Culture- and PCR-based detection of BV associated microbiological profile of the removed IUDs and correlation with the time period of IUD in place and the presence of the symptoms of genital tract infection

Abstract

ObjectivesThe long-term use of intrauterine devices (IUDs) may lead to biofilm formation on the surface. The aim of this study was to perform the culture- and PCR-based detection of bacteria/fungi from the biofilm of the removed IUDs with different time periods in place.MethodsFor a 2-year period, 100 IUD users were involved in the study. In the majority of the cases, IUDs were removed because of the patients’ complaints. Beside the aerobic and anaerobic culture, species-specific PCR was carried out to detect Chlamydia trachomatis Neisseria gonorrhoeae and the “signalling” bacteria of bacterial vaginosis (BV) in the biofilm removed by vortexing.ResultsSixty-eight percent of IUDs were used for more than 5 years, 32% were removed after 10 years in place. In 28% of the IUDs ≥ 3 different anaerobic species typically found in BV with or without other aerobic bacteria were found by culture method. Streptococcus agalactiae (14%) and Actinomyces spp. (18%) were also isolated frequently. The PCR detection of Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp. and Ureaplasma urealyticum were 62%, 32%, 23% and 16%, respectively. Seventy-six percent of the IUDs were PCR positive at least for one “signalling” bacterium of BV. C. trachomatis was detected by PCR only in one IUD together with other aerobic and anaerobic bacteria, while the presence of N. gonorrhoeae could not be confirmed from the biofilm of these removed devices.ConclusionSexually transmitted infections (STI)-related bacteria—except for one patient—were not detected on the IUDs removed due to different reasons including clinical symptoms of infection. Presence of any BV “signaling” anaerobic bacteria were detected in a much higher number in the biofilm of the removed IUDs by PCR-based method compared to use culture method (76 versus 28 samples). Different aerobic and anaerobic bacteria colonized an equal number of IUDs, independent of the time-period in place, which may be relevant, if the IUD is removed due to planned pregnancy or due to a fear from upper genital tract infection caused by anaerobic bacteria including Actinomyces spp.

High prevalence of group B streptococcus ST17 hypervirulent clone among non-pregnant patients from a Hungarian venereology clinic

“…On the other hand, others found that all examined GBS positive women had vaginal soreness and/or discharge and suggested that streptococci mostly play a secondary role and colonize an already damaged genital epithelium [12]. A very recent Hungarian study examined 100 removed intrauterine devices (57% of the patients showing some type of clinical symptom) and identified the presence of S. agalactiae in 14 cases [13].…”

Oligoarthritis associated with a “forgotten” IUD – a case report

“…Общо 62% от изследваните извадени спирали дават положителен резултат за аеробни и/или анаеробни бактерии. Честотата на полово предаваните инфекции е много ниска, докато микроорганизми, свързани с бактериална вагиноза, са често срещани в пробите от формирания биофилм [11]. В литературата са описани няколко случая на АСИ, обусловени от бактериална вагиноза [12,13], но значението на IUD за развитието на АСИ все още не е изяснено.…”

“…A total of 62% of the investigated removed devices had positive culture results for aerobic and/or anaerobic bacteria. While the prevalence of sexually transmitted infections was very low in the investigated low-risk population, species associated with bacterial vaginosis were often found in the biofi lm samples [11]. Several cases of IRA related to bacterial vaginosis have been described [12,13], but the role of IUD-s for the development of infection related arthritis has not been clarifi ed.…”

Gardnerella vaginalis as a Cause of Bacterial Vaginosis: Appraisal of the Evidence From in vivo Models

“…The condition is characterized by low levels of "healthy" lactobacilli and overgrowth of diverse bacteria from other taxonomic groups, including Gardnerella, Atopobium, Mobiluncus, Prevotella, Bacteroides, Anaerococcus, Peptostreptococcus, Sneathia, Leptotrichia, and members of the class Clostridia, among others (Ravel et al, 2011;Srinivasan et al, 2012). BV has been associated with higher risk of sexually transmitted infections (Wiesenfeld et al, 2003;Brotman et al, 2010;Van De Wijgert, 2017), urinary tract infections (Harmanli et al, 2000;Hillebrand et al, 2002), post-surgical complications (Watts et al, 1990), infertility (Spandorfer et al, 2001), pregnancy losses (Ralph et al, 1999), preterm birth (Svare et al, 2006), intrauterine (Di Paola et al, 2017;Ádám et al, 2018) and intraamniotic infections (Silver et al, 1989), as well as cervical infections, dysplasia, and cancer (Di Paola et al, 2017;Laniewski et al, 2018;Brusselaers et al, 2019). These conditions and health complications associated with BV and its member bacteria can be caused not only by bacteria, but also by eukaryotic (e.g., trichomoniasis) (Jarrett et al, 2019) and viral (e.g., HIV, HSV, HPV) pathogens.…”