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E.coli – from the Latin Escherichia coli (otherwise – Escherichia coli, Escherichia coli). This bacterium has a rod-shaped form and is part of the normal microflora of the human gastrointestinal tract. A huge number of microorganism varieties are known, among which more than a hundred (“collected” into 5 large groups) can cause various diseases. E. coli in men may also normally be present in the anterior urethra (in about 25% of healthy males). The detection of E. coli in the absence of signs of pathology is not an indication for therapy. Treatment of E. coli is carried out with antibiotics in the event of an infectious urogenital disease caused by this bacterium.
Causes of infection
The E.coli bacterium can be present in a normal male’s urethra, but can also be transmitted: • through sexual contact (especially anal-genital); • skidding from the intestines as a result of poor hygiene, with the flow of blood, lymph; • as a result of transplantation.
Sometimes there is infection by the mother of the newborn. After the penetration of a microorganism into the urogenital tract, several situations may develop, such as: • temporary carriage, otherwise transit (therefore, E. coli is referred to as a transient microflora), when the bacterium “lives” in the genitourinary organs for some time, a couple of weeks/months, and finally eliminated by the body’s defense mechanisms; • persistent carriage, otherwise positivity, when the bacterium is constantly detected, and its growth is restrained by the same protective factors; • development of infection.
In any case, it is possible to transfer the bacterium to a sexual partner. E.coli in men is the most common causative agent of urinary tract infections, such as: • prostatitis (acute – in 64% of all episodes of the disease, the culprit is Escherichia coli, chronic – Escherichia “fault” in 80% of cases) – inflammation of the prostate gland; • urethritis – damage to the urethra; • orchitis (inflammation in the tissues of the testis), epididymitis (inflammatory pathology of the epididymis), orchiepididymitis – in patients over 35 years of age, these problems are provoked mainly by Escherichia; • ascending infections of the kidneys, bladder (according to various sources, up to 95% of these diseases are caused by E.coli), etc.
The factors that prevent the reproduction of a microorganism and the development of an infectious disease in a man’s body include: • mechanical protection – a special element is located at the entrance to the urethra, otherwise the Guerin valve, which prevents the penetration of bacteria, in addition, there are glands, some of which secrete urethral mucus, and others during ejaculation a special secret (such secretions contribute to the removal of bacteria from the urethra); • slightly alkaline/neutral urethral environment; • immunological local protection; • prostate secretion
The secret of the prostate is a zinc-peptide complex, otherwise called the antimicrobial factor of the prostate gland, which has an antimicrobial effect, maintains an alkaline-neutral environment.
If a “breakdown” of one or more protective factors occurs in the body, the disease develops (they say that the transient microflora becomes pathogenic). In men, the factors of activation of pathological processes caused by E. coli include: • chronic prostatitis – in this disease, the content of zinc in the prostatic secretion decreases, which leads to dysfunction of the aforementioned zinc complex; • previous gonococcal and / or chlamydial infections – such problems cause scarring processes in the mucous membrane of the urinary tract, as a result of which the latter ceases to provide the necessary level of immunity.
In boys (in children, the vast majority of cases of UTIs (urinary tract infections) are due to Escherichia coli), the following risk factors are noted: • the first year of life; • an uncircumcised child (circumcised children are less likely to get sick by about 4-10 times, according to various sources); • prolonged catheterization of the urinary tract; • congenital structural anomalies of the urinary tract; • the presence of an episode of a similar infection in the past; • stagnation of urine due to phimosis, kidney stones, etc.; • family predisposition.
Symptoms of E.coli
Symptoms of an infection caused by Escherichia coli are not specific for this microorganism and are determined by the location of the inflammation.
Urethritis is characterized by: • frequent and painful urination; • pain during erection/ejaculation; • sometimes – constant urethral pain; • urethral itching; • discharge from the urethra; • in the area of the urethra – discomfort, irritation, redness, changes in the shape / color of the external opening, etc.
With prostatitis, patients may complain of: • pain and discomfort in the perineum; • pain in testicles; • sensation of pain/pain in the urethra; • burning sensation after urination, ejaculation; • various dysuric disorders – a feeling of incomplete emptying of the bladder after urination, increased frequency of the latter, weakness, discontinuity of the jet; • prematureness (or, conversely, prolonged intercourse), pain during ejaculation; • obliteration of orgasm; • purulent-mucous discharge (in case of urethroprostatitis).
The main signs of an acute form of orchiepididymitis are: • dull severe pain in the scrotum; • visual enlargement of one (or both) testicles; • sometimes – redness of the skin of the scrotum; • sharp soreness detected by palpation, compacted enlarged testicle and / or appendage; • Pren’s sign (pain is relieved by lifting the scrotum).
In a chronic disease, the pain is moderately pronounced (or absent at all), blood can be detected in the semen.
Diagnostic methods
Detection of E. coli can be carried out in various biological samples: urine, urethral secretions, prostate juice, etc. The presence of such microorganisms in the urine (so-called bacteriuria) has diagnostic value when there are more than 1 microbial bodies in 105 ml. Asymptomatic bacteriuria does not require treatment, but if there are signs of an infectious pathology, then the quantitative diagnostic value can be reduced. The signs of infection include not only the patient’s complaints (which may be absent), but also an increased content of leukocytes in the urine, a change in other laboratory parameters.
Diagnosis of E. coli in men with urogenital problems includes: • examination and questioning; • general urine and blood tests; • polymerase chain reaction (a very accurate technique, due to which it is possible to reliably detect bacteria even in the absence of clinical manifestations); • bacteriological seeding (otherwise cultural research); • other laboratory, such as microscopic examination, enzyme immunoassay, etc., as well as instrumental (ureteroscopy, MRI, ultrasound, CT) examinations to exclude other possible causes of pathology. It is important to understand that an E. coli infection can coexist with problems caused by other pathogens.
Treatment of E. coli in men
Treatment of E. coli infection (drugs, regimen, duration of administration and dosage) is prescribed by the doctor, based on the individual characteristics of the patient’s condition and the manifestations of the disease. It is important that the specialist be sure, thanks to the diagnostic data, that the problem is caused precisely by Escherichia coli, since the latter is a conditional pathogen and may be present in the norm (the presence of signs of the disease and the identification of this pathogen in the analyzes does not always indicate that the first consequence of the action of the second).
In case of accidental detection of E.coli, treatment is indicated only in the presence of relevant complaints, planning of surgical procedures on the organs of the urogenital tract, etc.
Treatment of E. coli in men is carried out with the help of antibacterial drugs, ideally after establishing sensitivity to the latter pathogen (determination of antibiotic resistance is carried out during a cultural study).
In general, for the treatment of acute prostatitis, the drugs of choice are oral forms of fluoroquinolones, such as ofloxacin, ciprofloxacin, etc., cephalosporins (II, III generations) – cefixime, cefuroxime, etc. Co-trimoxazole, doxycycline may be prescribed. The usual course of treatment should not be shorter than 4 weeks. Chronic prostatitis is treated longer (up to 12 weeks), mainly with fluoroquinolones.
Treatment of orchitis / epididymitis / orchiepididymitis is also carried out with fluoroquinolones, new generation cephalosporins, less often with co-trimoxazole, drugs based on ampicillin. Duration – at least 4 weeks, the form of administration is determined by the severity of the disease.
As a rule, one drug is enough to treat E. coli infection. Treatment of the sexual partner is carried out only with the appropriate recommendation of the doctor. At the time of therapy, you should refrain from sexual intercourse (especially anal-genital) or use barrier contraceptives. Sometimes a specialist may additionally prescribe enzyme and vitamin preparations, courses of massage and physiotherapy, etc.
Complications
In men, urinary tract infections often occur with complications (some experts consider the very episode of UTI in men to be a complicated infection). Complicated infections are most often caused by antibiotic-resistant Escherichia coli or an association of several groups of bacteria. The development of complications is facilitated by: • congenital or acquired structural anomalies (kidney stones, foreign bodies, doubling of the ureters, etc.); • metabolic disorders (diabetes mellitus, etc.); • decrease in the protective functions of the body (age, after transplantation, immunodeficiency states, etc.) and other factors.
In the absence of competent treatment, an infection caused by E. coli in men can lead to: • the spread of the inflammatory process; • chronization of pathology; • development of male infertility; • to such forms of potency disorders as wear or even lack of orgasm, premature ejaculation; • abscess, testicular necrosis (complications of epididymitis), etc.
Prevention
To prevent the development of an infectious process, it is recommended: • follow the rules of hygiene; • comply with the rules of safe sex (permanent sexual partner, use of barrier means of protection); • timely conduct therapy for gonococcal/chlamydial infections, chronic prostatitis; • adequately treat or correct chronic diseases; • adhere to the rules of a healthy lifestyle.
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- Enterococcus