Detection of common bacterial causes of urethritis in symptomatic men at the STD laboratory of MU-Sofia by microscopy, culture and NAAT

Abstract

INTRODUCTION: Urethritis is one of the major causes of morbidity in men. The primary pathogens are Chlamydia trachomatis and Neisseria gonorrhoeae, but also Mycoplasma genitalium. Ureaplasma urealyticum, Trichomonas vaginalis, anaerobes, Herpes simplex virus (HSV), and adenovirus. AIM: The aim of this study was to detect common bacterial causes of urethritis in symptomatic men by Gram stain, culture and nucleic acid amplification techniques (NAAT), and to compare them. MATERIALS AND METHODS: Seventy-eight male patients with clinical symptoms suggestive of urethritis were enrolled in the study. Three urethral samples were obtained from each one -for smear on a glass slide, culture, and NAAT. The glass slides were subjected to Gram stain. Culture on modified Thayer Martin media was used for detection of N. gonorrhoeae. Isolation of C. trachomatis was performed on McCoy cells, afterwards stained for immunofluorescence with anti-lipopolysaccharide monoclonal antibody. Cultivation and ennumeration of Ureaplasma spp. and M. hominis was done with Mycofast Revolution kit. DNA extractions and amplifications by using multiplex Real Time PCR tests were done for all the bacteria. RESULTS: In 30 persons, infections were detected by using different microbiological tests. N. gonorrhoeae was discovered by Gram stain in 5 samples; by cultivation -in 6; by PCR -in 8. C. trachomatis was found in 13 samples with cultivation; by PCR -in 14. Ureaplasma spp. was found in 7 samples with cultivation and in 9 with PCR. M. genitalium was detected only by PCR in 3 samples. M. hominis was negative in all tested swabs. Co-infections with two microorganisms were detected in 4 samples. All the samples with positive results showed increased number of leukocytes on Gram staining. DISCUSSION: Although many infections can be diagnosed on the basis of clinical criteria alone, accurate and timely diagnostic microbiology is essential for the clinical management of patients' infections. In our study the PCR was the most sensitive and rapid method for the diagnosis of urethritis in symptomatic

Prevalence of Neisseria Gonorrhoeae and Mycoplasma Genitalium in Bulgarian Population From Sofia Municipality of Reproductive Age, 2018-2019

“…In the present study, prevalence of M. genitalium infection was 2.49%. Other Bulgarian studies have reported rates from 0.29% to 2.45% (7)(8)(9). In addition, the only identified risk factor significantly associated with M. genitalium, was the presence of urogenital symptoms.…”

“…However, as in other settings the reporting of M. genitalium is not mandatory and the reporting of gonorrhea cases is likely to be incomplete (6). For these reasons and because of the scarce published studies on N. gonorrhoeae and M. genitalium infections in recent years (7)(8)(9), supplemental data on gonorrhea and genital mycoplasma prevalence would be very useful in assessing the burden of disease in Bulgarian population. The main objective of this study was to estimate the prevalence of N. gonorrhoeae and M. genitalium infections and the association with possible risk factors in Bulgarian population of reproductive age (18-49 years) from Sofia municipality.…”

Azithromycin treatment failure and macrolide resistance in Mycoplasma genitalium infections in Sofia, Bulgaria

“…Data from Bulgarian studies remain very scarce, reporting M. genitalium solely prevalence with rates ranging from 0.29% to 2.45%. [29][30][31] To the knowledge of the authors, this is the first observational study for azithromycin failure and macrolide resistance in M. genitalium-positive patients from Bulgaria. The obtained in this study azithromycin cure rate of 52.4% is alarmingly low and raises concerns over the continued use of azithromycin in Bulgarian population, making the investigation of new diagnostic and therapeutic strategies a priority.…”