This is a repository copy of Mollicutes antibiotic resistance profile and presence of genital abnormalities in couples attending an infertility clinic.. White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk/143263/ Version: Published Version Article: Maldonado-Arriaga, B., Escobar-Escamilla, N. orcid.org/0000-0001-8929-476X, Pérez-Razo, J.C. et al. (9 more authors) (2019) Mollicutes antibiotic resistance profile and presence of genital abnormalities in couples attending an infertility clinic. Journal of International Medical Research. ISSN 0300-0605 https://doi.org/10.1177/0300060519828945 Reuse This article is distributed under the terms of the Creative Commons Attribution-NonCommercial (CC BY-NC) licence. This licence allows you to remix, tweak, and build upon this work non-commercially, and any new works must also acknowledge the authors and be non-commercial. You don’t have to license any derivative works on the same terms. 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The Author(s) 2019 Article reuse guidelines: resistance profile and sagepub.com/journals-permissions DOI: 10.1177/0300060519828945 presence of genital journals.sagepub.com/home/imr abnormalities in couples attending an infertility clinic Brenda Maldonado-Arriaga1,5, Noe´ Escobar-Escamilla2 , Juan Carlos Pe´rez-Razo3, Sofia Lizeth Alcara´z-Estrada3, Ignacio Flores-Sa´nchez4, Daniel Moreno-Garcıa4, Rebeca Pe´rez-Cabeza de Vaca1, Paul Mondragon-Tera ´n1, Jonathan Shaw6, Cecilia Hernandez-Cortez7, Graciela Castro-Escarpulli5 and Juan Antonio Sua´rez-Cuenca1 5Laboratorio de Investigacion Clınica y Ambiental, Departamento de Microbiologıa, Escuela Nacional de Ciencias Biologicas, Instituto Polite´cnico Nacional 1Laboratorio de Metabolismo Experimental e Prolongacion de Carpio y Plan de Ayala S/N Colonia Investigacion Clınica; Division de Investigacion Clınica y Plutarco Elıas Calles, Alcaldıa Miguel Hidalgo C.P., Ciudad Coordinacion de Investigacion, C.M.N. “20 de de Me´xico 6 Noviembre”, ISSSTE, San Lorenzo, Colonia del Valle Sur, Department of Infection, Immunity & Cardiovascular Alcaldıa Benito Jua´rez, C.P., Ciudad de Me´xico, Me´xico Disease, University of Sheffield Medical School, Beech Hill 2Transferencia de Me´todos Moleculares, Departamento Road, Sheffield S10 2RX, United Kingdom 7 de Biologıa Molecular y Validacion de Te´cnicas, Instituto Laboratorio de Bioquımica Microbiana, Departamento de de Diagnostico y Referencia Epidemiologicos (InDRE), Microbiologıa, Escuela Nacional de Ciencias Biologicas, Francisco de P. Miranda # 177, Colonia Unidad Lomas de Instituto Polite´cnico Nacional Prolongacion de Carpio y Plateros, Alcaldıa Alvaro Obregon. Ciudad de Me´xico Plan de Ayala S/N Colonia Plutarco Elıas Calles, Alcaldıa C.P., Me´xico Miguel Hidalgo C.P., Ciudad de Me´xico 3Unidad de Ana´lisis y Referencia Virologica, C.M.N. “20 Corresponding author: de Noviembre”, ISSSTE, San Lorenzo, Colonia del Valle Juan Antonio Sua´rez Cuenca, Laboratorio de Metabolismo Sur, Alcaldıa Benito Jua´rez, C.P., Ciudad de Experimental e Investigacion Clınica; Investigacion Clınica, Me´xico, Me´xico Division de Investigacion Biome´dica, C.M.N. “20 de 4Clınica de Infertilidad, Biologıa de la Reproduccion Noviembre”, ISSSTE, San Lorenzo No. 502, Colonia del C.M.N. “20 de Noviembre”, ISSSTE, Fe´lix Cuevas, Valle Sur, Alcaldıa Benito Jua´rez, C.P. 03229, Ciudad de Colonia del Valle Sur, Alcaldıa Benito Jua´rez, C.P., Me´xico, Me´xico. Ciudad de Me´xico, Me´xico Email: [email protected] Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 Journal of International Medical Research 0(0) Abstract Objective: The present study aimed to identify Mollicutes infection in the reproductive system. We also examined the microbiological, biochemical, and antimicrobial profiles of Mollicutes infec- tion, which are potentially associated with clinical reproductive abnormalities causing infertility in couples. Methods: Thirty-seven couples who were attending an infertility clinic were enrolled. Detection of genital mycoplasmas was performed in cervicovaginal samples or male urethral swabs. Microbiological culture and biochemical and antimicrobial profiles were characterized using a Mycoplasma kit. The results were associated with reproductive abnormalities, as assessed by medical specialists from the infertility clinic. Results: Up to 28.3% of all biological samples (n ¼ 74) showed positive cultures. Bacterial isolates were Ureaplasma urealyticum (71.4%), Mycoplasma hominis (9.5%), or coinfections (19%). Most Mollicutes showed significant resistance to fluoroquinolones, macrolides, and tetra- cycline; and showed susceptibility to doxycycline, josamycin, and pristinamycin. The presence of resistant strains to any antibiotic was significantly associated with genital abnormalities (v2 test, relative risk ¼ 11.38 [95% confidence interval: 5.8–22.9]), particularly in women. The highest statistical association was found for macrolide-resistant strains. Conclusion: The microbiological antibiotic resistance profile is epidemiologically associated with abnormalities of the reproductive system in couples attending an infertility clinic. Keywords Mollicutes, antimicrobial resistance profile, reproductive abnormalities, infertility, bacterial iso- late, Mycoplasma Date received: 16 November 2018; accepted: 15 January 2019 Introduction the male and female reproductive systems are suitable for growth of various pathogen- The World Health Organization, as ic and non-pathogenic microorganisms.2 well as the European Society of Human Genital mycoplasmas belong to an inde- Reproduction and Embryology, define pendent taxonomic class called Mollicutes infertility as a disease of the reproductive system that leads to the inability to achieve and Mycoplasmataceae. This bacterial family a pregnancy after 12 months or longer with includes Mycoplasma spp., Mycoplasma hom- unprotected sex. Infertility is currently a inis, Mycoplasma genitalium, and Ureaplasma problem of global distribution and increas- urealyticum. These species may cause oligo- ing magnitude. An estimated 20% to 35% symptomatic genital infections in women of all couples who wish to procreate have and men of reproductive age, such as urethri- an infertility disorder.1 tis, urinary tract infections, chorioamnionitis, The main causes of infertility in couples pelvic inflammatory disease, and sperm cell include female endocrine disorders, ovulato- disorders. Complications from these infections ry dysfunction, tubal and peritoneal dis- mayleadtoinfertility.3,4 eases, and male endocrine and testicular In Mexico, the National Health System disorders and seminal obstruction caused has recognized the importance of infertility by sexually transmitted infections. Notably, as a public health problem. However, only a Maldonado-Arriaga et al. 3 few studies have addressed infertility This study was designed and performed causes, and mainly evaluated non- according to ethical guidelines of the 1975 infectious etiologies. Therefore, evaluating Declaration of Helsinki. The study was the potential participation of sexually trans- approved by the Local Committees of mitted infections is important because Research, Ethics in Research, and Mollicutes, such as U. urealyticum and Biosafety of the Centro Me´ dico Nacional M. hominis, have been identified in semen “20 de Noviembre”, ISSSTE, Mexico City samples and endocervical exudates (Protocol ID No. 033.2013). All partici- 5 from Mexican couples with infertility. pants provided written informed consent. Furthermore, M. hominis has been reported in 24.2% of infertile males with sperm Cervicovaginal samples abnormalities, whereas U. urealyticum has been reported in 86.8% of infertile females Samples were collected by specialized and with tubular abnormalities.6 experienced medical personnel according Antimicrobial therapy for Mollicutes to the routine procedure in the genital mycoplasmas includes quinolones, Department of Reproductive Biology. For tetracyclines, and macrolides as the drugs cervicovaginal exudate, the sample was of choice. However, the indiscriminate use taken by placing the patient in a gynecolog- of antibiotics has promoted development of ical position, and a sterile mirror was antibiotic-resistant strains.7 Nonetheless, inserted into the vagina, which was lubri- characterization of antibiotic resistance cated with sterile water and heated to and its association with reproductive disor- 37C if necessary. The use of commercial ders in Mexican couples with infertility lubricants or an antiseptic was avoided. remain unclear. Therefore, this study Once the cervix was located, the mirror aimed to identify Mollicutes infection in was fixed by opening the valves