Abstract

Chlamydia trachomatis is responsible for the most common sexually transmitted bacterial infection worldwide. Infections with Ureaplasma urealyticum and genital Mycoplasma hominis have been recognized for about a decade as common sexually transmitted infections (STIs) in developed countries. The aim of this study was to assess the diagnostic value of novel simple diagnostic kits used in the detection of C. trachomatis, U. urealyticum and M. hominis in urine of patients with complicated urinary tract infections (UTIs) and to compare these simple methods to molecular and cultural ones as gold standards. This study was conducted on two male patient’s groups; group I: 30 patients with compilcated UTIs and Group II: 50 patients with non complicated UTIs. Twenty (20) healthy male control subjects (Group III) were also included. The patients were chosen from those admitted to the urosurgery department or attending the urosurgery outpatient clinic in Theodor Bilharz Research Institute (TBRI). First voided urine (FVU) samples and mid-stream urine (MSU) were collected from patients and controls. FVU samples were investigated for C. trachomatis plasmid DNA using polymerase chain reaction (PCR) and for C. trachomatis antigen using Chlamyfast OIA test. MSU samples were used for inoculating of conventional culture media and three culture kits; Mycoplasma DUO, Mycoplasma IST and Mycokit NUM. Blood samples were investigated for the presence of C. trachomatis IgG antibodies using enzyme-linked immunosorbent assay (ELISA) and ImmunoComb Chlamydia Kit and for mycoplasmal antibodies using mycokit sero. C. trachomatis infection was found in 35% (28/80) of patients in both groups, 56.7% (17/30) was detected in group I and 22% (11/50) in group II compared to none of the controls. C. trachomatis infection was significantly higher in group I versus group II (PË‚0.05). Chlamyfast OIA test was less sensitive but more specific than serological assays. ImmunoComb assay had a higher sensitivity but lower specificity than ELISA. A total of 34 cases (42.5%) were positive in a pathogenic level for U. urealyticum and or M. hominis and 30% were positive for U. urealyticum only, 7.5% were positive for M. hominis only and 5% had mixed infection with both organisms. Mycoplasmas infection in group I was found to be significantly higher than in group II (PË‚0.05). Mycoplasma IST has the highest sensitivity (100%) andin identification of U. urealyticum while both mycoplasma ISTand mycoplasma DUO showed the highest sensitivity in identi-fication of M.hominis. Serological evidence was detected in 16/24 (66.7%), 2/6 (33.3%) and 4/4 (100%) of U. urealyticum, M. hominis and mixed infections respectively. The serological response to each infection is significantly higher in group I than in group II (P value Ë‚0.05). Our study detects a high prevalence rate of C. trachomatis, M. hominis and U. urealyticum in cases with complicated UTI. Commercially available kits are simple and sensitive methods to use in laboratories which do not routinely test for these pathogens.

Key words: Chlamydia trachomatis, urinary tract infections (UTIs), non gonorrheal urethritis (NGU).