Top

African Journal of Urology

Published in:

Open Access 01-12-2023 | Chlamydia Trachomatis | Original Research

Detection of urogenital pathogens in sterile pyuria samples by polymerase chain reaction

Authors: Omar B. Ahmed, Fayez S. Bahwerth

Published in: African Journal of Urology | Issue 1/2023

Abstract

Background

Patients with sterile pyuria may be infected with sexually transmitted diseases or have renal tuberculosis. This study investigated the possibility of detecting sexually transmitted diseases and Mycobacterial tuberculosis in sterile pyuria samples with polymerase chain reaction.

Methods

Forty-four day-3 negative urine culture samples were investigated for the presence of sexually transmitted diseases and Mycobacterial tuberculosis.

Results

Among the 44 samples, 61.4% were positive by polymerase chain reaction (PCR) for bacterial DNA (either sexually transmitted diseases or Mycobacteria). Among the 27 positive samples, 37% were positive for Ureaplasma urealyticum, 26% were positive for Chlamydia trachomatis, 14.8% were positive for Neisseria gonorrhoeae, 11.1% were positive for Mycoplasma genitalium, 7.4% were positive for Mycoplasma hominis, and only one sample (3.7%) was positive for Mycobacterial tuberculosis. No significant associations were found between PCR-positive urine samples and patient characteristics.

Conclusions

It was concluded that Ureaplasma urealyticum was predominant in sterile pyuria followed by Chlamydia trachomatis. There were no significant associations between PCR-positive samples and sex, symptomatic patients, or antibiotic use. PCR is an instant diagnostic tool for sexually transmitted diseases in sterile pyuria; hence, it is advised to be performed on negative culture samples as a routine laboratory screening test whenever possible.

Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332. https://doi.org/10.1016/j.ajic.2008.03.002CrossRef

Bendig DW (2021) The differential diagnosis of sterile pyuria in pediatric patients: a review. Global Pediatric Health 6(8):2333794X21993712. https://doi.org/10.1177/2333794X21993712CrossRef

Longo DL (2015) Sterile pyuria. N Engl J Med 372:1048–1054. https://doi.org/10.1056/NEJMra1410052CrossRef

Gottlieb SL, Low N, Newman LM, Bolan G, Kamb M, Broutet N (2014) Toward global prevention of sexually transmitted infections (STIs): the need for STI vaccines. Vaccine 32:1527–1535. https://doi.org/10.1016/j.vaccine.2013.07.087CrossRef

Glen P, Prashar A, Hawary A (2016) Sterile pyuria: a practical management guide. Br J Gen Pract 66(644):e225–e227. https://doi.org/10.3399/bjgp16X684217CrossRef

Malhotra M, Sood S, Mukherjee A, Muralidhar S, Bala M (2013) Genital Chlamydia trachomatis: an update. Indian J Med Res 138(3):303–316

Johnson RE, Newhall WJ, Papp JR, Knapp JS, Black CM, Gift TL, Steece R, Markowitz LE, Devine OJ, Walsh CM, Wang S, Gunter DC, Irwin KL, DeLisle S, Berman SM (2002) Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections–2002. MMWR Recomm Rep 18(51(RR–15)):1–38

Nassar, FA, Abu-Elamreen, FH, Shubair, ME, Sharif, FA (2008) Detection of chlamydia trachomatis and mycoplasma hominis, genitalium and ureaplasma urealyticum by polymerase chain reaction in sterile pyuria 53:80–86. https://doi.org/10.2478/v10039-008-0020-1

Gibson MS, Puckett ML, Shelly ME (2004) Renal tuberculosis. Radiographics 24(1):251–256. https://doi.org/10.1148/rg.241035071CrossRef

10.

Vitale AM, Lockwood GM (2020) Urine Microscopy: The Burning Truth – White Blood Cells in the Urine. In: Sharp V, Antes L, Sanders M, Lockwood G (eds) Urine Tests. Springer, Cham. https://doi.org/10.1007/978-3-030-29138-9_8CrossRef

11.

van der Zee A, Roorda L, Bosman G, Ossewaarde JM (2016) Molecular diagnosis of urinary tract infections by semi-quantitative detection of uropathogens in a routine clinical hospital setting. PLoS ONE 11(3):e0150755. https://doi.org/10.1371/journal.pone.0150755CrossRef

12.

Ahmed OB, Dablool AS (2017) Quality improvement of the DNA extracted by boiling method in gram negative bacteria. Int J Bioassays 6:5347–5349. https://doi.org/10.21746/IJBIO.2017.04.004CrossRef

13.

Taheri Beni B, Jenab A, Roghanian R, Motamedi H, Golbang N, Golbang P, Zaeimi Yazdi J (2012) Genotyping of endocervical chlamydia trachomatis strains and detection of serological markers of acute and chronic inflammation in their host. Int J Fertil Steril 6(2):101–106

14.

Mahony JB, Luinstra KE, Tyndall M, Sellors JW, Krepel J, Chernesky M (1995) Multiplex PCR for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Genitourinary specimens. J Clin Microbiol 33(11):3049–3053. https://doi.org/10.1128/jcm.33.11.3049-3053.1995CrossRef

15.

Zeighami H, Peerayeh SN, Yazdi RS, Sorouri R (2009) Prevalence of Ureaplasma urealyticum and Ureaplasma parvum in semen of infertile and healthy men. Int J STD AIDS 20(6):387–390. https://doi.org/10.1258/ijsa.2008.008334CrossRef

16.

Munoz JL, Goje OJ (2016) Mycoplasma genitalium: An Emerging Sexually Transmitted Infection. Scientifica (Cairo) 2016:7537318. https://doi.org/10.1155/2016/7537318CrossRef

17.

Blanchard A, Yanez A, Dybvig K, Watson HL, Griffiths G, Cassell H (1993) Evaluation of interspecies genetic variation within the 16SrRNA gene of Mycoplasma hominis and detection by polymerase chain reaction. J Ckin Microbil 31(5):1358–1361. https://doi.org/10.1128/jcm.31.5.1358-1361.1993CrossRef

18.

Eisenach KD, Donald Cave M, Bates JH, Crawford JT (1990) Polymerase chain reaction amplification of a repetitive DNA sequence specific for Mycobacterium tuberculosis. J Infect Dis 161(5):977–981. https://doi.org/10.1093/infdis/161.5.977CrossRef

19.

Lin Y, Fan Y, Cheng C, Sue Y, Hsu Y, Hou C et al (2008) The case | Sterile pyuria and an abnormal abdominal film. ‘Autonephrectomy’ of right kidney. Kidney Int 73:131–133. https://doi.org/10.1038/sj.ki.5002593CrossRef

20.

Liu T, Lai SY, Zhou W, Liu YL, Chen SS, Jiang YM (2022) Analysis of Ureaplasma urealyticum, Chlamydia trachomatis, Mycoplasma genitalium and Neisseria gonorrhoeae infections among obstetrics and gynecological outpatients in southwest China: a retrospective study. BMC Infect Dis 22(1):283. https://doi.org/10.1186/s12879-021-06966-zCrossRef

21.

Krõlov K, Frolova J, Tudoran O, Suhorutsenko J, Lehto T, Sibul H, Mäger I, Laanpere M, Tulp I, Langel Ü (2014) Sensitive and rapid detection of Chlamydia trachomatis by recombinase polymerase amplification directly from urine samples. J Mol Diagn 16(1):127–135. https://doi.org/10.1016/j.jmoldx.2013.08.003CrossRef

22.

Gdoura R, Kchaou W, Ammar-Keskes L, Chakroun N, Sellemi A, Znazen A, Rebai T, Hammami A (2008) Assessment of Chlamydia trachomatis, Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis, and Mycoplasma genitalium in semen and first void urine specimens of asymptomatic male partners of infertile couples. J Androl 29(2):198–206. https://doi.org/10.2164/jandrol.107.003566CrossRef

23.

Hwang JH, Park HC, Jeong JC, Ha Baek S, Han MY, Bang K, Cho JY, Yu SH, Yang J, Oh KH, Hwang YH, Ahn C (2013) Chronic asymptomatic pyuria precedes overt urinary tract infection and deterioration of renal function in autosomal dominant polycystic kidney disease. BMC Nephrol 7(14):1. https://doi.org/10.1186/1471-2369-14-1CrossRef

24.

Hooker JB, Mold JW, Kumar S (2014) Sterile pyuria in patients admitted to the hospital with infections outside of the urinary tract. J Am Board Fam Med 27(1):97–103. https://doi.org/10.3122/jabfmCrossRef

25.

Muhammid HA, Naher HS, Al-Hamadani AH (2015) Detection of Mycoplasma hominis and Ureaplasma Urealyticum in urethritis from sexual active men by real-time PCR. Al-Qadisiah Med J 11(2):60–66

26.

Stellrecht KA, Woron AM, Mishrik NG, Venezia RA (2004) Comparison of multiplex PCR assay with culture for detection of genital mycoplasmas. J Clin Microbiol 42(4):1528–1533. https://doi.org/10.1128/JCM.42.4.1528-1533.2004CrossRef

27.

Domingues D, Tavora Tavira L, Duarte A, Sanca A, Prieto E, Exposto F (2003) Genital mycoplasmas in women attending a family planning clinic in Guine-Bissau and their susceptibility to antimicrobiol agents. Acta Trop 86:19–24. https://doi.org/10.1016/s0001-706x(03)00002-0CrossRef

28.

Abusarah EA, Awwad ZM, Charvalos E, Shehabi AA (2013) Molecular detection of potential sexually transmitted pathogens in semen and urine specimens of infertile and fertile males. Diagn Microbiol Infect Dis 77:283–286. https://doi.org/10.1016/j.diagmicrobio.2013.05.018CrossRef

29.

Peerayeh SN, Sattari M (2006) Detection of Ureaplasma urealyticum and Mycoplasma hominis in endocervical specimens from infertile women by polymerase chain reaction. Middle East Fertility Soc J 11(2):108–108

30.

Rahman MS, Beever W, Skov S, Boffa J (2014) Using urinary leucocyte esterase tests as an indicator of infection with gonorrhoea or chlamydia in asymptomatic males in a primary health care setting. Int J STD AIDS 25:138–144. https://doi.org/10.1177/0956462413495670CrossRef

31.

Rane VS, Fairley CK, Weerakoon A, Read TH, Fehler G, Chen MY, Bradshaw CS (2014) Characteristics of acute nongonococcal urethritis in men differ by sexual preference. J Clin Microbiol 52(8):2971–2976. https://doi.org/10.1128/JCM.00899-14CrossRef

32.

Hemal AK, Gupta NP, Rajeev TP, Kumar R, Dar L, Seth P (2000) Polymerase chain reaction in clinically suspected genitourinary tuberculosis: comparison with intravenous urography, bladder biopsy, and urine acid fast bacilli culture. Urology 56:570–574. https://doi.org/10.1016/s0090-4295(00)00668-3CrossRef

33.

Yazdani M, Shahidi S, Shirani Shirani M (2008) Urinary polymerase chain reaction for diagnosis of urogenital tuberculosis. Urol J 5(1):46–49

34.

Tuddenham S, Hamill MM, Ghanem KG (2022) Diagnosis and treatment of sexually transmitted infections: a review. JAMA 327(2):161–172. https://doi.org/10.1001/jama.2021.23487CrossRef

35.

Rowley RTaN F (2012) Global incidence and prevalence of selected curable sexually transmitted infections-2008. In: World Health Organization (ed) World Health Organization. pp 1–20

36.

Goonewardene S, Persad R (2015) Sterile pyuria: a forgotten entity. Ther Adv Urol 7(5):295–298. https://doi.org/10.1177/1756287215592570CrossRef

Title: Detection of urogenital pathogens in sterile pyuria samples by polymerase chain reaction
Authors: Omar B. Ahmed
Fayez S. Bahwerth
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Chlamydia Trachomatis
Tuberculosis
Mycobacterium Tuberculosis
Sexually Transmitted Infection
Gonococcus
Sexually Transmitted Infection
Antibiotic
Tuberculosis
Sexually Transmitted Infection
Gonorrhoea
Chlamydia Trachomatis
Sexually Transmitted Infection
Polymerase Chain Reaction
Published in: African Journal of Urology / Issue 1/2023
Print ISSN: 1110-5704
Electronic ISSN: 1961-9987
DOI: https://doi.org/10.1186/s12301-022-00332-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Detection of urogenital pathogens in sterile pyuria samples by polymerase chain reaction

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

Outcome of extra mucosal single interrupted layer (EMSIL) ileo-ileal anastomosis in urinary diversions during open radical cystectomy

Pre-therapeutic lymphocytopenia: a new prognostic factor for failure of endovesical BCG-immunotherapy in non-muscle invasive bladder cancer

Validation of MAP (Mayo Adhesive Probability) score and preoperative factors to predict adherent perinephric fat in robotic-assisted partial nephrectomy

Benign urinary bladder masses: rare entities

3D-Laparoscopic transperitoneal pyelolithotomy in a rare case of pelvic cake kidney: case report and review of literature

Concomitant clear cell renal cell carcinoma with osseous metaplasia and papillary thyroid microcarcinoma: a case report with literature review