Prevalence of Chlamydia trachomatis, Ureaplasma spp., Mycoplasma hominis and Mycoplasma genitalium in patients with sterile pyuria

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INTRODUCTION: Sterile pyuria poses a diagnostic challenge due to varied aetiologies. Atypical pathogens including Chlamydia trachomatis and genital mycoplasmas are considered etiological agents but are under-reported, especially in resource-limited settings. This study determined the prevalence of these atypical pathogens in sterile pyuria patients. MATERIALS AND METHODS: This 4-year prospective observational study screened 640 adults admitted to Medicine wards of a tertiary care hospital for sterile pyuria, defined as urine microscopy showing >10 WBCs/HPF with no bacterial growth on culture. All sterile pyuria patients were evaluated for Chlamydia trachomatis (CT), Ureaplasma spp., Mycoplasma hominis (MH) and Mycoplasma genitalium (MG) from first void urine samples. Mycoplasma hominis and Ureaplasma spp. were detected by culture and PCR assay. Chlamydia trachomatis was detected by PCR assay. Mycoplasma genitalium was detected by Real-time PCR assay. Additional assessments for other potential causes were carried out. Patients were treated with doxycycline or azithromycin and followed for outcomes. Risk factors for infection with these atypical agents were explored. RESULTS: Of 640 patients screened, 100 (15.6 %) had sterile pyuria. Atypical pathogens were detected in 40 %. CT, Ureaplasma spp., and MH were detected in 19 %, 15 % and 5 % respectively. One patient tested positive for MG. Multivariate logistic regression identified multiple sexual partners (adjusted OR 12.01, 95 % CI 2.07-69.40, p = 0.005) and past pelvic surgery (adjusted OR 5.64, 95 % CI 1.43-22.24, p = 0.013) as risk factors. Twenty-five (62.5 %) of 40 patients achieved complete clinical and microbiological cure with treatment. Laboratory records revealed genitourinary tuberculosis in 2 patients. CONCLUSION: This study identified 40 % prevalence of atypical pathogens in sterile pyuria patients. Unlike previous assumptions, genitourinary tuberculosis was not a common cause in our population. Our findings emphasize the necessity for comprehensive screening for CT, Ureaplasma spp., MH, and MG in sterile pyuria patients.

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