(620) Clinical Case Report: Isolation of Ureaplasma Urealyticum in Anal Exsudate

Abstract Introduction Ureaplasma urealyticum is a commensal microorganism of the human genitourinary tract. However, under certain conditions such as immunosuppression, genital flora dysbiosis, or sexual transmission, it may be associated, in men, with infections of the urogenital tract, namely non-gonococcal urethritis and prostatitis. Detection of this microorganism in anal exudate samples is uncommon, as this species is not part of the normal commensal microbiota of the anal or rectal mucosa; therefore, it is scarcely reported in the scientific literature. Objective To describe a rare case of Ureaplasma urealyticum isolation in anal exudate and highlight the importance of multiplex RT-PCR testing in the diagnosis of sexually transmitted infections (STIs) from extragenital samples. Methods An adult male patient presented with anal discomfort and requested comprehensive STI testing. Self-collected samples of anal exudate, oropharyngeal exudate, and first-void urine were analysed separately using standard molecular methodology (multiplex RT-PCR). Results Ureaplasma urealyticum was detected in both anal exudate and first-void urine samples. The microorganism was not found in the oropharyngeal sample. The use of multiplex RT-PCR enabled the identification of the Ureaplasma in this rare extragenital localization, which is often overlooked. Conclusions Infection by this microorganism may occur through direct sexual transmission, particularly in individuals engaging in unprotected anal intercourse. It is worth noting that anal infections that damage the mucosa, such as those caused by Ureaplasma species, may increase the risk of HIV transmission. Colonization of the anal mucosa by Ureaplasma urealyticum may also be associated with the development of proctitis (inflammatory lesions of the rectal wall). This microorganism lacks a cell wall and is therefore naturally resistant to all β-lactam antibiotics, which act by inhibiting cell wall synthesis. The recommended antibiotics include macrolides, tetracyclines, or fluoroquinolones. The scarcity of reports in the literature may be due to the routine use of molecular panels limited to Chlamydia trachomatis and Neisseria gonorrhoeae, as well as the relatively low number of clinical requests for multiplex testing of anal exudate samples. This case underscores the importance of increasing clinical adherence to the prescription of multiplex RT-PCR panels and the use of anal samples, particularly in symptomatic individuals. As a commensal/colonizing agent, the presence of Ureaplasma urealyticum may not be clinically relevant in asymptomatic individuals. However, monitoring colonization remains important, especially in at-risk groups, since silent colonization may progress to active infection under immunosuppressive conditions. Disclosure No