Danish Medical Bulletin - No. 2. May 2006. Vol. 53 Page 229

ABSTRACT OF PhD DISSERTATION

Mycoplasma genitalium as a human pathogen and its potential role in infertility Molecular, diagnostic and clinical trials

Helle Friis Svenstrup, MSc

PDF

The PhD dissertation was accepted by the Faculty of Health Sciences of the University of Aarhus, and defended on May 5, 2006.

Official opponents: Birger Reinholt Møller, Søren Ladefoged and Knud Poulsen. Supervisor: Gunna Christiansen and Jens Fedder.

Correspondence: 68 Blackheath Park, London SE3 0ET, United Kingdom.

Email: helle@svenstrup.net

ABSTRACT

Mycoplasma genitalium is a wall-less bacteria causing non-chlamydial non-gonococcal urethritis (NCNGU) in men. It is sexually transmitted and associated with urogenital diseases of women. Like infections with Chlamydia trachomatis , the infections with M. genitalium can be both symptomatic and asymptomatic; however, symptomatic urethritis is more common in men infected with M. genitalium than with C. trachomatis . In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID). If the PID develops into salpingitis it can lead to occlusion of the Fallopian tubes and infertility. The most common causes of PID are sexually transmitted microbes such as Neisseria gonorrhoea and C. trachomatis . Because these microorganisms cannot explain all cases of PID and infertility we wanted to study the role of M. genitalium in infertility.

In a retrospective study of 308 couples attending fertility clinics for infertility workup in Denmark during 1997-2000 we showed an association of antibodies to M. genitalium and women with tubal factor infertility (TFI). Of the women with TFI 29 22% had antibodies against M. genitalium as compared to 11 (6%) of women with normal tubes. The correlation was independent of antibodies to C. trachomatis which showed an even higher prevalence among the women with TFI. Later, in a prospective study during the years 2002-2005 cervical swabs and blood samples were collected from 212 women attending Danish fertility clinics for fertility work-up. None of the women were PCR positive to M. genitalium indicating that the women did not have an acute infection with M. genitalium . Also in this study a significant association between antibodies to MgPa and women with TFI was shown.

Other studies have demonstrated that M. genitalium is sexually transmitted, but the mech-anism of transmission is unknown. Most likely, the microorganisms attach to the epithelial cells of the lower genital tract and cause cervicitis followed by a spread to the upper genital tract. In addition, there may be alternative routes of transmission. We demonstrated by immunofluorescence microscopy that M. genitalium was able to bind to motile spermatozoa suggesting that spermatozoa may act as vectors for the transportation of M. genitalium to the upper genital tract.

In conclusion, we have shown indirect evidences that M. genitalium is associated with TFI and thus emphasise the importance of studying the role of this pathogen in acute PID and long-term sequela.

DANISH MEDICAL BULLETIN
The Danish Medical Bulletin reserves the right to store and publish articles (texts and illustra-tions), electronically too, eg on CD-ROM and the Internet. All rights reserved, ie prohibition against publication of texts and illustrations from the Danish Medical Bulletin. Rights can only be obtained by written acceptance from the author and editors and by quoting the Danish Medical Bulletin as source. Quotations of information from the Danish Medical Bulletin may not be published until after the publication of the issue in question and quotation of the source.