Ureaplasmas: to treat or not?

Health Tips

Inflammatory diseases of the reproductive system are a common problem and the most common reason for visiting a doctor. In addition to the well-known sexually transmitted infections, the so-called opportunistic microorganisms are often the cause of inflammatory processes. Today, a dermatovenereologist tells the readers of Goodshapetips about them.

Opportunistic microorganisms, as the name implies, may or may not cause disease, and their presence does not always indicate the need for treatment.

Some genital mycoplasmas belong to such conditionally pathogenic microorganisms.

Diagnostics

Among genital mycoplasmas, 3 pathogens are most often detected during examination.

They are the cause of the development of inflammatory diseases of the genitourinary system: Mycoplasma genitalium (Mg), Mycoplasma hominis (Mh), and Ureaplasma urealyticum (Uu).

Of the listed pathogens, it has been proven to date that only Mg is an absolute pathogen – that is, a microorganism, the detection of which requires treatment.

Diseases that can be caused by mycoplasmas:

Genital mycoplasmas can cause various diseases of the urogenital area.

Among women:
inflammation of the mucous membrane of the vulva (vulvitis), vagina (colpitis), cervix (cervicitis), cause inflammatory diseases of the pelvic organs (PID), pathology of the course of pregnancy, inflammatory complications after childbirth and abortion.

For men:
inflammation of the prostate gland (prostatitis), inflammation of the testicles (orchitis) and epididymis (epididymitis), impaired sperm quality.

For both sexes:
inflammation of the mucous membrane of the urethra (urethritis), bladder (cystitis) and some others.

The main route of transmission of genital mycoplasmas is unprotected sex, including oral-genital.

Also, genital mycoplasmas can be affected children passing through the birth canal of an infected mother (vertical route) – with the development of inflammatory diseases of the respiratory system (pneumonia, etc.), the nervous system (meningitis, etc.), some other body systems.

And also people after organ transplantation (transplantation route).

Indications for treatment

To detect genital mycoplasmas, material taken from the genital organs (from the urethra in men and from the urethra, vagina and cervix in women) is needed.

Currently The most common and used diagnostic methods are:

– polymerase chain reaction (PCR), which allows you to identify even a single microbial cell,
– cultural method, when the test material enters a special environment in which ureaplasmas multiply well.

The cultural method allows you to determine the amount of the pathogen (titer) and, if necessary, to analyze for sensitivity to antibiotics.

The PCR method gives the answer “positive” (if the microorganism is detected) and “negative” (if not detected), that is, it answers the yes / no question.

The cultural method with a quantitative determination (used to diagnose diseases caused by U.urealyticum and M.hominis) shows how much of the pathogen is in the test sample.

Typically the answer looks like > 10 4 CFU / ml, and (an amount of 10 4 CFU/ml is acceptable in the absence of obvious signs of inflammation).

Recently, the RealTime PCR method (real-time PCR) has been used for diagnostics, which is also capable of detecting the amount of the microorganism under study.

The study of the level of antibodies in the blood is not diagnostically significant. Until now, one can meet questions regarding Ureaplasma parvum and Ureaplasma urealyticum (T-960) and their differences.

Previously it was believed that Ureaplasma parvum causes inflammatory diseases in women, and Ureaplasma urealyticum (T-960) causes urethritis in men. This division has now been abandoned.

Treatment of inflammatory diseases of the urogenital area caused by genital mycoplasmas is carried out with the use of antibacterial drugs.

Why don’t ureaplasmas cause disease in everyone?

What is the indication for treatment?

examination revealed M.genitalium;

there are clear clinical signs of an inflammatory disease (discharge from the genital tract; pain, burning, discomfort when urinating, etc.) + signs of inflammation according to bacterioscopic examination (smear) + laboratory tests revealed U.urealyticum and / or M. hominis;

according to the examination, U.urealyticum and / or M.hominis were found in high diagnostic quantities (titers) > 10 4 cfu/ml;

U.urealyticum and/or M.hominis detected prior to planned pregnancy.

There are no obvious clinical and laboratory manifestations of inflammation, and U.urealyticum and / or M.hominis are found in low diagnostic titers

In this case, drugs that stimulate the immune system (for local and / or systemic use) are often prescribed, and the examination is repeated after 2 months.

Such appointments help to avoid unnecessary use antibiotics and help the body itself “drive out” genital mycoplasmas.

Here it is worth stopping at a very sensitive moment: if a patient who has a permanent sexual partner comes to be examined, then the appointment of treatment should be based on the results of the examination of both.

So, for example, there is often a situation when one of the partners has clinical manifestations of inflammation (discharge from the genital tract, itching, burning during urination, etc.), according to the results of the examination, the level of genital mycoplasmas can be as > 10 4 CFU / ml, and

In this case, both must be treated. Since in one of the sexual partners the body cannot cope with the presence of genital mycoplasmas and responds to their introduction with inflammation, therefore, any unprotected sexual contact will cause the described troubles.

Another option: both sexual partners were found to have genital mycoplasmas in low diagnostic titers and there are no clinical and laboratory signs of an inflammatory process.

In this case, observation with the appointment of immunotropic drugs and re-examination after 2-3 months is necessary.

There are also cases when genital mycoplasmas are found in one of the partners, but not in the other. In this case, you should not immediately throw accusations against each other.

It is likely that the body of the partner, in whom, according to the results of the examination, genital mycoplasmas were not found, turned out to be sufficiently “strong” and coped with the pathogen on their own.

It is especially worth noting that when U.urealyticum and / or M.hominis are detected, even in low titers and in the absence of signs of inflammation, the woman is usually treated due to the large number of studies and evidence of the negative impact of genital mycoplasmas on the course and outcome of pregnancy, childbirth and the postpartum period.

one. The leading role belongs to immunodeficiencies. Poor nutrition, poor ecology, a sedentary lifestyle and other reasons negatively affect our immune system, which weakens and becomes difficult to resist various infectious agents.

Due to severe damage to the immune system, mycoplasmas (including genital ones) cause complicated lesions in HIV-infected people.

2. Violation of local protection factors. Normally, in a healthy person, the body, in particular the genitourinary system, functions in such a way as to prevent the entry of foreign microorganisms.

In women, the pH of the vaginal biocenosis plays a major role. Normally, an acidic environment prevents the appearance and reproduction of conditionally pathogenic flora.

In men, a secret secreted by various glands, in particular the prostate gland, plays a similar role.

With various diseases, violations of the vaginal microflora, the effectiveness of local protection is sharply reduced, which allows pathogens to multiply freely.

3. The presence of concomitant infections. In the presence of concomitant inflammatory diseases of the urogenital area, the risk of reproduction of genital mycoplasmas with the development of additional inflammatory processes is much higher.

At the end of the article, I would like to remind you again about protection. The condom protects against most sexually transmitted infections, and from the transmission of genital mycoplasmas.

Be healthy!

M. Yu. ZOLOTOVA,
dermatovenereologist

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