Mycoplasma genitalia in men and women

The smallest microorganism parasitizing on the cell membrane, attaching and integrating into it, mycoplasma genitalia is recognized, in the opinion of the majority of researchers, as an unconditioned pathogen, in contrast to its other congeners-mallikuts, more common and known - ureaplasma and mycoplasma hominis, which are still referred to conditionally pathogenic microbes. All of them are pathogens of urogenital mycoplasmosis, their pathogenicity for humans in the light of modern research leaves no doubt, although infection does not necessarily lead to the development of the disease - these microorganisms are often found in practically healthy people.

[1], [2], [3], [4], [5],

Structure of the mycoplasma genitalia

With mycoplasma, the genitalium was first encountered by scientists "face to face" not so long ago, just in the early 80s of the last century. It is precisely this mollikut that it is not expedient to identify with the help of culture analysis (it is not difficult to grow its culture, but very long), light microscopy in this case is also powerless. Not a virus and not a bacterium, like all the representatives of the molluscum, which does not have a cell nucleus (prokaryotes) and some cell wall ingredients bounded by a thin elastic membrane, mycoplasma genitalia has the shape of a cone and the shortest DNA chain (genome) among all known mycoplasmas parasitizing cells of a human being. This tiny parasite develops only on the mucous membrane of the genito-urinary organs of warm-blooded animals, its life cycle is completely dependent on the nutrients received from the cell on which it parasitizes. Unlike mycoplasma viruses, the genitalium has DNA and RNA chains in its structure (there is one virus in viruses). Under adverse conditions, for example, treatment with antibiotics - the parasite can penetrate inside the cell and wait there until better times. It will not develop, but it will not die, retaining its viability. The microbe is able to migrate from the danger of being destroyed, leaving an unfavorable mucous membrane, and moving into a zone of greater comfort for it. With bacteria mycoplasma genitalia has a similar pathogenicity and ability to inhibit the immune response. It is assumed that the mycoplasma genitalia can act as a pathogenetic element in the development of an autoimmune process in the body of an infected, in particular arthritis.

[6], [7], [8], [9], [10]

Epidemiology

These parasites prefer the cells of the mucous membrane of the body of warm-blooded mammals, mainly they like the genitourinary system. Therefore, it is clear how mycoplasma is transmitted to the genitalia. The main way of transmission is unprotected sex contact of any type, kisses are absolutely safe, if they were not preceded by oral sex. On the mucous membrane of the oral cavity of the mycoplasma, the genitalia does not parasitize, but it retains its viability for a long time.

The study on the primates of this rare parasite showed that when the genital mucosa is infected, the pathological process develops almost always, which has given rise to a cause for it to be a pathogenic microbe.

A study in Britain showed that the mycoplasma genitalium was found in almost the same number of men (1.2%) and female (1.3%) in the group, and it was found only in people living sexually. In people who are in the sample and practicing oral sex or who do not have sexual intercourse, mycoplasma genitalia has never been found. In sexually active individuals, the highest frequency of detection of this parasite was noted: the leaders of the study were the age group of males 25-34 years, among them mycoplasma genitalia was found in 2.1% of the subjects. In the women's group, representatives from 16 to 19 were leading - some 2.4% were infected. There were no signs of discomfort, indicating the presence of a urogenital infection of 94% of the studied males and 56% of the female.

The study of mycoplasma genitalia, the ways of its transmission and ways of treatment is not finished yet and the final conclusions are ahead.

It is likely the infection of the newborn from the mother during childbirth, such cases are known. Parasitic infestation threatens the infant with pneumonia, immune disorders, increased blood density, meningoencephalitis, however, more often over time, children stop detecting mycoplasma - self-healing occurs. Among children with perinatal mycoplasmosis, there are more girls than boys. Transmission of infection in the process of carrying the child through the placenta has not yet been studied, but another genital mycoplasma (hominis) is found in the amniotic fluid, so it can be assumed that the genitalia can overcome the placental barrier.

The contact-household way is unlikely, however, is not excluded, especially for the female. In a warm moist environment mycoplasmas remain viable from two to six hours. Contact contamination occurs through bed and underwear, wipes and towels of common use, non-sterile gynecological instruments. Men by contact do not practically become infected, in women the probability of not sexual infection is much higher.

The incubation period after infection with mycoplasma genitalia can range from 21 to 35 days.

[11], [12], [13], [14], [15], [16],

Symptoms

Specific signs of mycoplasmosis are not revealed. As a monoinfection it is very rarely detected, in almost 90% of cases, mycoplasma infection is detected in patients with other sexually transmitted diseases. Most often - chlamydia, trichomoniasis, gonorrhea. So, if you have any symptoms that indicate infection or the presence of inflammation of the urogenital system, it makes sense to look for another cause of mycoplasmosis. Much more often, the mycoplasma hominis is detected during the examinations, but, perhaps, it is partly due to the fact that it is easier to identify.

It is assumed that the infection in most cases occurs asymptomatically before exposure to the body of any stress factor. With a decrease in immunity, pathogens become more active and symptoms appear, characteristic of diseases of the genitourinary sphere. Mycoplasma genitalia in men most often causes non-gonorrhagic urethritis - a slight transparent discharge from the penis, disturbing most after a night's sleep, soreness in the process of urinary retention, pulling pains in the pubic area. Urethritis caused by mycoplasma genitalia, is among the non-nosocomial in second place after Chlamydia and accounts for 15 to 30% of all cases of this group.

If the parasite persists into the prostate gland, then signs of inflammation appear - a rapid, not too abundant emptying of the bladder, accompanied by pain; periodic or persistent pain in the lower abdomen, an exciting crotch; potency is deteriorating.

Symptoms of infection correspond to inflammation of the affected organ - balanopost, epidemic. Long-term parasites in the body of microbes lead to a decrease in male fertility - a violation of the production and maturation of spermatozoa, as mycoplasma genitalia is able to parasitize on their cell membrane.

In general, mycoplasmosis is more common in women. In female genitalia, they are found in cervicitis and vaginitis, trichomoniasis, gonorrhea, chlamydia, in women suffering from infertility, miscarriages, in premature infants. Much more often found mycoplasma hominis. However, this suggests that genital mycoplasmas still play an important role in the development of pathological conditions.

Mycoplasma genitalia in women also manifests nonspecific signs, characteristic of urogenital diseases in general. Allocations from the vagina can be either transparent or grayish, frothy, and also yellowish or greenish. Their abundance and color depends on the presence of other pathogens. Itching and erosion can be observed during emptying of the bladder, pain in the lower abdomen, with coition. In women, mycoplasmosis is often asymptomatic. In pregnant women, mycoplasmas are found 1.5-2 times more often (this applies to both types of genital parasites). It is believed that the presence of mycoplasmosis complicates the course of pregnancy and the process of childbirth.

Mycoplasma genitalia is mainly the cause of cervicitis. Inflammation of the cervix, associated with this parasite, occurs in six to ten cases of one hundred inflammations of this localization. In studies it was found that mycoplasma infection of the genitalia can cause inflammation of the endometrium, fallopian tubes and, as a consequence, their obstruction and the associated infertility.

Diagnostics

Male patients with symptoms of inflammation of the urethra, prostate, testes and their appendages are subject to examination, in the presence of discharge from the penis.

It is recommended to examine the genitalia of patients with cervicitis, symptoms of inflammation of the pelvic organs and genitourinary tracts complaining of pain in the lower abdomen and during copulation, unusual vaginal discharge, irregular menstrual periods, as well as those planning a pregnancy, having a history of miscarriage, stillborn and premature babies.

Diagnostic examination is also subject to persons of both sexes without manifestations of genitourinary diseases, however, whose sexual partners have been diagnosed with mycoplasma genitalia.

This infectious agent is one of the smallest microbes, its visualization even with the help of a microscope is not possible, it is also very long to cultivate, so this method is also not used in routine laboratory studies. Currently, patients are assigned PCR analysis for mycoplasma genitalia. The basis of the polymerase chain reaction test is the use of enzymatic reagents, which allow the copying of nucleic acid fragments characteristic for a given microorganism. To determine the DNA of mycoplasma genitalia in samples of biological material is required no more than 24 hours.

Mostly for research use a smear on the mycoplasma genitalia or the first portion of morning urine. Women are examined scrapings from the mucous membranes of the vagina or cervical canal, taken before the onset of menstruation or after their end in 48 hours. In men, a smear from the urethra, semen, the secretion of the prostate gland is examined. If synovial pathology is suspected, synovial fluid can be studied.

Studies are conducted for both diagnosis and evaluation of treatment effectiveness. Different sets of reagents are used to detect DNA or RNA by polymerase chain reaction. Positive analysis is the basis for the treatment and examination of a sexual partner.

For the diagnosis of mycoplasmosis, including genitalia, the method of direct immunofluorescence can be used, however, it was not widely used in diagnostic practice.

[17], [18], [19], [20], [21]

Differential diagnosis

Differentiate the infection of mycoplasma genitalia from other urogenital infections - gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, as well as mycoplasma hominis.

To date, there are two types of mycoplasmas, causing damage to the organs of the genitourinary system - genitalia and hominis. The second species is more common, it is classified as conditionally pathogenic microorganisms, whereas the former is considered by the majority of specialists to be a pathogen.

What is the difference between mycoplasma genitalia and mycoplasma hominis? For us, almost nothing - both these microorganisms parasitize on the cells of the mucous membrane of the genito-urinary organs, and prefer sex. Persisting inside, affect the mucous uterus, prostate, bladder and kidney, causing the corresponding inflammation - endometritis, prostatitis, pyelonephritis, etc. The vast majority of infections are sexually transmitted. Mycoplasmas can perfectly "live" on our cells, absolutely not giving out their presence, which causes some experts to doubt their pathogenicity.

For researchers, these mycoplasmas differ in form - the genitalia has a stable shape of the bulb with a narrow neck, and the hominus is polymorphic, i.e. Can take a variety of forms, from round to branched filament. Genitalia is difficult to diagnose, before the appearance of the polymerase chain reaction method it was practically impossible to detect it. It is easy to grow, but the process itself takes a long time and in ordinary studies for the diagnosis of patients is inexpedient. Hominis can be detected by enzyme immunoassay for the presence of antibodies in the patient's blood, using direct or indirect immunofluorescence, and also by culture microscopy, however, the polymerase chain reaction is the most progressive and accurate method, as in the diagnosis of the genitalia.

[22], [23], [24], [25],

Treatment

The need to treat infected patients is still debated. The wide distribution of asymptomatic carriage gives reason to consider these microorganisms harmless and do not require treatment. But still prevails the opinion of the majority, which insists on the pathogenicity of mycoplasma genitalia and the need to kill microbes, even if they do not cause the symptoms inherent in sexual infections. The treatment is indicated by the fact that the carrier can infect his partner who gets sick really; a mother can infect a child during childbirth; In addition, intrafamily infection also can not be discounted. Yes, and the asymptomatic carrier at risk of getting sick at the slightest decrease in immunity.

Scheme of treatment of mycoplasma genitalia involves the use of antibacterial agents, and drugs whose action is directed to the destruction of the cell walls of bacteria, use is meaningless, since the walls are absent as such.

The drugs of choice are:

• macrolides - block the synthesis of protein molecules on ribosomes of a pathogenic microorganism cell, their tissue concentration surpasses serum, besides anti-bacterial, anti-inflammatory and immunostimulating effect;
• tetracyclines - which have a similar effect;
• fluorinated quinolones of III-IV generation - inhibit the enzymatic activity of two enzymes of the pathogen (DNA-gyrase and topoisomerase IV), blocking the construction of its DNA.

Antibiotics for mycoplasma genitalium are chosen based on the patient's anamnesis, taking into account the results of the previous treatment and the patient's tolerance (because the culture grows long and sensitivity can not be checked in the usual way). The therapy scheme also includes antifungal agents if the patient has symptoms of candidiasis; antiseptic preparations of local action, for example, vaginal suppositories or a cream with metronidazole; probiotics for the restoration of vaginal biocenosis, as well as immunomodulators, vitamins, drop infusions of detoxification solutions.

The most commonly treated mycoplasma is the genitalium Azithromycin, since the microbe is very susceptible to this antibiotic-macrolide. His sensitivity to a representative of tetracycline drugs - Doxycycline is also quite high. Usually, these two antibiotics are prescribed. The standard antibacterial scheme of mycoplasma eradication of the genitalia includes a single ingestion of 1000 mg of Azithromycin, followed by a weekly or ten-day oral dose of Doxycycline, whose daily single dose is 100 mg.

A study of the susceptibility of in vitro antibiotics belonging to the quinolone group showed that the first and second generations of these drugs are not effective in treating genitalia infected with mycoplasma. Preparations of the third generation with the active substance Levofloxacin are used as alternatives in the eradication of this microorganism if the basic scheme was not effective.

For example, Tigeron (levofloxacin) from the mycoplasma of the genitalia can be prescribed. Antibiotics are taken orally once a day at a dose of 500 mg for reception from ten days to four weeks. The duration of treatment is determined by the attending physician. Can be used in treatment regimens with antibacterial drugs of other groups.

A more effective drug of the second line of choice has been shown in studies of Moxifloxacin, belonging to the IV generation of fluoroquinolones. This preparation of bactericidal action is chosen in the absence of sensitivity to macrolides. Monotherapy with an oral dose of 400 mg, taken once a week or a week, was effective, however, cases of toxic effects on the liver were recorded. Moreover, with complex therapy in combination, for example, with Doxycycline, no such side effect was observed.

High activity of the genitalium in vitro in mycoplasma is demonstrated by Pristinamycin, a macrolide with a broad spectrum of action, to which mycoplasma genitalia strains sensitive to a combination of macrolides with Moxifloxacin are sensitive. The effects of this drug are still ongoing. Also, the effect of a new antibacterial drug Solitromycin, a veterinarian antibiotic Lefamulin, which is active towards the mycoplasma genitalia, is investigated in vitro, especially strains resistant to Azithromycin.

Currently, antibacterial agents of the tetracycline series - Metacyclin and Tetracycline, macrolide - Clarithromycin and Erythromycin, fluoroquinolone - Levofloxacin and Pefloxacin can be an alternative to the basic drugs.

When infected with a strain sensitive to macrolides, a standard treatment regimen is prescribed. The duration of reception of Azithromycin is determined by the doctor, in the absence of effect or the appearance of resistance, the doctor can recommend mono-intake of Moxifloxacin. The control test is carried out after 21-28 days of treatment and, if the pathogen is still being determined, the treatment continues for two more weeks with doxycycline.

Treatment should appoint a doctor, self-medication is fraught with the fact that mycoplasma genitalia will acquire resistance to all groups of antibacterial drugs.

Prevention of the mycoplasma genitalia

Given the main path of infection of this microbe, it becomes clear that the best prevention of infection is safe sexual contact with the use of condoms.

Observance of elementary hygienic rules - individual towels, washcloths, underwear ensures the elimination of infection by contact and household.

If the infection still occurred, it is necessary to carry out treatment to the end, having received a negative test for the presence of mycoplasma genitalia. Convince a sexual partner to be examined to avoid re-infection.

[26], [27],

Forecast

Mycoplasmosis is not a fatal disease, but very unpleasant, especially when combined with other sexually transmitted infections. They are fraught with complications, infertility, impotence, loss of interest in sexual life. Therefore, it is worth every effort to avoid infection, and if this is not possible, then cure, treating the process of treatment in all seriousness.

[28], [29], [30]