Mycoplasma hominis it is a very small bacteria that can be found in the genitourinary tract of men and women. The colonization rate is between 0 to 31%, being directly related to sexual activity with multiple partners..
Therefore, this microorganism is considered a sexually transmitted microorganism. Although it may be colonizing asymptomatically, its finding is important in patients with infertility, as it has been related to this affectation.
It is also associated with pelvic inflammatory disease in women and non-gonococcal urethritis in men. Another important aspect of M. hominis is that it does not have a rigid cell wall, therefore they are not susceptible to penicillins and other antibiotics that act on this structure.
However, they are susceptible to a variety of other broad-spectrum antibiotics. But in this sense you have to be careful, since M. hominis has acquired resistance to many of them.
Mycoplasma hominis it does not use glucose, but it does use arginine and form basic end products from it. This characteristic differentiates it from M. pneumoniae and of M. genitalium.
Grows at an optimal pH of 5.5 to 8 with a CO atmospheretwo at 35 ° C, although it also grows anaerobically. On the other hand, all the species of the genus Mycoplasma are demanding from the nutritional point of view, needing for their growth in vitro the addition of sterols, purines and pyrimidines.
However, M. hominis it is the least demanding of all. For this reason, it can sometimes be isolated in routine culture media such as Columbia agar and chocolate agar, as long as it does not contain SPS like some blood culture bottles..
Mycoplasma hominis It has polypeptides on its surface called P50, P100, P140, P110, MG218 and MG317 that help it adhere to eukaryotic cells, that is, they act as adhesins.
Likewise, M. hominis has a special affinity for sulfated glycolipids present in sperm and in the urogenital tract of men and women.
This explains the tropism that this microorganism has to the urogenital tissue and the rapid adhesion to sperm cells, which in studies in vitro has occurred in just 10 minutes of exposure.
The bacteria Mycoplasma hominis measures approximately 0.2-1 μm in diameter. It lacks a cell wall and contains a plasma membrane with three layers (trilaminar).
The absence of the cell wall gives the bacteria excessive plasticity and flexibility, managing to adopt various forms (pleomorphism).
In addition, the lack of a cell wall makes this bacterium incapable of staining with the Gram stain. Its inability to form the cell wall is believed to be due to its DNA being made up of 500,000 base pairs. That is, it is extremely small.
The typical morphology of the colony of M. hominis It is in fried egg, and measures 50 to 300 µm in diameter and grows from 5 - 7 days.
Colonies can be stained with the Dianes stain as a visualization aid. In liquid cultures such as M broth, it produces a slight turbidity in addition to a color change.
The paper of M. hominis as a pathogenic microorganism is controversial, since it has been found in asymptomatic people, therefore it is believed that it may act as an opportunist.
In this sense, Mycoplasma hominis It has been linked to cases of bacterial vaginosis. If it is accompanied by anaerobic germs and Gardnerella vaginalis as co-pathogens, they produce pelvic inflammatory disease and infertility.
This microorganism alone or associated with other bacteria is a risk element for human fertility and therefore should be investigated whenever the reason for consultation is the impossibility of procreating.
It can cause infertility if they persist for a long time without treatment. Mycoplasmas ascend through the mucosa and settle in the epithelia of the female or male reproductive system.
They produce changes in vaginal pH, alter the characteristics of the cervix and cervical mucus, which thins the endocervical epithelium and increases capillary fragility that facilitates bleeding..
All of this interferes with fertilization (mucocervical-semen interaction).
Through sexual intercourse, the infected sperm reach the woman's uterus, generating alterations such as endometriosis and disorders in pregnancy that can cause embryo loss..
It has also been isolated M. hominis of the blood of 10% of women with postpartum or post-abortion fever.
Has been isolated M. hominis in many patients with this condition who have tested negative for N. gonorrhoeae Y C. trachomatis.
Lots of research in vitro have revealed that Mycoplasma hominis is capable of adhering to any part of the sperm, damaging the membrane and the acrosome, modifying its morphology.
The morphological changes observed in sperm consist of tail curls and vesicles on the neck. All this decreases its viability.
Motility is affected by damage to the inner membrane of the sperm. This is due to the formation of hydrogen peroxide and reactive oxygen species (ROS) that induce the peroxidation of sperm lipids..
The decrease in motility and viability influences the ability to penetrate the oocytes, being a cause of infertility. In addition, the bacterium also increases the rate of sperm DNA fragmentation..
Any spermogram with a high percentage of morphological abnormalities and an increase in leukocytes per field is a candidate for studies of Mycoplasma hominis.
Although this is not the only bacteria that should be investigated, since other similar bacteria such as Mycoplasma genitalium Y Ureaplasma urealyticus, are important in patients who complain of infertility.
These bacteria are not visible in a bright field microscope, which makes their diagnosis difficult with the naked eye, so it is necessary to have methodologies that allow their detection and identification..
These include culture methods and molecular biology tests for quick and efficient identification. Currently there is the Mycoplasma System Plus KIT, among others.
This system consists of 24 wells containing desiccated antibiotics and biochemical substrates. It is used for the semi-quantitative identification and execution of the antibiogram to the urogenital mycoplasmas isolated by vaginal swabs..
This assay allows the detection of antimicrobial susceptibility to tetracycline, pefloxacin, ofloxacin, doxycycline, erythromycin, clarithromycin, minocycline, clindamycin and azithromycin..
It is important to highlight that its detection even in asymptomatic patients can prevent the appearance of diseases at the gynecosbtetric level..
Antibiotic therapy in patients with Mycoplasma hominis it is recommended, as it improves seminal quality and increases the probability of pregnancy.
Among the antibiotics that can be used are: fluoroquinolones, tetracyclines and chloramphenicol. On the other hand, azithromycin and ofloxacin are also effective.
However, some studies have revealed strains of Mycoplasma hominis resistant to macrolides (clarithromycin, azithromycin and erythromycin), in addition cases of resistance to tetracycline have been reported.
In persistent infections, the combination of doxycycline and azithromycin has been recommended. Likewise, M. hominis has shown high sensitivity to minocycline and clindamycin.
For obvious reasons Mycoplasma hominis It cannot be treated with antibiotics that have the cell wall as a target binding site, nor those that intervene with the synthesis of folic acid, such as beta-lactams and Rifampicin, respectively..