Investigation of mycoplasma and ureaplasma species using molecular method in male patients with urethritis symptoms

Most genitourinary tract infections are caused by sexually transmitted pathogens. The term sexually transmitted infection (STI) refers to the transmission of a pathogen through sexual contact and causing infection. While STIs can be asymptomatic, common symptoms include vaginal discharge, urethral discharge or burning during urination in men, genital ulcers and abdominal pain. Microscopy, culture and molecular methods are used to detect the causes of genitourinary tract infections. Our study aims to investigate the frequency of Mycoplasma and Ureaplasma species in male patients presenting with urethritis symptoms using a molecular method. It was also aimed to determine the frequency of T. vaginalis and N.gonorrhoeae, which are other STI agents. 94 men who applied to urology outpatient clinics with complaints of urethritis between February 2023 and August 2023 were included in this study. M. hominis, M. genitalium, U. urealyticum, U. parvum were investigated in first void urine using the multiplex PCR method. T. vaginalis and N. gonorrhoeae were investigated by microscopy and culture methods. Gram stained microscopic examination of urethral swab samples revealed PMNL and Gram negative diplococci in two patients (2,1%). Direct microscopic examination of urine samples for T. vaginalis revealed that all samples were negative. N. gonorrhoeae was detected on modified Martin-Lewis agar in nine patients (9,6%). T. vaginalis was not detected in any sample on Diamond's TYM medium. The multiplex PCR results showed that only one microorganism was detected in 28 patients (29,8%), mixed infections were detected in 9 patients (9,6%) (M. hominis + U. urealyticum was detected in 3 (3,2%), M. hominis + U. parvum in 2 (2,1%), and U. parvum + U. urealyticum in 4 (4,3%) patients). A total of 55 microorganisms were detected in 39 patients (41,5 % of the patients) using all methods. Of these, 18 (33%) were U. urealyticum, 14 (25%) were U. parvum, 9 (16%) were N. gonorrhoeae, 8 (15%) were M. hominis and 6 (11%) were M. genitalium. In seven of the nine patients with N. gonorrhoeae, at least one microorganism was also detected by PCR. U. urealyticum alone was detected in three of these patients, M. genitalium alone was detected in two patients, and the combination of U. urealyticum and U. parvum was detected in two patients. A statistically significant relationship was found between M. genitalium and N. gonorrhoeae positivity and having more than three partners in the last 12 months (p<0,05). A significant relationship was found between U. urealyticum and N. gonorrhoeae positivity and genital discharge in patients (p<0,05). Additionally, a significant relationship was found between genital itching and pain and discomfort during sexual intercourse and N. gonorrhoeae positivity (p<0,05). The results of this study revealed that 41,5% of male patients with urethritis symptoms had at least one microorganism. The most common infection agents were U. urealyticum, U. parvum, N. gonorrhoeae, M. hominis and M. genitalium, respectively. Keywords: Urethritis, Mycoplasma genitalium, Neisseria gonorrhoeae, Ureaplasma, PCR