Estudio prospectivo de la incidencia de patógenos genitales oportunistas y estrictos que crecen en medios de cultivo artificiales

Trichomoniasis in a tertiary hospital of Madrid, Spain (2013-2017): prevalence and pregnancy rate, coinfections, metronidazole resistance, and endosymbiosis

Trichomoniasis is the most prevalent curable sexually transmitted infection (STI) worldwide and a risk factor for the acquisition of other STIs and adverse pregnancy outcomes. The objectives of this study were to determine the prevalence of T. vaginalis and related coinfections in women attending a third-level hospital of Madrid (Spain). A retrospective study of 24,173 vaginal exudates from women with suspected vaginitis was conducted between 2013 and 2017. Likewise, among T. vaginalis positive samples, co-occurrence with gonorrhea, chlamydia, syphilis, VIH, Mycoplasma hominis, and Ureaplasma urealyticum was checked. Moreover, seven T. vaginalis isolates from 2017 were randomly collected for endobionts, drug resistance, and microsatellite (MS) instability determinations. The prevalence of T. vaginalis was 0.8% between 2013 and 2017. Less than 20% of patients with trichomoniasis were submitted to a complete screening for other genital pathogens. From that, two patients were coinfected with chlamydia and three with syphilis. Surprisingly, 6.4% of positive samples were diagnosed among pregnant women, showing an alarming increase from 3.2% (2014) to 10% (2017). Among the isolates randomly analyzed, five carried T. vaginalis virus, five harbored mycoplasmas, and one was metronidazole-resistant. The molecular genotyping showed a high variability in the three MS evaluated. To our knowledge, this is the first study in Spain that evaluates the prevalence of trichomoniasis in general and pregnant population and includes biomolecular determinations. These results warn about the increasing prevalence and highlight the importance of including T. vaginalis detection in routine gynecological revisions with special emphasis on childbearing age women and patients with previous STIs.

[Prevalence among males from the general population of agents responsible of not ulcerative genital tract infections, assisted in specialized care]

OBJECTIVE

Male genital infections are a major problem due to their high frequency and morbidity and their role in cases of male infertility. We studied the presence, in males assisted in specialized care, of non-ulcerative genital tract infections-producing agents.

METHODS

We studied descriptively and retrospective microbiological results of 3,066 samples of male patients, with diagnosis of genital tract infection episode, received between January 1, 2016 and December 31, 2017. Detection of microorganisms in the sample was performed using techniques of artificial culture and PCR (BD-MAX).

RESULTS

Positive results were obtained in 451 samples (14.71%). By culture, the most frequent pathogens were Enterobacterales (18.40%), Enterococcus (13.75%), Haemophilus (8.65%), Neisseria gonorrhoeae (8.43%), Ureaplasma (5.10%), and Candida (3.77%). By polymerase chain reaction (PCR), the most frequent were N. gonorrhoeae (28.37%), Chlamydia trachomatis (26.95%), Ureaplasma urealyticum (17.73%), Mycoplasma hominis/Ureaplasma parvum (10.64%), and Mycoplasma genitalium (7.10%). The age was older in patients infected with Enterobacterales, Candida, or Enterococcus and younger in those infected with N. gonorrhoeae.

CONCLUSIONS

N. gonorrhoeae and C. trachomatis are still more common in male genital infection pathogens, although other culturable microorganisms have an important role. These findings demonstrate the importance of systematically applying both conventional culture and PCR techniques for pathogen detection.