Urethritis caused by mycoplasmas and ureaplasmas

In recent years, the frequency and importance of urogenital and mycoplasma infections in the occurrence of non-specific (non-gonococcal) urethritis have increased.

In most cases, inflammatory diseases of the urogenital tract of this nature are chronic.

Causes urethritis caused by mycoplasmas and ureaplasmas

According to literary data, mycoplasmas and ureaplasmas are isolated with high frequency in all inflammations of the urethra in men (from 10 to 59%). The etiological role of mycoplasmas and ureaplasmas can be judged by the detection of specific antibodies to these pathogens in the blood. In this case, the level of antibody growth increases significantly in most patients by the end of the disease. Mycoplasmas and ureaplasmas are usually found in inflammation products and urine, but under certain conditions they can also penetrate into the bloodstream.

Acute non-gonococcal urethritis in men is classified as an STI, but relatively often (in 20-50% of cases) the pathogen is not identified. Diagnosis of non-gonococcal urethritis is based on the detection of more than 5 band neutrophils in the field of view of a microscope (at 1000-fold magnification) in the discharge from the urethra. At the same time, a number of studies indicate that in 30-50% of cases, non-gonococcal urethritis is caused by Chlamydia trachomatis and in 10-30% - Mycoplasma genitaliuin. There are indications of a probable role in the etiology of non-gonococcal urethritis in men of Ureaplasma urealyticum, Haemophilus species, Streptococcus species and Gardnerella vaginalis, but convincing evidence has not yet been obtained. Some studies have examined the potential role of herpes simplex virus and adenoviruses in the development of non-gonococcal urethritis.

Of particular interest are the data obtained in the treatment of patients with non-gonococcal urethritis and negative test results for Chlamydia trachomatis, Mycoplasma genitalmm, Ureaplasma urealyticum, Unaplasma parvum. Treatment was carried out with drugs effective against chlamydial, mycoplasma and ureaplasma infections. As a result of a 7-day course of treatment, normalization of laboratory parameters was noted in 90.7% of patients receiving clarithromycin, 89.7% - levofloxacin, 87.5% - gatifloxacin and 75% - minocycline. The data obtained confirmed the effectiveness of these drugs in the treatment of non-gonococcal urethritis in men.

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Symptoms urethritis caused by mycoplasmas and ureaplasmas

There are no specific symptoms of non-gonococcal urethritis caused by mycoplasmas and ureaplasmas. As a rule, such urethritis is asymptomatic. The incubation period in most cases is 50-60 days. Sometimes spontaneous healing is noted, but in the absence of treatment, the symptoms of urethritis persist for more than a year, while mycoplasmas and/or ureaplasmas are isolated from the discharge of the urethra. Mycoplasmal urethritis in men can be accompanied by balanitis and balanoposthitis.

Complications and consequences

Ureaplasma prostatitis and vesiculitis are the most common complications of urethritis. Clinically, they are sometimes difficult to differentiate from prostatitis caused by another infection. There are no specific clinical features in ureaplasma lesions. In men, ureaplasma epididymitis occurs much more often, which proceeds sluggishly, without pronounced clinical manifestations.

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Diagnostics urethritis caused by mycoplasmas and ureaplasmas

Mycoplasmas are most easily detected in cultures on artificial nutrient media, taking into account the typical morphology of colonies, and ureaplasmas - by the ability to break down urea into carbon dioxide and ammonia. Due to the large variety of microorganisms, methods of direct microscopy of clinical material in the diagnosis of ureaplasma infection have not found application; in recent years, DNA diagnostics have been widely used.

An increase in the number of ureaplasmas in the urethral discharge and urine does not yet prove their etiologic role in the development of urethritis, since they can be present as saprophytes in the unaffected urethra. Currently, a quantitative method of cultures has been proposed for the diagnosis of ureaplasma lesions of the urethra - detection of the pathogen by the number of CFU. Thus, ureaplasma should be considered the causative agent of urethritis and prostatitis if over 10,000 CFU are determined in 1 ml of prostate secretion or more than 1000 CFU in 1 ml of urine. According to R. Werni and E.A. Mardh (1985), the diagnosis of ureaplasma lesions can be considered reliable if ureaplasmas are detected in the cultures in the absence of other pathogenic flora and a characteristic increase in the antibody titer in paired sera is established.

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Treatment urethritis caused by mycoplasmas and ureaplasmas

Most strains of mycoplasma and ureaplasma are sensitive to tetracycline antibiotics (doxycycline) and macrolides (azithromycin, josamycin, clarithromycin, roxithromycin, midecamycin, erythromycin, etc.). When selecting drugs for the treatment of non-specific urethritis, it is necessary to take into account the capabilities of nitrofurans, especially furazolidone. Drugs of this group are prescribed in large doses and for a long time, doxycycline - 200 mg for the first dose, then 100 mg per day for 10-14 days.

Immunomodulatory treatment and local treatment of urethritis caused by mycoplasmas and ureaplasmas are recommended. After completing a course of tetracycline drugs, if there is no effect, it is advisable to conduct a course of treatment with macrolide drugs. Given the existence of a latent form and ureaplasma carriage in the genitourinary organs in men and women, an indispensable condition is the treatment of both partners. Relapses usually occur in the first 2 months after ineffective therapy, in connection with which it is recommended to carry out a monthly control examination of patients for 3-4 months after the end of the course of treatment.