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Mycoplasmas are small microorganisms that inhabit the human upper respiratory tract, oropharynx and organs of the urogenital tract. Of the seventeen known species, only four cause the disease. The causative agents of urethritis in men in a number of episodes are genital mycoplasmas and ureaplasma (genital ureaplasma is one of the types of mycoplasmas, but the pathologies it causes are often distinguished into a separate group called “ureaplasmosis” or “ureaplasma infection”).
Mycoplasmosis is conditionally called an inflammatory pathology in the organs of the genitourinary tract, in which, in the absence of other pathogens, a microorganism such as mycoplasma is detected in a laboratory. It is mycoplasma in men that causes most cases of non-gonococcal urethritis.
Causes of mycoplasma
Infection with genital mycoplasma can occur as a result of: • sexual, including oral-genital, contact; • mother-to-child transmission during pregnancy/birth; • organ transplants.
The possibility of contracting genital mycoplasmas through linen, public toilets or swimming pools has not been confirmed to date, although the survival of such microorganisms on environmental objects (in particular, toilet seats in public toilets) has been proven.
A feature of mycoplasma infection in men is its possible, although quite rare, self-healing.
In laboratory analyzes, the PCR method determines the common part of all types of mycoplasmas, denoting it Mycoplasma species. Such an analysis does not allow to determine a specific type of pathogen, therefore, the cause of the disease is established with a positive analysis of a smear from the place that raised questions (that is, the detection of mycoplasma in a smear from the oropharynx with urethritis is completely uninformative). In some cases, it may be necessary to conduct a repeated / additional study, since, for example, respiratory and genital mycoplasmas are sensitive to different antibiotics.
Risk Factors
An analysis for mycoplasma can show the presence of a microorganism in an absolutely healthy person. The exact reasons why this bacterium leads to the disease is still unknown. It has been proven that the probability of the disease is higher in persons: • with immunodeficiency, including those caused by HIV; • with hypogammaglobulinemia (decrease in the number of certain antibodies); • chronic prostatitis.
Types and symptoms of mycoplasma
After infection, it usually takes an average of 2-3 weeks for symptoms to appear. Genital mycoplasma in men can manifest itself in the form of: • urethritis – lesions of the urethra of an inflammatory nature; • epididymitis – inflammatory pathology of the epididymis; • Deterioration of the quality of sperm due to damage by bacteria to specific cells responsible for the production of spermatozoa and / or parasitism of microorganisms directly on spermatozoa.
Symptomatically, diseases caused by mycoplasma do not differ from similar pathologies caused by other pathogens. Thus, with mycoplasmal urethritis, small discharges of a mucopurulent nature, mild discomfort, slight itching in the urethra, and slight burning during urination can be observed. Mycoplasmal epididymitis proceeds without severe pain and fever, manifested by an increase / thickening of the epididymis. With the spread of pathology to the entire testicle, orchiepididymitis develops.
This type of mycoplasma, like M. penetrans, is found predominantly in homosexual men (in the rectum, urethra, throat) in 40% of cases versus 1% in heterosexual individuals. There is an assumption that the presence of this microorganism can serve as a marker of HIV infection.
Mycoplasma is detected by laboratory methods in approximately 2-5% of sexually active healthy men. This condition is called carriage – asymptomatic (the absence of signs of the disease must also be confirmed by laboratory and instrumental diagnostics) the presence of a microorganism in the genitourinary tract.
Diagnosis and detection of mycoplasma
The main methods for detecting mycoplasmas are a cultural study (otherwise, bacterial seeding on a nutrient medium) and the polymerase chain reaction method (the so-called PCR diagnostics). Diagnostic confirmation does not require determination of the presence and/or amount of antibodies in the blood.
In a general study, the following can be used: • enzyme immunoassay (abbreviated as ELISA); • reactions of direct and indirect immunofluorescence (RPIF/RNIF).
The latest methods are widespread in the territory of the CIS countries, but are characterized by insufficient accuracy.
As additional methods of examination to confirm the presence of the disease, especially if there are no symptoms, they resort to: • examination of the genital organs with palpation of the spermatic cord, testicles with appendages; • rectal examination of the prostate, seminal vesicles; • examination under a microscope of smears from the urethra, urinary sediment (from urine obtained by collecting sequentially without interrupting the stream in two glasses, the so-called two-glass sample), prostatic secretions; • Ultrasound of the prostate, scrotum organs; • study of spermograms.
If mycoplasma is detected in one of the partners, a mandatory diagnostic examination is carried out and the second.
Methods and methods of treatment
Treatment of mycoplasma in men is urgently required in all cases of the presence of a disease caused by this microorganism. In the absence of symptoms, the treatment of mycoplasma is strictly mandatory for: • the presence of a disease caused by mycoplasma infection in a sexual partner to eliminate the risk of reinfection; • possible change of sexual partner (so-called “epidemiological indications”); • planning by a married couple of pregnancy to prevent the occurrence of possible complications of the course of the latter, serious pathologies of the newborn, fetus.
When deciding on the need for therapy, the amount (titer in the analyzes) of the pathogen, its sufficient presence and the above factors do not play any role.
Antibiotic therapy is the main treatment for mycoplasma carriers/pathologies caused by mycoplasma. As a rule, drugs of the fluorine / difluoroquinolones groups, doxycycline (a group of tetracyclines) are used. Macrolide antibiotics, azalides are also used (azithromycin is quite effective). Sensitivity to similar preparations of different types of mycoplasmas is different.
Additionally, the following may be prescribed: • enzymes; • immunostimulants; • vitamins; • topical agents in the form of ointments, baths, instillations (infusions of liquid solutions of drugs into the urethra), etc.; • physiotherapeutic procedures; • homeopathic remedies; • methods of traditional medicine (based on decoctions of herbs, infusions, etc.).
For the period of therapy and until complete laboratory confirmation of the absence of mycoplasmas, a complete renunciation of sexual intercourse is required. When a pathogen is detected in a sexual partner, it is important to carry out therapeutic measures for them. The control of cure is carried out some time later (from two weeks to a month) after the end of the course of taking the drugs. Diagnostic method – PCR.
A relapse of the disease is possible if the bacterium is not completely destroyed, although modern methods have not been able to detect it in control tests. Long-term lack of effect requires a revision of the treatment regimen and determination of the sensitivity of the identified pathogen to antibacterial drugs.
In many cases, mycoplasma infection can “coexist” with other pathologies: gonococcal, chlamydial, ureaplasma, trichomonas, etc. In this case, the corresponding “set” is detected in the laboratory tests, for example, chlamydia and mycoplasma, ureaplasma and mycoplasma, etc. This situation requires the use of drugs that are effective against all pathogens, even if it will be necessary to take several drugs at once.
Complications
A complication of mycoplasmal infection is the development of: • infertility; • arthritis – lesions of the inflammatory type of joints, the so-called sex-related arthritis; • osteomyelitis – the defeat of purulent-necrotic nature of the bones, bone marrow and nearby tissues; • abscesses – purulent inflammation of tissues; • pyelonephritis – inflammatory pathology of the kidneys.
A serious problem is the infection of a woman by a man, especially at the stage of pregnancy planning or already at its onset. In this case, the following are possible: • premature termination of pregnancy (miscarriage, premature birth); • inflammatory pathologies of the pelvic organs; • postpartum complications (fever, endometritis); • infection of the fetus (intrauterine, during childbirth).
Infected infants may develop pneumonia, chronic lung disease, meningitis, and sepsis (called blood poisoning).
Prevention
The main methods for preventing infection with mycoplasma infection are: • correct use of a condom (unfortunately, in the case of mycoplasma and ureaplasma infections, the inefficiency of such a barrier method reaches 20%); • Refusal of promiscuous sexual life; • compliance with the rules of hygiene and a healthy lifestyle; • timely detection and treatment of concomitant chronic diseases, primarily chronic prostatitis.
Vaccines to protect against mycoplasmosis have been developed but have not been proven to be effective.