Letter: Mycoplasma pneumoiae in a tubo-ovarian abscess

Mycoplasma pneumoniae: a rare cause of vulvar ulcers or an undiagnosed one?

OBJECTIVES

Acute vulvar ulcers are quite common, and often, an etiological diagnosis cannot be achieved. This article reports 3 cases of vulvar ulcers in adult women infected with Mycoplasma pneumoniae. The authors were able to find only one similar report in the literature.

MATERIAL AND METHODS

Two women in their third decade of life and 1 in the fourth presented to the hospital with acute and intense vulvar pain. Two of them reported oropharyngeal symptoms in the preceding days. All 3 presented with extensive, painful, and destructive vulvar ulcers. A standard protocol was applied, including samples taken from the ulcer (microbiology and polymerase chain reaction) and blood drawn for serological examination and liver function testing. All 3 had the remarkable finding of a positive immunoglobulin G (IgG) and IgM for M. pneumonia (in one of the cases, IgM was initially inconclusive but turned to positive when repeated 2 weeks later). One patient had an extensive destruction of one labium minus, requiring surgical reconstruction.

RESULTS

Two of them were treated with antibiotics, and one was not. However, in fact, all 3 healed in a similar period, making it probable that this kind of medication is not helpful.

CONCLUSIONS

M. pneumoniae might be associated with some cases of vulvar ulcers and should always be tested in this context. Probably, antibiotic treatment is not helpful, even when this agent is identified as the possible causal agent of vulvar ulcers.

Postmenopausal tubo-ovarian abscess due to Pseudomonas aeruginosa in a renal transplant patient: a case report and review of the literature

BACKGROUND

Pseudomonas aeruginosa is an uncommon cause of infection in the female genital tract. We report a case of postmenopausal tubo-ovarian abscess (TOA) due to P. aeruginosa in a renal transplant recipient. The presentation included mild abdominal symptoms with rapid progression of peritonitis and surgical abscess drainage. This is the first such case in an organ transplant recipient described in the English literature.

METHODS AND RESULTS

Published reports of 1040 cases of TOA were reviewed. The most common features were a history of sexually transmitted disease or pelvic inflammatory disease, and symptoms including abdominal pain and fever. Escherichia coli, Bacteroides spp., and Klebsiella pneumoniae were the most frequently encountered pathogens. Neisseria gonorrhoeae and Chlamydia trachomatis, which are frequently isolated from cervical cultures, are uncommonly isolated from tubo-ovarian abscesses. Forty percent of patients were treated with antibiotics alone, 18.8% with abdominal surgery, and 32% with surgery and antimicrobial therapy.

CONCLUSION

This report illustrates the muted presentation and atypical microbiology of gynecologic infection in an organ transplant recipient.

Colonization of the respiratory and genital tracts of female mice with Mycoplasma pneumoniae and protection afforded to the genital tract by prior respiratory colonization

Mycoplasma pneumoniae, strain MY 12763, colonized the throats of 6 BALB/c female mice for at least 18 days after intranasal inoculation. The same strain colonized, in high titre, the vagina of 9 of 10 progesterone-treated BALB/c mice for at least 35 days, but none of 10 oestradiol-treated mice. Mice were less susceptible to genital-tract colonization with the multiple broth-passed FH strain of M. pneumoniae, only 3 of 10 becoming colonized. The 6 mice inoculated intranasally with strain MY 12763 were immune to genital-tract colonization with the same strain, whereas 10 mice without respiratory-tract colonization were susceptible. Protection of the genital tract in this way was at least as effective as that afforded by previous genital-tract colonization. In a further experiment, 26 immunocompetent BALB/c mice colonized previously in the respiratory tract were resistant to vaginal colonization, whereas 20 BALB/c nude mice, similarly colonized in the respiratory tract, were susceptible in the vagina, illustrating the importance of cell-mediated immunity. The possible relevance of the findings to the human situation is discussed.

Oral sex and transmission of non-viral STIs

OBJECTIVES

To review the literature on the role of oral sex in the transmission of non-viral sexually transmitted infections (STIs).

METHOD

A Medline search was performed using the keywords oro-genital sex, and those specific to each infection. Further references were then taken from each article read.

CONCLUSIONS

Oral sex is a common sexual practice between both heterosexual and homosexual couples. Oro-genital sex is implicated as a route of transmission for gonorrhoea, syphilis, Chlamydia trachomatis, chancroid, and Neisseria meningitidis. Other respiratory organisms such as streptococci, Haemophilus influenzae, and Mycoplasma pneumoniae could also be transmitted by this route. Fellatio confers risk for acquisition of infection by the oral partner. Cunnilingus appears to predispose to recurrent vaginal candidiasis although the mechanism for this is unclear, while a link between oro-genital sex and bacterial vaginosis is currently being studied. Oro-anal sex is implicated in the transmission of various enteric infections. In view of the increased practice of oral sex this has become a more important potential route of transmission for oral, respiratory, and genital pathogens.

Detection and confirmation of Mycoplasma pneumoniae in urogenital specimens by PCR

Following the isolation of Mycoplasma pneumoniae from urogenital specimens (M. Goulet, R. Dular, J. G. Tully, G. Billows, and S. Kasatiya, J. Clin. Microbiol. 33:2823-2825, 1995), a study was undertaken to confirm the observations by PCR. Specific primers directed to the P1 adhesin gene of M. pneumoniae were used. A total of 300 genital specimens were tested for M. pneumoniae and Mycoplasma genitalium by culture and PCR. Of these, 15 were positive by culture and 17 were positive by PCR for M. pneumoniae. No M. genitalium was detected in any of the specimens by either method. The present study demonstrates that PCR is sensitive and rapid compared to cumbersome culture methods and can be used to detect M. pneumoniae in urogenital specimens in a routine diagnostic laboratory.

Isolation of Mycoplasma pneumoniae from the human urogenital tract

Mycoplasma pneumoniae is a common etiologic agent of lower respiratory tract infections in humans. However, it has been reported previously that the organism has occasionally been isolated from sites other than the oropharynx and respiratory tract. We report the isolation of 24 strains of M. pneumoniae from urogenital specimens obtained from 22 female patients. Most isolates were of cervical origin from patients attending several local gynecological clinics over a 2-year period. Strains were also isolated from the urethra of one of three healthy male sexual partners of female patients positive for the organism. Single serum specimens obtained from three female patients and three different male sexual partners showed antibody levels suggestive of either recent respiratory infection or genital tract colonization with M. pneumoniae. Although there is no apparent definitive explanation for the localized outbreak of the organism at these unusual sites, the possible transfer through sexual and/or orogenital contact remains the most likely mode of transmission. The occurrence of an organism with obvious pathogenicity for human epithelial tissue in the urogenital tract suggests such transfer could play a role in genital tract infection.