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ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 32-36

Mycoplasma genitalium antibody among infertile women in Kano, Northwestern Nigeria


1 Department of Medical Microbiology and Parasitology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
2 Department of Medical Laboratory Science, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria

Date of Submission13-Aug-2020
Date of Decision06-Sep-2020
Date of Acceptance20-Oct-2020
Date of Web Publication20-May-2021

Correspondence Address:
Mr. Abdulrazak Muhammad Idris
Department of Medical Microbiology and Parasitology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njecp.njecp_30_20

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  Abstract 


Background: Infertility is an emerging health problem in many countries of the world including Nigeria. In many instances of asymptomatic or oligosymptomatic infection in women with infertility, it is difficult to find the etiological cause. Mycoplasma genitalium can be a cause of such asymptomatic infections and easily overlooked by clinicians. These bacteria can cause pelvic inflammatory disease leading to infertility. The seroprevalence of M. genitalium among infertile women will help in determining the extent of infection and define the medical attention it deserves. Objective: The study aimed to determine the seroprevalence of M. genitalium among women with infertility in Kano metropolis. Materials and Methods: About 2 mL of blood samples was collected from 59 infertile women attending infertility clinics and 31 pregnant women attending antenatal clinics (as controls) at Murtala Muhammad Specialist Hospital, Kano. ELISA kit (Sunlog Biotech, M. genitalium) was used to detect the presence of M. genitalium antibody (MG-IgG). Results: Most of the participants in both groups found to have positive M. genitalium-IgG, with 50 (84.7%) among infertile women and 28 (90.3%) among fertile women. Among all the possible risk factors observed, only vaginal discharge was found to have a statistically significant relationship with the presence of M. genitalium-IgG (P = 0.0356). Conclusion: The study observed that M. genitalium has no significant association with infertility in Kano because the observed prevalence in the control group is a little bit higher than that of the study participants. The high prevalence of M. genitalium-IgG obtained among infertile and fertile women strongly suggests that they are not always associated with symptoms, thus supporting the need for screening among women of reproductive age.

Keywords: Immunoglobulin, infertility, Mycoplasma genitalium, serology, seroprevalence


How to cite this article:
Bakori HS, Idris AM, Kumurya AS. Mycoplasma genitalium antibody among infertile women in Kano, Northwestern Nigeria. Niger J Exp Clin Biosci 2021;9:32-6

How to cite this URL:
Bakori HS, Idris AM, Kumurya AS. Mycoplasma genitalium antibody among infertile women in Kano, Northwestern Nigeria. Niger J Exp Clin Biosci [serial online] 2021 [cited 2021 Jun 14];9:32-6. Available from: https://www.njecbonline.org/text.asp?2021/9/1/32/316525




  Introduction Top


Infertility is a global problem particularly in developing countries and a common gynecological consultation in most Nigerian clinics.[1] According to Maheshwari,[2] it is estimated that one in three couples is affected by infertility in countries within Central and West Africa.[2] This burden of infertility has increased by 4% since the 1980s, mostly from problems with fecundity (the rate and ability to produce an offspring) due to an increase in age.[3] It has been estimated that up to 60% of infertility cases in Africa are attributive to genital tract infections in males and females as compared to other regions of the world, with about 30% of the cases involving males, 30% females, and 5% resulting from complications with both partners, leaving 25% of causes being unexplained.[4]

The prevalence of infertility in the sub-Sahara Africa ranges from 20% to 40%. Although there is scarcity of data with regard to the burden of infertility in Nigeria, an institutional-based study done by Abiodun et al.[5] puts institutional-based incidence of infertility reported in some parts of Nigeria as 4.0%, 15.4%, and 48.1% from Ilorin (north central), Abakaliki (south east), and Oshogbo (south west), respectively. However, a survey of the department of health services from 1994 to 2000 reported a prevalence rate of primary infertility of 22.7% in 15–49-year-old women and 7.1% in 25–49-year-old women.[6]

In the southwest, it was reported that male factor has been responsible for 42.4% infertility cases,[7] while in Maiduguri, North-Eastern Nigeria, infertility accounted for about 40% of all gynecological consultations;[8] in Kano, northwestern Nigeria, 40.8% prevalence was reported;[9] 46% in Ile-Ife;[10] and 55%–93% was observed in Enugu, eastern Nigeria[11] for male-factor infertility. In general, females are held responsible for virtually all cases of infertility.[6]

Mycoplasma genitalium is associated with urethritis, cervicitis, endometritis, and pelvic inflammatory diseases (PIDs) and may be considered a cause of infertility in women.[12] M. genitalium was found in 16% of women with infertility.[13] Mycoplasma is the simplest and the smallest free living organism and is unique among prokaryotes in that it lacks cell wall.[14] Mycoplasmas can cause acute and chronic diseases at multiple sites with a wide range of complications and has been implicated as a cofactor in various diseases.[15] The genital Mycoplasmas are important pathogens of the urogenital tract of human and in women, they have been reported to be associated with a variety of diseases and conditions such as PID, bacterial vaginosis, and infertility.[16] Arooye[17] reported that the major causes of infertility in Nigeria are infection, sexually transmitted diseases, and postabortal and puerperal sepsis, with the problem by no means restricted to women. Studies have shown the direct relation of M. genitalium to infection of the cervix and vagina in women. These bacteria can cause PID and infertility.[15]

The knowledge of seroprevalence of M. genitalium among infertile women will help in determining the extent of infection and define the medical attention it deserves. The present study aimed to determine the seroprevalence of M. genitalium among women with infertility in Kano metropolis.


  Materials and Methods Top


Study area

The study was conducted between April 2018 and August 2018 among participants aged 18 and above in Murtala Muhammad Specialist Hospital located in Kano State, northwestern Nigeria. The hospital is usually attended by moderate socioeconomic groups and therefore, it is affordable and accessible to most dwellers of Kano city and neighboring states, with being the largest state government-owned hospital. Kano State is located in the northwestern part of the country between longitude 8.5°E and latitude 12.0°N; it occupies a total surface area of 20,131 km[2] (77,773 m[2]) and has a total population of approximately over 13 million.[18]

Study population

The study consists of only infertile women attending the infertility clinic of Murtala Muhammad Specialist Hospital, Kano, Nigeria. The control group constituted women attending antenatal clinic of the hospital.

Inclusion and exclusion criteria

Those women that are consented and agreed to participate in the study, with a history of infertility, and pregnant women attending infertility and antenatal clinics, respectively, were included in the study. Women not among these set were excluded from participating in the study.

Study design

This is a descriptive cross-sectional study.

Ethical consideration

Ethical approval was obtained from the Kano State Ministry of Health before the commencement of the study (MOH/OFF/797/T.I/703). A consent form containing the research topic, researcher's name, and purpose of the study was administered to the participants for their consent and sign before the commencement of the study. The data for this study were collected using simple questionnaires to evaluate the participants' bio data, sociodemographic data, and medical history.

Sample collection

Following the administration questionnaire, 2 mL sterile syringe and needle were used to obtain blood using venipuncture method, which was transferred into a sterile plain tube and labeled with the participant's code. The samples were transported in a cold box containing ice packs to the microbiology laboratory for serum preparation.

Serum preparation

After collection of whole blood, the blood was allowed to clot by leaving undisturbed at room temperature for about 10–20 min. The clot was removed by centrifuging at 2000–3000 rpm for 20 min.[19]

Storage of samples and reagents

The serum was stored at −20°C in the freezer, while the ELISA kit was stored at 2°C–8°C in the refrigerator.

Procedure

In the micro-ELISA strip plate, three wells were set as negative control, two wells as positive control, and one well was empty which served as blank control. Negative and positive control in a volume of 50μL were added. In the sample wells, 40 μL sample dilution buffer and 10 μL samples were added and mixed by gentle shaking without touching the well wall.

It was sealed with a closure plate membrane, and the micro-ELISA stripe plate was incubated at 37°C for 30 min. Exactly 20 mL of the concentrated washing buffer was diluted with 580 mL of distilled water. The closure plate membrane was carefully peeled off, aspirated, and refilled with wash solution. The wash solution was discarded after resting for 30 s. The washing procedure was done for five times. Accurately 50 μL of Horseradish peroxidase (HRP)-conjugate reagent was added to each well except the blank control well. Following sealed with the closure plate membrane, the micro-ELISA stripe plate was incubated at 37°C for 30 min. The closure plate membrane was carefully peeled off, aspirated, and refilled with the wash solution. The wash solution was discarded after resting for 30 s. The washing procedure was done for five times. Precisely 50 μL of chromogen solution A and 50 μL of chromogen solution B were added to each well, mixed with gentle shaking, and incubated at 37°C for 15 min. Exactly 50 μL of the stop solution was added to each well to terminate the reaction. Using the microtiter plate reader, the optical density (OD) value of the blank control well was set as 0 and the absorbance was read at 450 nm.[19]

Determination of result

  • Test effectiveness: The average value of positive control ≥1.00; the average value of negative control ≤0.100
  • The critical value (cutoff) calculation: Critical value = the average value of negative control + 0.15
  • Negative judgment: If the OD value < cutoff, the sample is human M. genitalium-IgG negative
  • Positive judgment: If the OD value ≥ cutoff, the sample is human M. genitalium-IgG positive.


Data analysis

SPSS version 20.0 (IBM Inc, Armonk, New York, USA) was used for statistical analysis. Chi-square test was used to examine the associations between demographic factors and prevalence of the infection. Percentage and tables were used to show the distribution and prevalence of the infection. The level of statistical significance was set as P < 0.05.


  Results Top


Of the 90 women studied, 59 were infertile and 31 were pregnant (as controls). M. genitalium-IgG was found to be positive in 50 (84.7%) and 28 (90.3) among infertile and pregnant women, respectively. Thus, only 9 (15.3%) and 3 (9.7%) of the fertile and pregnant women showed negativity for M. genitalium-IgG, respectively [Table 1].
Table 1: Seroprevalence of Mycoplasma genitalium infection among the study groups

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Women aged 25–29 years were the predominant participants among both infertile and fertile women, following those in the age group of 30–34 years among fertile women. The least number were among the age group of 40–44 years in both the groups. Majority of the participants had secondary level of education [Table 2].
Table 2: Relationship between age groups and educational level between the two study groups

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The relationship between possible risk factors of the infection showed a statistically significant relationship to vaginal discharge of the two variables at P = 0.0356. There were no statistical relationships between all the other variables as their P values are ≥ 0.0500 [Table 3].
Table 3: Relationship between risk factors among the study groups

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On analyzing the relationship between M. genitalium-IgG and its possible risk factors among infertile women, it was observed that there was a statistical relationship to one type of family setup as P = 0.0270. While all the remaining variables showed no statistical relationship as all their P values are ≥ 0.0500 [Table 4].
Table 4: Relationship between Mycoplasma genitalium-IgG and possible risk factors among infertile women

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  Discussion Top


Infertility is an emerging health problem in many countries of the world including Nigeria. In many instances of asymptomatic or oligosymptomatic infection in women with infertility, it becomes difficult to find the etiological cause. M. genitalium can be a cause of such asymptomatic infections and can be easily overlooked by clinicians.

In this study, an overall prevalence rate of 84.7% M. genitalium-IgG antibodies was obtained from infertile women and 90.3% from fertile women. Not much report was obtained on M. genitalium from infertile women elsewhere, but Idahl et al.[20] worked on the seroprevalence of M. genitalium among infertile and fertile women in northern Sweden and reported the seroprevalence of 5.4% and 1.6% among infertile and fertile women, respectively. This is much lower than the 84.7% observed from this study on M. genitalium, although the two studies were from different geographical locations. However, higher seroprevalence rate of 70.4% Mycoplasma species was reported among HIV-infected women in Washington, England, which is similar to the prevalence rate obtained from infertile women.[21]

In this study, it was found that individuals aged 25–34 years have higher incidence of infertility due to M. genitalium. It was observed that as the age increases >25 years, the incidence increases and declines as age reaches 34 years in both fertile and infertile women. This is in accordance with the findings of Ugoh et al.,[22] who worked on the prevalence of Mycoplasma species infection among female patients visiting University Teaching Hospital, Abuja, Nigeria. Age is therefore an independent risk factor.

In the current study, it was observed that there was a significant association between virginal discharge and the rate of M. genitalium infection because this infection causes sexually transmitted diseases. From this study, M. genitalium appears to be sexually transmitted. This is in accordance with the finding of Manhart et al.[23] that M. genitalium infection is associated with having engaged in vaginal intercourse because the participants of this study were all sexually active.

Risk factors associated with M. genitalium infection among infertile women in this study showed no significant association with sharing of personal wears and toilet type. This is in dissimilarity with the findings of Chukwuka et al.[24] who reported risk factors for genital mycoplasma colonization among adolescents to be statistically significantly (P < 0.05) associated with sharing of personal wears and poor personal hygiene.


  Conclusion Top


The overall prevalence of M. genitalium-IgG was found to be high, with 84.7% and 90.3% for infertile and fertile women, respectively. The pathogen has no significant association with infertility because the observed prevalence in the control group is a little bit higher than that of the study participants.

Recommendation

The high prevalence of M. genitalium-IgG among infertile and fertile women strongly suggests that they are not always associated with symptoms, thus supporting the need for screening among women of reproductive age.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Makar RS, Toth TL. The evaluation of infertility. Am J Clin Pathol 2002;117 Suppl: S95-103.  Back to cited text no. 1
    
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Abiodun OM, Balogun OR, Fawole AA. Aetiology, clinical features and treatment outcome of intrauterine adhesion in Ilorin, Central Nigeria. West Afr J Med 2007;26:298-301.  Back to cited text no. 5
    
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Chukudebelu WO. The male factor in infertility-Nigerian experience. Int J Fertil 1978;23:238-9.  Back to cited text no. 11
    
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Vantani SH, Ghazisaidi K, Mohammadi M, Naji AR, Fatemesisab F, Zerati H. The survey of contamination with genital Mycoplasma in women with bacterial vaginosis by PCR Method. J Gorgan Univ Med Sci 2006;8:45-50.  Back to cited text no. 15
    
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Arooye OM. Epidemiology of infertility: Social problem of infertile couples. West Afr J Med 2003;22:190-6.  Back to cited text no. 17
    
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Sunlong Biotech, Hangzhou, China. Human Mycoplasma genitalium Antibody IgG (MG IgG) ELISA Kit Instruction Manual; 2018.  Back to cited text no. 19
    
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Idahl A, Jurstrand M, Olofsson JI, Fredlund H. Mycoplasma genitalium serum antibodies in infertile couples and fertile women. Sex Transm Infect 2015;91:589-91.  Back to cited text no. 20
    
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Iverson-Cabral SL, Manhart LE, Totten PA. Detection of Mycoplasma genitalium-reactive cervicovaginal antibodies among infected women. Clin Vaccine Immunol 2011;18:1783-6.  Back to cited text no. 21
    
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Ugoh SC, Nneji LM, Samuel S. Prevalence of Mycoplasma species in urine samples collected from females attending University of Abuja Teaching Hospital, Gwagwalada, FCT – Nigeria. Researcher 2014;6:99-104.  Back to cited text no. 22
    
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Manhart LE, Holmes KK, Hughes JP, Houston LS, Totten PA. Mycoplasma genitalium among young adults in the United States: An emerging sexually transmitted infection. Am J Public Health 2007;97:1118-25.  Back to cited text no. 23
    
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Chukwuka CP, Agbakoba NR, Emele FE, Oguejiofor C, Akujobi CN, Ezeagwuna DA, et al. Prevalence of genital mycoplasmas in the vaginal tracts of adolescents in Nnewi, South-Eastern. Nigeria World J Med Sci 2013;9:248-53.  Back to cited text no. 24
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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