Contents
Ureaplasma are small microorganisms that inhabit the human genitourinary tract and do not have a rigid cell wall, which allows them to penetrate the smallest, up to 0.22 microns, pores and quickly acquire resistance to certain antibacterial drugs. Ureaplasmas parasitize on the cell membrane of spermatozoa, the epithelium of the genitourinary organs.
There are several types of such microorganisms. Two separate species that parasitize humans are grouped together under the name Ureaplasma species. Together with mycoplasmas Mycoplasma genitalium and Mycoplasma hominis, they belong to the group of genital mycoplasmas. That is why, when ureaplasmosis is detected in men, a diagnostic examination should also be carried out for mycoplasmosis (mycoplasmal infection).
The term “ureaplasmosis” is used to conditionally designate inflammatory processes in the organs of the urogenital tract, in which, in the absence of other pathogens, a specific microorganism, ureaplasma, is detected (in Latin – Ureaplasma urealyticum (species)). Ureaplasmas are detected, according to various research data, in 3-20% of healthy men. After the discovery of such a pathogen in 1054, disputes about its harmfulness, attitude towards STDs, the need for treatment in the absence of symptoms, etc., do not stop.
To date, the name “ureaplasma infection” is generally accepted, and the microorganism, according to the WHO classification, belongs to a number of causative agents of sexual infections.
Causes
The main ways of infection with ureaplasma: • the most common – sexual contact, including oral-genital; • to the fetus from the mother intrauterine, during childbirth; • rarely – in organ transplantation. The likelihood of a contact-household route (through bedding, toilet seats, pools, etc.) of infection has not been proven, although the corresponding microorganisms were found in crops produced from the surfaces of public toilet seats.
The main ureaplasmic “reservoir” is women who change from two or more sexual partners per year, with a stable carriage. Men can be carriers of ureaplasmas temporarily, while maintaining the possibility of infecting a sexual partner during the appropriate period.
Risk Factors
Ureaplasma in men is detected more often, the more sexual partners the latter has: it increases in the presence of two or more sexual partners per year by almost 8 times, compared with persons with one permanent partner.
It is not known for certain what factors lead to the development of the disease in infected people. It is assumed that this process may be facilitated by: • immunodeficiency states, including those caused by HIV; • violation of local protective factors, for example, in men – prostatic antimicrobial factor and local immunity systems; • associated infections.
So, in men with chronic prostatitis, damage due to gonococcal / chlamydial infection of the urethral mucosa, excessive use of local anesthetics, the risk of developing ureaplasma infection is higher.
Types and symptoms of ureaplasma
Symptoms of ureaplasma can be completely different, since pathology in men can occur in the form of the following diseases: • non-gonococcal urethritis, an inflammatory lesion of the urethra, which is characterized by mucopurulent discharge, mild itching and discomfort in the urethral region, sluggish course (about 30% of all episodes of non-gonococcal urethritis due to ureaplasma); • epididymitis (inflammation of the epididymis), which is manifested by a slight increase, thickening of the epididymis in the absence or mild severity of pain, occurring without fever; • orchiepididymitis (with the spread of the inflammatory process to the testicle); • violations of the quality of sperm in the form of a decrease in the mobility and / or number of spermatozoa (ureaplasmas provoke the process of self-destruction of spermatogenic cells, stick to the neck of the spermatozoon itself, reducing its mobility, release substances that change sperm fluidity), etc.
Urethritis caused by ureaplasmas is characterized by an incubation period of a week to 10 days, the absence of severe symptoms, and a rapid effect with timely antibiotic therapy.
In some people, infection with ureaplasma may not be accompanied by clinical manifestations at all. In such a situation, they talk about carriage or ureaplasma positivity. This condition is detected in almost 20% of men who have an active sex life. Ureaplasma positivity can be transitory (i.e. temporary), lasting from a couple of hours to several weeks, and persistent, lasting for months, years, and sometimes for life.
Ureaplasma positivity is a risk factor for the development of ureaplasma infection due to the possibility of: • the development of the disease in the future when the body’s defenses are weakened; • infection of sexual partners; • infection of newborns by mother.
Methods for diagnosing and detecting a disease
For laboratory confirmation of the presence of ureaplasma in men, use: • polymerase chain reaction (abbreviated as PCR); • enzyme immunoassay (or ELISA); • reactions of direct/indirect immunofluorescence (RPIF/RNIF); • sowing on a nutrient medium (cultural methods).
At the same time, PCR is a faster, more sensitive method for detecting ureaplasmas than seeding. Determining the presence/quantity of antibodies in the blood is not used for diagnostic purposes. Quantitative determination of ureaplasmas in scrapings from the urethra is uninformative.
To confirm the presence of a disease caused by ureaplasma, especially in the case of an asymptomatic course, the following is performed: • examination of the genital organs; • palpation of the scrotum (testicles, their appendages, spermatic cord); • examination of seminal vesicles, prostate rectally; • urethral smear microscopy; • microscopy of prostate secretion; • microscopy of urine sediment from a two-glass sample (when urine is collected sequentially in two glasses without interrupting the stream); • spermogram; • Ultrasound of the scrotum and prostate.
Ureaplasma treatment
The presence of a disease caused by ureaplasma infection is an absolute indication for treatment! It is also very important to carry out urgent and adequate therapy when planning a pregnancy by a married couple, if a sexual partner has a disease, when a sexual partner changes, etc. The effectiveness is higher, the earlier the pathology is detected and treatment is started.
Treatment of ureaplasma in men is carried out by a proven effective method – taking antibacterial drugs, mainly of two groups: fluorine / difluoroquinolones and macrolides. Due to the presence of resistant strains of ureaplasmas, tetracyclines, such as doxycycline, are now less commonly used. Also ineffective in ureaplasma infection is a common method of treating urogenital infections by taking 1 gram of azithromycin.
They can be prescribed (although the benefits of such techniques have not been proven, many patients report an improvement in their condition against the background of their use): • immunostimulants; • local treatment; • physiotherapy; • enzyme preparations; • homeopathic remedies; • methods of traditional medicine.
Some time after the end of ureaplasma therapy, it is necessary to re-conduct a diagnostic examination. In the absence of the desired result, the doctor prescribes a new course of antibiotics.
Treatment is carried out in parallel for both partners (with laboratory detection of ureaplasma) to eliminate the risk of reinfection. If the partner does not have symptoms of the disease and the pathogen is not detected in the tests, his treatment is not necessary. In such a situation, complete abstinence from sexual intercourse for the entire period of therapy until laboratory confirmation of complete cure is important.
It is important to understand that ureaplasma and mycoplasma infections are often accompanied by other infectious pathologies, such as gonococcal, chlamydial, trichomonas, etc., which requires competent diagnosis and additional prescription of appropriate medications.
Complications
Lack of adequate treatment of ureaplasma infection is fraught with the development of a number of problems: • chronic pathologies (prostatitis, pyelonephritis, etc.) • infertility; • meningitis (mainly in newborns, but a case has also been recorded in an adult male, doctors do not exclude that the case was not isolated, since the analysis of cerebrospinal fluid for ureaplasma is difficult to carry out in routine practice); • arthritis (10-15% of all joint lesions associated with genital infections are due to ureaplasma); • urolithiasis; • osteomyelitis; • subcutaneous abscesses, etc.
Serious complications are observed when a man infects a woman in the process of pregnancy planning, while increasing the risk of: • ectopic pregnancy; • premature termination of pregnancy; • development of postpartum endometritis; • the birth of a small child; • development of bronchopulmonary dysplasia, pneumonia, meningitis, blood poisoning in newborns.
Prevention
The main method of preventing infection with ureaplasma infection is the exclusion of promiscuity. Unfortunately, such a common prevention of sexual infections as the use of condoms in the case of ureaplasmosis is only relatively effective: the inefficiency is approximately 20%.