TITLE:
Therapeutic Challenges of Co-Infections with Chlamydia Trachomatis and Urogenital Mycoplasmas during Pregnancy and Obstetric Consequences: A Report of Three Cases
AUTHORS:
Michèle Florence Mendoua, Astrid Ruth Ndolo, Astride Mbono Samba, Charlotte Tchente Nguefack, Emile Mboudou
KEYWORDS:
Chlamydia Trachomatis, Urogenital Mycoplasmas, Pregnancy, Neonatal Infection, Case Report, Cameroon
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.15 No.9,
September
22,
2025
ABSTRACT: Introduction: Urogenital mycoplasmas and Chlamydia trachomatis are common pathogens in women of reproductive age and may act synergistically during pregnancy. Their management is challenging, because the most effective antibiotics, such as tetracyclines and fluoroquinolones, are contraindicated due to fetal toxicity, while resistance to safer alternatives like azithromycin is increasing. These infections are associated with miscarriage, preterm delivery, and neonatal respiratory complications. Case presentation: We report three cases of pregnant women in Cameroon co-infected with Chlamydia trachomatis and Urogenital mycoplasmas. The first patient, presenting with threatened miscarriage at 21 weeks, had Ureaplasma urealyticum resistant to azithromycin but sensitive to tetracyclines; azithromycin was nevertheless prescribed to target Chlamydia trachomatis, with good maternal and neonatal outcomes. The second patient, at 28 weeks, presented with threatened preterm labor due to polymicrobial infection (Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum) and improved under azithromycin therapy, delivering at term a healthy neonate. The third patient, diagnosed at 9 weeks with Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, and candidiasis, later developed threatened miscarriage and underwent emergency cesarean delivery at 35 weeks for fetal distress. The newborn developed respiratory distress and neonatal infection, illustrating adverse perinatal consequences. In all cases, sexual partners were empirically treated to prevent reinfection. Discussion: These cases highlight the therapeutic dilemmas posed by co-infections during pregnancy. Vaginal dysbiosis (type III-IV Doderlein flora) was consistently present, favoring pathogen proliferation. The link between maternal colonization and neonatal morbidity underscores the need for improved detection and management. Conclusion: Targeted screening and timely treatment of urogenital mycoplasmas and Chlamydia trachomatis during pregnancy, though controversial, may prevent severe obstetric and neonatal complications in high-burden settings.