Genital mycoplasma infections.

Since 1937, 13 Mycoplasma species, two Acholeplasma species, and one Ureaplasma species have been isolated from humans. Six of these have the urogenital tract as the primary site of colonisation but others, which have the oropharynx and respiratory tract as the primary site, are found occasionally in the urogenital tract because of orogenital contact. Mycoplasma hominis was the first to be isolated and is most strongly associated with bacterial vaginosis (BV), together with a variety of other bacteria. Its involvement in pelvic inflammatory disease (PID) and other conditions may be as part of BV, although when isolated in pure culture from the blood of women who have postpartum or postabortal fever there is no reason to suspect its aetiological role. There is evidence for an aetiological role for Ureaplasma urealyticum organisms (ureaplasmas) in acute non-gonococcal urethritis (NGU) and particularly chronic NGU in men, but they rank third to Chlamydia trachomatis and M. genitalium. Whether the association of ureaplasmas with miscarriage and preterm labour is in the context of BV is not clear. Of no doubt, however, is the ability of ureaplasmas to cause septic arthritis in hypogammaglobulinaemic patients and there is evidence that they may cause some cases of sexually acquired reactive arthritis. The advent of polymerase chain reaction technology has seen an advance in the understanding of the role of M. genitalium; there is strong evidence that it is one of the causes of both acute and chronic NGU independent of C. trachomatis. There is some support for the role of M. genitalium in PID, but this needs to be substantiated. Other mycoplasmas, for example M. fermentans, M. pivum, M. primatum, M. penetrans, M. spermatophilum and even M. pneumoniae have the capacity to cause urogenital tract disease but there is no evidence to indicate that they do so.