Contents
Author – Yu.A. Yashenok
staphylococcus – a bacterium of a spherical (absolutely round or slightly elongated) shape, which is a representative of the normal flora that inhabits the skin and mucous membranes of a person. Pathogenic varieties of staphylococcus can cause the development of the disease – staphylococcal infection.
The pathogenic effect of staphylococci is due to their production of: • enzymes that destroy the tissues of the infected organism; • toxins, hemolysins that inhibit the immune activity of cells; • enterotoxins, which have a toxic effect. Staphylococci tolerate drying well, die under the action of chloramine within 2-3 minutes, 50% alcohol – 10 minutes.
Types and prevalence of staphylococcus aureus
In male infants, already a few hours after birth, epidermal (usually inhabiting the skin) staphylococcus aureus is found in the navicular fossa (a small area in the initial / anterior part of the urethra, which borders on the mucous membrane of the head). As you move away from the entrance deep into the urethra, the number of bacteria decreases and already at a distance of about 5 cm, the urethra is almost sterile. With age, the composition of the urethral microflora in men, unlike women, does not change, but is sensitive to other factors (some microorganisms “live” in the urethra all the time, others only for some time). Also, unlike women, the urethral microflora of men does not have any specific functions.
In addition to the epidermal (the frequency of detection, according to various sources, from 50 to 100%), saprophytic staphylococcus is also found in men in about 25% of cases. The neutral-alkaline environment of the male urethra favors the reproduction and development of the latter.
Epidermal and saprophytic staphylococci do not cause disease and “treatment of staphylococcus” in this case is not required. More pathogenic is Staphylococcus aureus. In males, the detection of Staphylococcus aureus on the skin or scaphoid fossa of the urethra is possible against the background of complete health (detection rate up to 5%). At the same time, Staphylococcus aureus, under certain conditions, can cause a number of pathologies, an example of which is non-gonococcal urethritis in men. Such a disease does not apply to sexually transmitted infections, and if a woman does not have bacterial vaginosis, then she cannot become infected from a sexual partner.
In any case, it is not necessary to treat staphylococcus aureus in men, as doctors joke – “he does not get sick”, therapy may be necessary when it comes to a staphylococcal infection, that is, a disease caused by this microorganism.
In addition to staphylococci in the anterior urethral part of a healthy man, the following can be found: • streptococci (namely Streptococcus mitis) – with a frequency of 25%; • fecal enterococcus – 25%; • Neisseria (Neisseria sp.) – 25%; • Enterobacteriaceae (E. coli) – 25%; • proteas (Proteus sp.) – 25%; • Pseudomonas aeruginosa (Pseudomonas aeruginosa) – up to 5%; • Corynebacteria (Corynebacteria) – 25%; • Bacteroides (Bacteroides sp.) – 25%.
Causes of staphylococcal infection and provoking factors
Staphylococcal infection in men develops when pathogenic varieties of staphylococcus multiply in the urogenital organs, which can lead to the development of a number of diseases: • urethritis (with inflammation of the urethra); • prostatitis (inflammatory lesions of the prostate gland); • cystitis (bladder damage); • pyelitis (pathology of the renal pelvis); • pyelonephritis (kidney disease of an inflammatory nature); • glomerulonephritis (damage to the renal glomeruli of an autoimmune-inflammatory nature), etc.
In men, the lower urinary tract is predominantly affected. Staphylococcal urethritis can develop against a background of trichomonas / gonorrhea infection, with mechanical or chemical irritation of the urethra. Possible infection with pathogenic staphylococcus from a patient with an inflammatory disease caused by the corresponding pathogen, a woman (for example, with colpitis, endocervicitis). Staphylococcal glomerulonephritis occurs in patients who first had another infection of a similar nature (pneumonia, enterocolitis, etc.).
Staphylococci, which are normally present on the mucous membrane of the male urethra, can cause disease in exceptional cases: • against the background of immunodeficiency caused by HIV; • after prolonged antibiotic therapy; • after a serious illness; • against the background of prolonged fasting, etc.
Contribute to the development of pathology: • unprotected sex; • anal sex; • insufficient hygiene of genital organs; • hypothermia, excessive exercise, unhealthy lifestyle; • chronic infectious and inflammatory pathologies; • contact with infected household items and medical instruments, etc.
Staphylococcal infection symptoms
Symptoms of staphylococcal infection are not specific and appear depending on the location of the lesion. A significant increase in temperature, the presence of general intoxication manifestations are uncharacteristic. So, with urethritis caused by staphylococcus, there are: • redness, irritation, discomfort in the urethra; • pain during urination, its increase; • selection of various types.
Prostatitis is characterized by: • soreness, swelling of the testicles (on one or both sides); • pain in the lower abdomen of different nature and intensity; • violations of urination (difficulties up to acute urinary retention); • selection, etc.
As well as for similar diseases caused by other pathogens, the intensity of the symptoms is determined by the nature of the process: acute or chronic. Chronic pathology can occur with minimal manifestations. Only on the basis of symptoms it is impossible to reliably establish the fact that staphylococcus is the cause of the problem, a full diagnostic examination is required.
Diagnostic methods
If you suspect a urinary tract infection caused by staphylococcus aureus, the doctor may prescribe the following tests: • general urine and blood tests; • bacteriological examination of urine (urinalysis for pathogenic microflora), with the determination of the number of bacteria and their sensitivity to antibiotics; • examination of urine by PCR (an abbreviation for “polymerase chain reaction”) to exclude the gonorrheal, trichomonas, chlamydial nature of urethritis; • smear from the urethral mucosa, taking a sample of prostate secretion and examining them with a light microscope; • bacteriological seeding (analysis of secretions from prostatitis and other pathologies, semen analysis); • enzyme immunoassay (to rule out syphilis, HIV infection, etc.); • other laboratory, as a rule, to exclude non-staphylococcal causes of the disease, and instrumental (magnetic resonance and / or computed tomography, ultrasound of the prostate, etc.), to determine the location and extent of the lesion, exclude tumor pathologies, etc., studies.
Treatment of staphylococcus
Detection of staphylococcus in a urethral smear during routine examination is an indication for therapy only in the presence of a corresponding disease (urethritis, etc.). The carriage of staphylococcus aureus by a healthy man does not require treatment. In some cases, for example, when planning a pregnancy for a married couple, if staphylococcus aureus is detected in a man, the doctor may prescribe therapy with local agents (Bactroban, etc.).
In a situation where there are manifestations of a staphylococcal infection, one has to resort to antibiotic therapy. Local funds in this case are ineffective, but can be used as additional ones. Staphylococcus aureus is often (but not always!) resistant to ciprofloxacin, but sensitive to amoxicillin, clarithromycin, and other drugs.
Standard treatment regimens for uncomplicated urogenital infection due to saprophytic staphylococci include (if susceptibility is confirmed): • cephalexin 500 mg orally several times a day for a week; • amoxicillin-clavulanate (875-125 mg); • ciprofloxacin in dosages of 250 mg several times a day or 500 mg once for a prolonged form; • levofloxacin 250 mg.
In case of a complicated course of diseases, the following can be used: • amoxicillin-clavulanate (875-125 mg) in a course of up to two weeks; • ampicillin-sulbactam; • cephalexin 500 mg up to two weeks; • cefazolin, ceftriaxone intravenously; • ciprofloxacin 500 mg or 1 g for the extended form orally, 400 mg intravenously for up to two weeks; • levofloxacin 750 mg.
Also, in the treatment of urogenital infection, the cause of which turned out to be saprophytic staphylococcus aureus, Co-trimoxazole, Norfloxacin are used. The ideal option in the selection of treatment is a preliminary determination of the sensitivity of the pathogen to certain drugs. If the diagnostic examination revealed the presence of other infectious pathogens, several antibacterial drugs of different groups, a combination of antibacterial and antifungal drugs, etc., can be prescribed at the same time.
In addition to antibiotics, bacteriophages (staphylococcal bacteriophage) can be used in the treatment of staphylococcal chronic diseases of the urogenital tract, both locally, by injection through the urethra, and inside. Bacteriophages are special viruses that can specifically infect the cells of specific bacteria.
Physiotherapy, massage (for prostatitis), enzyme preparations, immunomodulators (polyoxidonium, etc.), folk remedies (cranberry juice, herbal decoctions) in the treatment of staphylococcal infections do not have reliably proven effectiveness, although some patients report an improvement with their use.
A separate problem is the so-called methicillin-resistant Staphylococcus aureus (otherwise Staphylococcus aureus with multiple drug resistance). This bacterium, like other staphylococci, can inhabit the urinary tract and is resistant to most commonly used antibiotics. When the body is weakened, such a microorganism causes infectious diseases that are difficult to treat.
Complications
Long-lasting staphylococcal urethritis in men in the absence of treatment can cause: • impotence; • staphylococcal prostatitis, etc.
It is possible to spread inflammation to the seminal tubercle (colliculitis), seminal vesicles (vesiculitis), the epididymis (epididymitis), the testicle itself (orchitis, orchiepididymitis).
Such serious complications of staphylococcal diseases as staphylococcal “scalded skin” syndrome, toxic shock, etc., are not typical in the case of infections of the urogenital tract in men. In women, toxic staphylococcal shock rarely develops against the background of the use of tampons during menstruation, vaginal contraceptives (diaphragms, caps, spermicidal sponges).
Prevention against staphylococcus aureus
Since staphylococci are normal inhabitants of human mucous membranes and skin, specific preventive measures are usually not required.
Recommended: • careful observance of the rules of personal hygiene (daily hygiene procedures, change of underwear, etc.); • exclusion of unsafe sexual contacts; • tempering procedures, rational nutrition, moderate physical activity; • timely detection and elimination of foci of chronic infection.
In persons with an increased risk of developing infections (workers in industrial and agricultural enterprises, with frequent injuries, etc.), staphylococcal toxoid can be used to prevent toxin-related diseases, for example, toxic staphylococcal shock, etc.
عالی بود