozoospermia was
defined by a sperm concentration ,20610
6
/ml, asthe-
nozoospermia by progressive sperm motility ,50%,
teratozoospermia by normal morphology ,15%, and
necrozoospermia by sperm vitality ,50. Leukocyto-
spermia was defined by a concentration of leukocytes
>1610
6
/ml.
Analysis for mycoplasma detection
Samples were obtained using swabs that were inserted
3–4 cm into the urethral meatus. Investigation to
diagnose the presence of U. urealyticum and M.
hominis was done using the kit Mycofast R Evolu-
tion 3 Elitech Microbiology (Elitech Microbiology,
Signes, France) according to the manufacturer pro-
tocol. Briefly, 300 ml of each sample were fed on
lyophilized growth medium. Homogenization was
obtained by slight rotation. Then 100 ml of each
sample were transferred to one microplate contain-
ing proliferation wells and antibiotics separately for
the quantitative determination of U. urealyticum and
M. hominis. Fifty microliters were added in two wells
of supplement activator to reveal the presence of M.
hominis. To provide for the anaerobic conditions,
two drops of paraffin oil were added to each well
of the microplate. Microplates were closed with the
adhesive film and incubated at 37uC for 48 hours.
After 2 days incubation at 37uC, the growth was
evaluated through color change.
During growth, U. urealyticum and M. hominis
metabolize urea and arginine, respectively, resulting
in a color change of the medium (which contains
phenol red indicator) from yellow-orange to red. This
color change is due to the liberation of ammonia
resulting in an alkaline pH of the medium. Then, the
test is objective and easy to be interpreted. The wells
allow testing the susceptibility of these bacteria to
seven antibiotics at two concentrations: doxycicline,
pristinamycin, roxithromycin, azithromycin, josamy-
cin, ciprofloxacin, and ofloxacin. Based on the results
of antibiogram, antibiotic treatment was given to
all patients who were found to have proliferation.
Doxycicline was the antibiotic of choice which was
found devoid of resistance in all cases examined.
Accordingly, high rates of susceptibility to this anti-
biotic (97.5% and 96.8%, respectively) have been
reported for both U. urealyticum and M. hominis.
18
Statistical analysis
Results are reported as mean6SEM throughout the
study. The data were analyzed by Student’s t-test or
Chi-square, as appropriate. The software SPSS 9.0
for Windows was used for statistical evaluation
(SPSS Inc., Chicago, IL, USA). A statistically signi-
ficant difference was accepted when the P value was
lower than 0.05.
Results
The threshold value of positivity was determined to
be 10
3
color changing units (ccu)/ml for U. urealyti-
cum and 10
4
ccu/ml for M. hominis. Any value below
this threshold was considered negative.
Frequency of U. urealyticum and/or M. hominis
in semen samples
Forty-nine patients out of the 250 couples enrolled in
this study (19.6%) showed the presence of mycoplas-
mas in their semen samples. The infection with U.
urealyticum was more common than that with M.
Salmeri et al. Prevalence of U. urealyticum and M. hominis infection
82 Journal of Chemotherapy 2012 VOL.24 NO.2
Page 2
hominis. Indeed, U. urealyticum was detected in 39
patients with a prevalence of 15.6%, whereas M.
hominis was detected in nine patients with a preva-
lence of 3.6%. One patient had a co-infection with
both pathogens, and two patients had co-infection
with Streptococcus agalactiae, one with Enterococcus
fecalis and one with both Chlamydia trachomatis and
Candida albicans. No significant frequency of myco-
plasma infection was detected in the various age
ranges (Table 1). The mean length of infertility was
2.3260.23 and 2.760.2, in patients with or without
infection, respectively. The difference was not statis-
tically different.
Urogenital symptoms/signs in patients with U.
urealyticum and/or M. hominis infection
Twenty-nine infertile patients with U. urealyticum
and/or M. hominis infection (59.2%) had no urogen-
ital symptoms. The remaining had the following
symptoms/signs: five patients referred dysuria and
testicular discomfort (10.2%); five had epididymis of
increased consistency at the physical exam (10.2%);
10 had epididymal pain during palpation at the
physical exam (20.4%) and one of these had enlarged
bilateral inguinal lymph nodes (2%).
Sperm parameters in patients with U.
urealyticum and/or M. hominis infection
The main sperm parameters in patients infected with
U. urealyticum and/or M. hominis are reported in
Table 2. We found a significantly lower total sperm
motility in patients with M. hominis infection alone
compared to patients with U. urealyticum infection
alone (P,0.05, Student’s t-test), whereas the latter
had a significantly lower number of normally-shaped
spermatozoa (P,0.05, Student’s t-test).
The frequency of sperm parameter abnormalities in
patients without mycoplasma infection and with U.
urealyticum and M. hominis infection is reported in
Table 3. Normal sperm parameters were found in a
lower number of patients with mycoplasma infection
compared with non-infected infertile men, but the
frequency showed only a trend (Chi-square53.61,
P50.057). On the other hand, a significantly higher
percentage of patients with oligo-astheno-teratozoos-
permia (Chi-square5127.3, P,0.0001) or astheno-
zoospermia alone (Chi-square55.74, P,0.05) were
found in the infected group compared to non-infected
men. No statistical significant differences were ob-
served in the frequency distribution of the other
sperm abnormalities.
Discussion
The results of this study showed that mycoplasma
infection involved a large number (19.6%) of unse-
lected infertile male patients. The prevalence we
found is similar to that repeated in other studies
which show an increased frequency of mycoplasma
infection in men.
7–11,19–21
The infection with U.
urealyticum was more common than that with M.
hominis. In fact, U. urealyticum was detected in 39
patients out of the 250 couples enrolled in this study,
whereas the presence of M. hominis was found in nine
patients. The prevalence of U. urealyticum infection
we found is within the range (5–42%) reported by
other authors.
7–11,22
One patient had a co-infection
with both pathogens, whereas four patients had co-
infection with other microbes and/or yeast. Co-infections
cause dysmicrobism and increase the microorganism
resistance to antibiotic treatment.
23
The association between U. urealyticum and/or M.
hominis infection and symptoms/signs of urethritis
has rarely been investigated.
24
Taylor-Robinson and
Furr reported that mycoplasmas represent the se-
cond most common cause of acute NGU, after C.
Table 1 Prevalence of Ureaplasma urealyticum and/or Mycoplasma hominis infection in 250 infertile male patients
according to their age range
Age range U. urealyticum infection M. hominis infection Co-infection Overall prevalence
20–29 years (n543) 6 2 1 20.9%
30–39 years (n5129) 22 5 0 20.9%
40–49 years (n566) 10 1 0 16.7%
50–59 years (n512) 1 1 0 16.7%
Note: n5number of patients.
Table 2 Main sperm parameters in patients with Ureaplasma urealyticum and/or Mycoplasma hominis infection
Sperm parameters
U. urealyticum infection M. hominis infection Overall
(n539) (n59) (n548)
Volume (ml) 2.560.2 2.960.6 2.660.2
Sperm concentration (mil/ml) 48.168.1 49.2612.6 47.766.9
Total sperm count (mil/ejaculate) 120.8620.1 115.3631.4 118.8617.2
Total motility (%) 56.763.8 35.565.6* 54.363.5
Progressive motility (%) 19.263.0 14.765.3 19.962.9
Normal forms 18.461.6 29.266.1* 20.561.7
Leukocytes (mil/ml) 0.860.2 1.060.2 0.860.1
Note: *P,0.05 versus U. urealyticum alone (Student’s t-test).
Salmeri e t al. Prevalence of U. urealyticum and M. hominis infection
Journal of Chemotherapy 2012
VOL.24 NO.2 83
Page 3
trachomatis, and perhaps mycoplasmas may play an
important role in chronic NGU.
25
In addition,
recently, M. hominis has been called into play as a
pathogenetic factor for the development of prostate
cancer.
26
Investigators assert that mycoplasmas are
genitourinary tract commensals; thus, their presence
suggests a silent colonization and not a real infec-
tion; for this reason, the majority of infected pa-
tients are asymptomatic and the infection cannot be
suspected.
27
In contrast, other studies suggest that M.
hominis may have an effect on the genital tract
leading to an inflammatory obstructive process. The
presence of U. urealyticum has been reported in 11.7–
19% of men with urethritis symptoms or with chronic
prostatitis symptoms.
13,28,29
Indeed, a high preva-
lence of inflammatory (8.1%, 158 patients out of
1954) and non-inflammatory (5.9%, 63 patients out of
1075) chronic prostatitis syndrome related to U.
urealyticum infection has been reported.
30
We found
that about two-thirds of the patients with U.
urealyticum and/or M. hominis infection did not have
urogenital symptoms, whereas the remaining had
dysuria and testicular discomfort, and/or, at the
physical exam, epididymal increased consistency and
pain, and enlarged bilateral inguinal lymph nodes.
The role of U. urealyticum on male infertility has
been controversial ever since Fowlkes showed that
U. urealyticum adheres to spermatozoa by electron
microscopy.
31
Some studies suggest that mycoplas-
mas have only a marginal role, whereas others show a
primary role of these microbes on sperm function.
31,32
Several studies failed to show any relationship between
sperm parameter abnormalities and the presence of
mycoplasma infection.
8,9,33–37
This discrepancy may
relate to the different results obtained in studies
conducted in vitro or in vivo. Zdrodowska-Stefanow
and colleagues reported an elevated prevalence of M.
hominis (2.7%) or U. urealyticum (21.6%) infection in
infertile patients.
13
This is in agreement with other
reports showing the relatively high percentage of U.
urealyticum in patients treated for infertility.
38
We found a higher percentage of patients with
oligo-astheno-teratozoospermia or asthenozoospermia
alone in patients with mycoplasma infection compared
with non-infected infertile men. U. urealyticum seems to
mainly alter sperm morphology compared to M. hominis
infection, whereas the latter mainly decreases sperm
motility.
A study conducted in rats experimentally infected
with U. urealyticum revealed a decline in spermato-
genesis 3–5 weeks after the infection.
4
A dual energy
metabolism-dependent effect of U. urealyticum on
sperm motility has been reported in vitro with a
suppressive effect on sperm motility at low pH and a
stimulatory one at high pH.
39
Nu´n˜ ez-Calonge and
colleagues also reported that U. urealyticum reduces
sperm motility, vitality, and morphological altera-
tions in the sperm membrane in vitro, but in vivo the
presence of the microorganism in the seminal fluid
was not found associated with alterations of the
sperm parameters.
5
Other studies showed that U.
urealyticum has negative effects on semen volume,
pH, sperm concentration, morphology, motility, and
vitality, and these parameters improve after oral
antibiotic treatment.
4,40,41
A study comparing the
sperm parameters of infertile men with or without
mycoplasmas infection showed that mycoplasmas
infection is associated with low sperm concentration
and abnormal sperm morphology.
42
To confirm the
possible influence of mycoplasmas on male infertility,
some authors found a decline in the success rate of
assisted reproductive techniques in presence of myco-
plasma infections. U. urealyticum may cause infertility
through its deleterious effects on sperm chromatin and
DNA, resulting in an impaired embryo development,
so the screening for mycoplasmas is clinically relevant
especially for couples undergoing assisted reproduc-
tive technique.
15,43,44
The precise pathogenetic role played by myco-
plasmas on male fertility has not been clarified; some
authors tried to explain their effects with the
microorganism ability to attach and invade the
urinary cells, erythrocytes, and especially human
spermatozoa.
12,45,46
Some studies have reported that
U. urealyticum produces sperm membrane altera-
tions which stimulate the formation of antisperm
Table 3 Number and frequency (in parentheses) of sperm parameter abnormalities in 250 infertile men according to the
absence (non-infected) and in presence of Ureaplasma urealyticum and/or Mycoplasma hominis
Sperm parameter abnormalities
Non-infected Mycoplasma infection
(n5201) (n549)
Normal sperm parameters 55 (27.4%) 7 (14.3%)
Oligozoospermia 1 (0.5%) 0 (0%)
Oligo-asthenozoospermia 22 (10.9%) 6 (12.2%)
Oligo-astheno-teratozoospermia 18 (9.0%) 7 (14.3%)*
Asthenozoospermia 62 (30.8%) 24 (49.0%)*
Astheno-teratozoospermia 32 (15.9%) 5 (10.2%)
Teratozoospermia 1 (0.5%) 0 (0%)
Azoospermia 10 (5.0%) 0 (0%)
Note: n5number of patients; *P,0.05 versus non-infected (Chi-square test).
Salmeri et al. Prevalence of U. urealyticum and M. hominis infection
84 Journal of Chemotherapy 2012 VOL.24 NO.2
Page 4
antibodies, with an increased risk of infertility on an
immunological basis.
35–43
Others authors observed that
U. urealyticum reduces sperm acrosome reaction.
47
In conclusion, we found that mycoplasmas are
frequently present in unselected infertile patients and
that U. urealyticum detection was more common than
M. hominis. More than a half of these patients did not
have symptoms and/or signs of urogenital infection.
Finally, a lower number of patients with normal
sperm parameters and a higher percentage of asteno-
zoospermic patients were found among mycoplasma-
infected men. These results suggest that infertile
patients should be screened for the presence of
mycoplasmas in their urogenital system.
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    • "In a study from Lee et al. low total motility and total motile sperm count were significantly related to the presence of this mycoplasma [135]. In a study among 250 unselected infertile men, there were a significantly higher percentage of patients with oligoasthenoteratozoospermia or asthenozoospermia alone in the group infected with M. hominis compared to noninfected, infertile patients [138]. The presence of M. hominis DNA in semen samples was associated with low sperm concentration and abnormal sperm morphology in a study from Tunisia, although the mean values of pH, total volume, vitality, motility, and polymorphonuclear count were not significantly related to the detection of genital mycoplasmas [139]. "
    [Show abstract] [Hide abstract] ABSTRACT: The most prevalent, curable sexually important diseases are those caused by Chlamydia trachomatis (C. trachomatis) and genital mycoplasmas. An important characteristic of these infections is their ability to cause long-term sequels in upper genital tract, thus potentially affecting the reproductive health in both sexes. Pelvic inflammatory disease (PID), tubal factor infertility (TFI), and ectopic pregnancy (EP) are well documented complications of C. trachomatis infection in women. The role of genital mycoplasmas in development of PID, TFI, and EP requires further evaluation, but growing evidence supports a significant role for these in the pathogenesis of chorioamnionitis, premature membrane rupture, and preterm labor in pregnant woman. Both C. trachomatis and genital mycoplasmas can affect the quality of sperm and possibly influence the fertility of men. For the purpose of this paper, basic, epidemiologic, clinical, therapeutic, and public health issue of these infections were reviewed and discussed, focusing on their impact on human reproductive health.
    Full-text · Article · Dec 2014
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    • "Earlier male urogenital bacterial studies have focused on heterosexual men [18,19,22], where vaginal bacteria such as Lactobacillus, Prevotella, Porphyromonas, Veillonella have been shown in their semen, coronal sulcus, urethral, and urine [19,23– 25]. We observed that bacteria in the semen of MSM overlapped with those previously described in the vagina, including Prevotella and Mycoplasma; the latter, as well as Ureaplasma, has been implicated in male infertility [26]. Our findings of Mollicutes in the semen of MSM, together with previous reports in heterosexual men, suggest that semen is a source for Mollicutes and may shed light on the directionality of their sharing in heterosexual couples. "
    [Show abstract] [Hide abstract] ABSTRACT: Semen is a major vector for HIV transmission, but the semen HIV RNA viral load (VL) only correlates moderately with the blood VL. Viral shedding can be enhanced by genital infections and associated inflammation, but it can also occur in the absence of classical pathogens. Thus, we hypothesized that a dysregulated semen microbiome correlates with local HIV shedding. We analyzed semen samples from 49 men who have sex with men (MSM), including 22 HIV-uninfected and 27 HIV-infected men, at baseline and after starting antiretroviral therapy (ART) using 16S rRNA gene-based pyrosequencing and quantitative PCR. We studied the relationship of semen bacteria with HIV infection, semen cytokine levels, and semen VL by linear regression, non-metric multidimensional scaling, and goodness-of-fit test. Streptococcus, Corynebacterium, and Staphylococcus were common semen bacteria, irrespective of HIV status. While Ureaplasma was the more abundant Mollicutes in HIV-uninfected men, Mycoplasma dominated after HIV infection. HIV infection was associated with decreased semen microbiome diversity and richness, which were restored after six months of ART. In HIV-infected men, semen bacterial load correlated with seven pro-inflammatory semen cytokines, including IL-6 (p = 0.024), TNF-α (p = 0.009), and IL-1b (p = 0.002). IL-1b in particular was associated with semen VL (r2 = 0.18, p = 0.02). Semen bacterial load was also directly linked to the semen HIV VL (r2 = 0.15, p = 0.02). HIV infection reshapes the relationship between semen bacteria and pro-inflammatory cytokines, and both are linked to semen VL, which supports a role of the semen microbiome in HIV sexual transmission.
    Full-text · Article · Jul 2014 · PLoS Pathogens
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    • "The share of an infectious agent in general prevalence of DED may vary depending on the prevalence of this agent in the population. A rather high prevalence of ocular (conjunctival) C. trachomatis infection in persons aged 25–45 years may be related to the increased risk for urogenital infections for this age group [8–10]. Here, the infection can be transmitted to the conjunctiva by contact or hematogenously [20]. "
    [Show abstract] [Hide abstract] ABSTRACT: Aim. To determine the frequency of detection of conjunctival C. trachomatis (CT), M. hominis (MH), and U. urealyticum (UU) infections in young adults with dry eye disease (DED), since these infections may potentially produce the chronic subclinical inflammation characteristic of DED. Materials and Methods. The study included subjects of 25–45 years of age, divided into the DED ( n = 114 ) and nondry eye control ( n = 98 ) groups, with the diagnosis based on self-reported complaints, biomicroscopy, the Schirmer I test, and break-up time. All patients had conjunctival scrapings taken to detect CT, MH, and UU with direct fluorescent-antibody assay kits. Results. At least one of the three microorganisms was found in 87.7% of the DED patients versus 8.2% of the controls. Of all the DED patients, 63.2%, 50.8%, and 42.1% were found to be infected with CT, MH, and UU, respectively. Multiple pathogens were identified in 65% of the DED patients found to be infected. CT infection was detected in 6.1% of the controls. Conclusion. C. trachomatis, M. hominis, and U. urealyticum were detected with high frequency in the conjunctiva of young adults with DED and may be an important risk factor for DED in them.
    Full-text · Article · May 2014 · Journal of Ophthalmology
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