Silent sexual threat | Lead Stories

Untested and underreported bacteria-related sexually transmitted infections (STIs) are at the root of many reproductive and vaginal health issues affecting mothers and their newborns.

And according to one microbiologist, there is a particularly overlooked bacteria-related sexually transmitted disease that may be causing infertility and other serious complications in women locally.

The culprit? Mycoplasma hominis – a species of bacteria commonly found in the lower urinary and genital systems.

This type of organism is sexually transmitted and associated with illnesses such as bacterial vaginosis, pelvic inflammatory disease and postpartum fever. It is also linked to infertility, and systemic neonatal infections, some of which may cause the deaths of newborns.

Molecular microbiologist and medical doctor, Mellesia Lee, believes that almost 30 per cent of Jamaican females are infected with the bacteria, and may be suffering health complications, including infertility, caused by it.

“While other types of bacteria can cause similar issues, mycoplasma hominis, detected locally last year, often goes unscreened due to a lack of resources and expertise to test for it,” Lee, founder of Molecular Evolution Laboratories Limited (MELL), shared with The Sunday Gleaner.

Of the 253 STI samples tested at MELL from February 2023 to March 2024, 18.2 per cent (46) persons who tested for mycoplasma hominis were positive.

The prevalence in Jamaican males is currently 4.3 per cent, but up to 26.6 per cent in females, Lee shared, adding that based on existing literature, the numbers could be much higher.

She noted, however, that females test more often as they are more symptomatic. Men are largely asymptomatic but can experience abnormal genital discharge.

Another concern she raised was that the numbers could be higher among men who have sex with men.

“Our findings indicate that one in every five persons is possibly walking around with mycoplasma hominis undetected,” charged Lee, as she emphasised the importance of persons getting tested.

Being observed under the theme ‘Get Yourself Tested’, April is STI Awareness Month and this Wednesday, April 10, is STI Awareness Day.

VARIOUS COMPLICATIONS

Mycoplasma hominis typically colonises the female reproductive tract through the vagina and affects the cervix and fallopian tubes, Lee explained.

“This may lead to scarring and fibrosis of the fallopian tubes, leading to blocked fallopian tubes and ultimately infertility or other complications such as ectopic pregnancies,” she outlined.

“Also, bloodstream infection in newborns is associated with high mortality rates, and mycoplasma hominis has been shown to induce bloodstream infection and present clinical diagnostic and therapeutic challenges in other countries.”

She added, “That’s why we are trying to get the pediatricians to incorporate PCR (Polymerase Chain Reaction) testing for these bacteria in babies with bloodstream infection locally.”

DECLINE IN BIRTH RATE

These types of bacteria, and others such ureaplasma, which Lee explained is usually present along with mycoplasma hominis in test samples and is not easily detectable, is cause for concern as it is one factor impacting Jamaica’s fertility and infant mortality rates, she said.

Statistics obtained from the Registrar General’s Department last week revealed a steady decline in the island’s birth rate, from 39,544 births in 2012 to 32,294 births in 2022.

The National Family Planning Board (NFPB), in its Reproductive Health Survey of 2021, also reported a decline in fertility rate from 4.5 births per female between 1973 and 1975, to 1.9 in 2021; while infant mortality rates continue to decline.

Clinically, a woman is considered infertile if she is younger than 35 years and hasn’t been able to get pregnant after trying for a year. This characterisation also applies to women older than 35 who, after six months, have been unsuccessful in conceiving. Women who have had two or more miscarriages and who are unresponsive to fertility treatments are also deemed infertile.

“I think all physicians, especially pediatricians, should also incorporate PCR detection, especially in neonates suspected of having sepsis (blood infection). Very commonly, that pathogen colonising the female tract can pose a risk to the fetus or child before and especially during delivery with an active infection,” Lee noted.

She explained that traditional laboratories mostly depend on growing bacteria for a few days before the species is identified. Mycoplasma hominis, however, are slow-growing organisms without cell walls, and thus difficult to grow by traditional means.

“So the organism has gone on largely undetected in the Jamaican population due to a lack of appropriate available testing options as well as expertise,” said Lee, reiterating that PCR testing is the mainstay for diagnosis.

NO SYMPTOMS IN MAJORITY OF CASES

Renowned physician Dr Alfred Dawes last week said most Jamaican women are not even aware that they have an STI and that it could be the cause of their infertility. This is because in many cases such mostly asymptomatic infections go untested locally.

“Several STIs are not routinely tested for, and those have been fingered in infertility,” the head of Windsor Wellness Centre shared with T he Sunday Gleaner.

“Those asymptomatic STIs can also be passed on to the child at the time of birth or during pregnancy, and can cause long-term complications, especially with the eyes.”

Citing ureaplasma bacteria as the most common culprit locally, he said, “In many instances, we don’t consider it an STI. It can be transmitted during sexual intercourse but in the majority of cases, it has no symptoms but is a cause of infertility. Most people don’t know they have it. We have more ureaplasma cases here; hominis is not as common, and so people tend not to screen for it as often.”

IMPACT DEVELOPMENT

OF CHILD

Pediatrician Dr Lisa Franklin Banton noted that bacteria-causing STIs have implications within and outside of the womb, which could result in children being born disabled or with developmental complications that may not be easily treated.

“It’s not only when they (babies) are born that the problems arise. It affects development, some of them may not grow at the rate that we would expect,” she shared with The Sunday Gleaner.

“Development of certain organs may be affected, you may have some blindness, some deafness. It can lead to liver issues and in the extreme can cause babies not to survive. You may also have stillbirths.”

Dr Banton could not say how common birth defect cases are islandwide, but stressed that it is always important for expectant mothers to get screened earlier. PCR testing is the “gold standard” in screening for such infections, she also noted.

“We just need to encourage our pregnant women to make sure they are screened appropriately for these things because they are preventable in terms of having issues with the newborn and we wouldn’t want to miss the opportunity to catch it. So we are encouraging our mommies to get properly screened.”

TAKE NECESSARY PRECAUTIONS

In stressing the “get yourself tested” theme in keeping with STI Awareness Month, Health Minister Dr Christopher Tufton told The Sunday Gleaner yesterday that sexually transmitted infections continue to be an issue that the country cannot ignore.

He is urging the populace, especially expectant mothers, to make use of services on offer in the public health system to get screened and safeguard themselves against health complications that can impact both themselves and their newborn.

“People should inform themselves, take whatever protection necessary, access the services that our health facilities offer, which include education for a better understanding of STIs and the impact,” Tufton said.

“Taking the necessary precautions and getting tested mean that people will be in a better position to protect themselves and their loved ones.”

The minister pointed out that teams from the Ministry of Health and Wellness continue to work on the ground in communities across the island to bring awareness.

CALL TO ACTION

Dr Ché Bowen said this should be seen as a call to action, especially during STI Awareness Month.

“This call to action emphasises the critical role that testing plays in safeguarding individual and public health. Regular testing not only enables early detection and treatment but also empowers individuals to take control of their sexual health and well-being,” said the digital health entrepreneur and CEO of MDLink Diagnostic Laboratory.

“Early detection is key in the fight against STIs. Many of these infections may not exhibit noticeable symptoms initially, leading to unknowing transmission and potentially severe health consequences.”

By undergoing routine testing, individuals can detect infections early on, allowing for prompt intervention and treatment. Moreover, early detection not only protects the individual but also helps prevent the spread of STIs within communities, Bowen noted.

“It is essential to recognise that STI testing should be a routine part of healthcare, irrespective of one’s sexual activity or perceived risk. Everyone, regardless of age, gender, or sexual orientation, can benefit from regular testing. By normalising and destigmatising the process of testing, we can encourage more individuals to prioritise their sexual health and well-being,” he said.

“As we navigate through STI Awareness Month, let’s renew our commitment to promoting sexual health and well-being for all. Let’s continue to advocate for comprehensive sex education, accessible healthcare services, and non-judgemental support systems. By working together, we can create a future where STIs are no longer a source of shame or fear but rather a manageable aspect of overall health.”

374 MILLION NEW INFECTIONS EACH YEAR

According to the World Health Organization (WHO), there are more than one million sexually transmitted infections daily worldwide. WHO also noted that each year there are more than 374 million new infections, with one of four curable STIs, namely gonorrhoea, syphilis and trichomoniasis.

The world health authority noted that STIs have a direct impact on sexual and reproductive health through stigmatisation, infertility, cancers and pregnancy complications. They also increase the risk of HIV.

“More than 30 different bacteria and parasites are known to be transmitted through sexual contact, including vaginal, anal and oral sex. Some STIs can also be transmitted from mother to child during pregnancy and breastfeeding … STIs can have serious consequences beyond the immediate impact of the infection itself,” WHO stated.

corey.robinson@gleanerjm.com