Ureaplasma urealyticum: the Role as a Pathogen in Women’s Health, a Systematic Review
Purpose of Review
To evaluate the role of Ureaplasma urealyticum as a genital pathogen in women’s health. Three aspects were analyzed: (1) preterm delivery (PTD); (2) female infertility; and (3) lower genital tract pathology including pelvic inflammatory disease (PID), cervicitis, and genital discomfort (discharge, burning).
A systematic review was performed. Searching PUBMED and EMBASE for published articles from January 2003 to September 2017 using the key word “Ureaplasma urealyticum” yielded 1835 manuscripts. These were further screened using defined inclusion criteria: (1) original peer-reviewed observational studies; (2) English language; (3) U. urealyticum was specifically isolated; (4) present “cases”/“exposed” and “controls”/“unexposed” to enable calculating an association between U. urealyticum and the outcome studied. Altogether, 32 studies were included that underwent quality scoring based on methodology, sample size, study population, and method of identification of U. urealyticum. The association of U. urealyticum and PTD was inconsistent between the studies. Eight of the ten prospective studies failed to show an association between U. urealyticum and PTD, yet four of the six case control studies found a positive association. Regarding female infertility and genital discomfort, five of the six studies for each of these topics failed to find an association. Only two studies met the inclusion criteria for cervicitis with conflicting conclusions. Unfortunately, none of the studies met the inclusion criteria for PID.
It seems that U. urealyticum has a limited role as a pathogen in female infertility, cervicitis, PID, and genital discomfort. The role as a pathogen in PTD is unclear and future studies are needed to address this issue.
KeywordsUreaplasma Urealyticum Preterm delivery Female infertility Cervicitis Pelvic inflammatory disease Genital discomfort
We would like to thank Iris Arad PhD Head of Shaare Zedek Medical Center Library for her help.
Compliance with Ethical Standards
Conflict of Interest
Hanna Hershko Kletzel, Reut Rotem, Moshe Barg, Jennia Michaeli, and Orna Reichman declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 1.David H. Martin, Book chapter Genital mycoplasmas: Mycoplasma genitalium, Mycoplasma hominis, and Ureaplasma species Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, updated edition, Eighth edition, 2015, 186, 2190–2193.Google Scholar
- 2.Fraser CM, Gocayne JD, White O, Adams MD, Clayton RA, Fleischmann RD, et al. The minimal gene complement of. Science. 1995;270:397–403.Google Scholar
- 10.Payne MS, Feng Z, Li S, Doherty DA, Xu B, Li J, et al. Second trimester amniotic fluid cytokine concentrations , Ureaplasma sp. colonization status and sexual activity as predictors of preterm birth in Chinese and Australian women. BMC Pregnancy Childbirth. 2014;14:340.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Kafetzis DA, Skevaki CL, Skouteri V, Gavrili S, Peppa K, Kostalos C, et al. Maternal genital colonization with Ureaplasma urealyticum promotes preterm delivery: Association of the Respiratory Colonization of Premature Infants with Chronic Lung Disease and Increased Mortality. Clin Infect Dis. 2004 Oct 15;39(8):1113–22.CrossRefPubMedGoogle Scholar
- 22.Yoneda N, Yoneda S, Niimi H, Ueno T, Hayashi S, Ito M, et al. Polymicrobial amniotic fluid infection with Mycoplasma/Ureaplasma and other bacteria induces severe intra-amniotic inflammation associated with poor perinatal prognosis in preterm labor. Am J Reprod Immunol. 2016;75:112–25.CrossRefPubMedGoogle Scholar
- 24.Mitsunari M, Yoshida S, Deura I, Horie S, Tsukihara S, Harada T, et al. Cervical Ureaplasma urealyticum colonization might be associated with increased incidence of preterm delivery in pregnant women without prophlogistic microorganisms on routine examination. J Obstet Gynaecol Res. 2005;31:16–21.CrossRefPubMedGoogle Scholar
- 33.Lusk MJ, Garden FL, Rawlinson WD, Naing ZW, Cumming RG, Konecny P. Cervicitis aetiology and case definition: a study in Australian women attending sexually transmitted infection clinics. Sex Transm Infect 2015; (January):1–7Google Scholar