Prevalence of Urogenital Mycoplasmas in Iran and Their Effects on Fertility Potential: A Systematic Review and Meta-Analysis

By Ahmadi, Mohammad Hossein; Mirsalehian, Akbar et al. | Iranian Journal of Public Health, April 2016 | Go to article overview

Prevalence of Urogenital Mycoplasmas in Iran and Their Effects on Fertility Potential: A Systematic Review and Meta-Analysis


Ahmadi, Mohammad Hossein, Mirsalehian, Akbar, Bahador, Abbas, Iranian Journal of Public Health


Introduction

Mycoplasmas are in a class of bacteria designated as mollicutes, which lack cell walls, and this char-acteristic along with their minute size separates them from other bacteria. Mycoplasma hominis, Ureaplasma urealyticum, U. parvum, and M. genitalium are potentially pathogenic species frequently iso-lated from the genitourinary tract and are known as urogenital mycoplasmas (1). These bacteria to-gether with Neisseria gonorrhoeae and Chlamydia tra-chomatis are considered among the most prevalent sexually transmitted pathogens that have a global distribution (2-3). Urogenital mycoplasmas are as-sociated with some symptomatic and asympto-matic genitourinary tract infections in both males and females; for example, they may cause Pelvic Inflammatory Disease (PID) resulting in damage to the fallopian tubes, which may lead to ectopic pregnancy. These bacteria are also associated with non-gonococcal urethritis, endometritis, bacterial vaginosis, preterm delivery, postpartum, or post-abortal fever, as well as perinatal disorders such as low birth weight and neonatal bactere-mia/meningitis (4-12). The effects of urogenital mycoplasmas on spermatozoa and seminological variables and their role in male or female infertility are controversial and remain unclear (13-18); however, there is some evidence that M. genitalium may cause female infertility, particularly tubal in-fertility (19-20).

Some of investigators believe that mycoplasmas are genitourinary tract commensals; thus, one of the important problems concerning urogenital mycoplasmas is that there are many clinically asymptomatic carriers silently colonized by these bacteria while these microorganisms are poten-tially pathogenic and may play a role in urogenital tract infection or affect fertility potential as an op-portunistic pathogen, under certain circumstances (21-25). Nevertheless, the majority of asympto-matic infections may remain undetected and con-sequently untreated.

In Iran, to date, several studies have reported the frequency of urogenital mycoplasmas infections in males and/or females, in which the frequency of these pathogens varies significantly in different surveys. However, most of these studies are local and limited to an individual hospital or a special province or city, and a comprehensive analysis of the overall prevalence of these bacteria, which may be useful to set up control programs for the prevention of sexually transmitted infections (STIs), has not yet been performed.

Thus, the present study was designed to deter-mine the prevalence of urogenital mycoplasmas infections in Iran using a systematic review and meta-analysis according to the Preferred Report-ing Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (26).

Methods

Search strategies

We searched electronic databases, including OV-ID databases, PubMed, Web of Science, Scopus, and Google Scholar for the prevalence of uro-genital mycoplasmas infections in Iran from Nov 1999 to Feb 2015. The search was restricted to original articles published in English that present the prevalence, frequency, or incidence of urogen-ital mycoplasmas infections in Iranian males or fe-males using the following keywords with the help of Boolean operators (AND, OR): "Mycoplasma", "Ureaplasma", "urogenital mycoplasmas", "genital mycoplasmas", "M. hominis", "M. genitalium", "U. urealyticum", "U. parvum", "prevalence", "incidence", "frequency", "epidemiology", and "Iran" . We ad-ditionally searched for other urogenital tract asso-ciated mycoplasma species using keywords: "M. fermentans", "M. penetrans", "M. primatum", and "M. spermatophilum". In addition to articles published in English, we also looked for relevant articles in Persian published and indexed in Iranian data-bases, such as Scientific Information Database (SID) (http://www.sid.ir/), Magiran (http://www.magiran.com/), Irandoc (http://www.irandoc.ac.ir/), Regional Infor-mation Center for Science and Technology (RICST) (http://en. …

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