Contents
17.03.2017
Enterococcus is a small oval-shaped bacterium that is part of the normal human intestinal microflora (previously such microorganisms were classified as group D streptococci).
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Practice and experience of treatment
Looking ahead a little, we note that the editors are well aware that readers are looking for more information about how to cure enterococcus. For this reason, we first give you information about our Forum, where there is an active discussion on the topic of treatment of enterococcal bacterial infection in men. Here are a few popular topics that contain mostly information backed up by practice:
Enterococcus faecalis – Topic with a survey about the results of treatment Enterococcus is dead! And I haven’t yet – Treatment experience Where does the intestinal flora in the prostate come from – You need to know this
We invite everyone to join the discussion! The forum has been running since 2006. A storehouse of practical knowledge in the field of men’s health.
However, practical knowledge does not cancel the usefulness of methodological information. So let’s continue…
Types of enterococci. Causes of infection
Enterococci number more than 16 species, some of them can cause infectious diseases of the genitourinary system, endocarditis, etc. The most common are Enterococcus faecalis (fecal enterococcus) and Enterococcus faecium. Although the normal habitat of enterococci is the intestine, in almost 25% of healthy men, Enterococcus faecalis is present in the anterior part of the urethra. That is why enterococci are classified as opportunistic (transient) microflora of the genitourinary organs. In turn, Enterococcus faecium is responsible for the majority of vancomycin-resistant enterococcal infections. Insensitivity of bacteria to antibiotics is a serious problem of modern medicine.
Enterococci have both their own, due to the special structure, and acquired antibiotic resistance. This provides a significant contribution of these bacteria to the development of nosocomial infections and limits the ability of doctors in relation to such an important aspect as the treatment of enterococcus.
Enterococcus in men (more often – Enterococcus faecalis) can cause diseases of the organs of the urogenital tract, especially in persons who have undergone appropriate instrumental examination and / or taken antibiotics:
• prostatitis; • balanoposthitis; • urethritis; • epididymitis/orchoepididymitis; • cystitis, etc.
Infection routes:
• sexual contact (especially the alternation of genital-genital and anal-genital); • improper hygiene after using the toilet; • transmission from mother to newborn; • rarely – in organ transplantation.
When entering the genitourinary organs, enterococci can reside in them from several hours to weeks, eventually being destroyed by protective mechanisms. This state is called temporary carriage or transit. In this case, the carrier can transmit the pathogen to the sexual partner. Diagnosis of enterococcus with temporary carriage is possible with high-precision methods (for example, PCR).
Also, enterococci in a small amount can constantly be in the genitourinary organs (persistent carriage). Their growth is hindered by the same protective mechanisms and normal microflora. With a decrease in the number of normal microorganisms and / or a violation of the protection of enterococci, they begin to multiply rapidly, the process of inflammation develops. Persistent carriage is usually asymptomatic, except for the period of exacerbation, the detection of enterococcus is possible by PCR, a cultural method of research. In this case, there is also a possibility of infection of the partner.
When the body ceases to restrain the development of enterococci, the manifestation of the disease occurs. Factors predisposing to the development of enterococcal infection:
• the presence of serious illnesses; • past gonococcal/chlamydial infections; • violations of the protection mechanisms of the genital organs (such mechanisms include a neutral/weakly alkaline environment in the urethra, prostate antimicrobial factor, mechanical, local immunological protection) prostate antimicrobial factor – zinc-peptide complex); • long-term antibiotic therapy; • abuse of local anesthetics, leading to a burn of the urethra; • catheterization of the urinary tract or other instrumental examination, which can cause trauma to the mucous membranes; • old age, etc.
Enterococcal infection symptoms
There are no specific signs of damage to the genitourinary system by enterococcus. With the development of the pathological process, patients present complaints characteristic of a particular type of disease (depending on the localization of inflammation).
Urethritis is accompanied by:
• increased frequency, painful manifestations during urination; • urethral secretions; • redness, irritation, discomfort in the urethra.
Prostatitis is characterized by:
• syndrome in the form of pain and discomfort in the perineum, pain in the testicles, cramps / pain in the urethra, burning after sexual intercourse; • urination disorder syndrome (increase, feeling of incomplete emptying, weak/intermittent stream); • violations of orgasm, ejaculation (pain, orgasm wear, premature ejaculation or prolonged sexual intercourse); • in combination with chronic urethritis – mucopurulent discharge.
With balanitis / balanoposthitis, patients complain of pain and redness in the area of the glans penis, redness (erosion, sores, cracks), plaque, swelling, discharge. Orchiepididymitis is a combination of inflammation of the testicle (orchitis) and the epididymis of the latter (epididymitis). In acute disease, dull severe pain in the scrotum, enlargement / hardening of one testicle or both, hyperemia of the skin of the scrotum, enlargement / hardening of the epididymis with severe pain are noted. Pain is reduced in the scrotum when it is raised. A chronic disease is characterized by blurred symptoms, sometimes the appearance of blood in the semen.
Diagnostic methods
Diagnosis of enterococcus in the organs of the male urogenital tract involves:
• examination by a specialist; • general urine and blood tests; • polymerase chain reaction (allows to identify a microorganism even with asymptomatic carriage); • cultural studies (otherwise bacteriological inoculation) with the determination of antibiotic sensitivity; • other laboratory, such as RIF, ELISA, smear microscopy, etc., as well as instrumental (ultrasound, urethroscopy, MRI, CT) studies to exclude other causes of the disease (non-enterococcal genital infections, tumor processes, etc.) Urine samples are examined in the laboratory, semen, prostate secretion, urethral discharge.
In the presence of negative manifestations from the urogenital tract, it is important to understand that enterococcus is rarely the cause of such problems. If the tests did not show the presence of other pathogens, it may be necessary to re-diagnose (sometimes even in a different laboratory). Only after the exclusion of other possible pathogens (Trichomonas, gonococci, chlamydia, etc.) is an individual therapeutic course prescribed to eliminate enterococci.
Enterococcus treatment methods
In case of accidental detection of enterococcus during a routine examination, treatment is recommended only if there are characteristic complaints, planning surgical interventions on the organs of the genitourinary tract (in some situations, the doctor may recommend appropriate therapy when planning pregnancy). This is due to the fact that such a microorganism can be found normally in absolutely healthy men.
Enterococcus titers of the order of 1 * 10 in the 6th degree are considered diagnostically significant (in the absence of clinical manifestations). At the same time, asymptomatic bacteriuria (detection of enterococcus in the urine) may require only the supervision of a doctor and, if necessary, periodic tests: repeated crops. In boys without symptoms of urinary tract infection, routine laboratory detection of enterococcus is not recommended.
If enterococcus is suspected as the only cause of problems in a man from the urogenital tract (urethritis, prostatitis pyelonephritis, cystitis, etc.), adequate antibiotic therapy is necessary. Given the increased resistance of such microorganisms to the action of antibacterial drugs, it is highly desirable to determine the appropriate sensitivity before starting treatment (unfortunately, this is a time-consuming exercise and it is not always possible to postpone the start of treatment).
In most cases of inflammatory diseases of the genitourinary system in men, the cause of the infection is fecal enterococcus (Enterococcus faecalis). This type of enterococcus usually:
• sensitive to rifaximin, levofloxacin, nifuratel, some strains – to doxycycline; • moderately sensitive to ciprofloxacin; • slightly sensitive (for most strains) to tetracycline; • practically insensitive to lincomycin.
Penicillins, some cephalosporins, early fluoroquinolones are inactive or weakly active against fecal enterococcus.
For treatment, as a rule, one drug is sufficient; if it is ineffective, another or a combination of several may be prescribed. After the end of the course, a second diagnosis of enterococcus is carried out. Treatment of the sexual partner is carried out on the recommendation of a doctor (often in the case of pregnancy planning). In the case of a mixed infection, drugs that are active for each pathogen are selected.
A course of antibiotic therapy is usually sufficient for a complete cure. However, in some cases, the doctor may additionally prescribe:
• various physiotherapeutic procedures; • a course of massage (often used for inflammatory pathologies of the prostate gland); • enzyme preparations; • vitamins; • immunomodulating agents; • homeopathic treatment; • traditional medicine (baths of decoctions and infusions of medicinal herbs, drinking cranberry juice, etc.); • local treatment (infusions, so-called instillations, into the urethra of solutions of various medicinal substances, such as antiseptics).
Ignoring medical recommendations, excessive self-treatment and folk remedies can not only not lead to recovery, but also significantly worsen the patient’s condition. For example, the abuse of infusion of antiseptic solutions into the urethra often leads to a mucosal burn, which in itself serves as a provoking factor for the development of a bacterial infection.
Complications
In the absence of adequate therapy for enterococcal infection, the following are possible:
• distribution of the process of inflammation to other organs and tissues; • the transition of the disease to a chronic form; • deterioration in the quality of sperm and, accordingly, the development of male infertility; • violation of erectile function, etc.
Prevention
Prevention of enterococcal infection is:
• compliance with the rules of safe sex (use of barrier methods of protection, permanent partner); • timely detection and elimination/correction of chronic diseases; • competent therapy of identified sexual infections (especially gonococcal, trichomonas); • a healthy lifestyle (normalization of the regime of work and rest, full-fledged high-quality nutrition, moderate physical activity, minimization of stressful situations, etc.), etc.
Corrected and supplemented on 14.03.2021/XNUMX/XNUMX.
Used sources
1. Significance of bacteria of the genus Enterococcus in human life. Electronic scientific journal “Modern problems of science and education”. Krasnaya Yu.V., Nesterov A.S., Potaturkina-Nesterova N.I. FSBEI HPE “Ulyanovsk State University”. 2. Results of a multicenter study of antibiotic susceptibility of enterococci. Sidorenko S.V., Rezvan S.P., Grudinina S.A., Krotova L.A., Sterkhova G.V. State Research Center for Antibiotics, Moscow