Urethritis due to mycoplasmas and ureaplasms

In recent years, the frequency and significance of urogenital and mycoplasma infections in the development of nonspecific (non-gonococcal) urethritis have increased.

In most cases, inflammatory diseases of the urogenital tract of this nature proceed chronically.

Causes of the urethritis caused by mycoplasmas and ureaplasms

According to the published data, mycoplasma and ureaplasma with high frequency are allocated with all the inflammations of the urethra in men (from 10 to 59%). The etiological role of mycoplasmas and ureaplasma can be judged by the detection in the blood of specific antibodies to these pathogens. At the same time, the level of antibody growth is significantly increased in most patients by the end of the disease. Usually, mycoplasma and ureaplasma in the products of inflammation and urine are found, but under certain conditions they can penetrate into the bloodstream.

Acute non-gonococcal urethritis in men is attributed to 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 rod-shaped leukocytes in the field of view of the microscope (at 1000-fold magnification) in the discharge from the urethra. However, a number of studies indicate that in 30-50% of cases, non-gonococcal urethritis is caused by Chlamydia trachomatis and 10-30% by Mycoplasma genitaliuin. There are indications of a possible role in the etiology of non-gonococcal urethritis in men with Ureaplasma urealyticum, Haemophilus species, Streptococcus species and Gardnerella vaginalis, but conclusive evidence has not yet been obtained. In some studies, the potential role in the development of non-gonococcal urethritis of the herpes simplex virus and adenoviruses has been studied.

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, Unaplasm parvum. The treatment was carried out with drugs effective against chlamydia, mycoplasmal and ureaplasma infection. As a result of the 7-day course of treatment, the normalization of the laboratory was indicative in 90.7% of patients receiving clarithromycin, 89.7% of levofloxacin, 87.5% of gatifloxacin, and 75% of minocycline. The obtained data confirmed the effectiveness of these drugs in the treatment of non-gonococcal urethritis in men.

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

Symptoms of the urethritis caused by mycoplasmas and ureaplasms

Specific symptoms of non-gonococcal urethritis, caused by mycoplasmas and ureaplasms, are absent. As a rule, such urethrites are not very common. The duration of the incubation period in most cases is 50-60 days. Sometimes spontaneous cure is noted, but if untreated, the symptoms of urethritis persist for more than a year, while mycoplasma and / or ureaplasma are secreted from the discharge urethra. Mycoplasma urethritis in men can be accompanied by balanitis and balanoposthitis.

Complications and consequences

Ureaplasma prostatitis and vesiculitis are the most frequent complications of urethritis. Clinically, it is sometimes difficult to differentiate them from prostatitis caused by another infection. Specific clinical features with ureaplasma lesions are absent. In men, ureaplasmic epididymitis occurs more often than not, and it is lethargic, without pronounced clinical manifestations.

[5], [6], [7], [8], [9],

Diagnostics of the urethritis caused by mycoplasmas and ureaplasms

Mycoplasma is most easily detected in crops on artificial nutrient media, taking into account the typical morphology of colonies, and ureaplasma - by the ability to split urea into carbon dioxide and ammonia. Because of the wide variety of microorganisms, the methods of direct microscopy of clinical material in the diagnosis of ureaplasma infection have not been applied, in recent years, DNA diagnostics have been widely used.

The increase in the number of ureaplasma in the urethral discharge and urine does not yet prove their aetiological role in the development of urethritis, since they can be present as saprophytes in the uninjured urethra. At present, a quantitative method of sowing is proposed for the diagnosis of ureaplasma urethral defection - detection of the pathogen by the number of CFUs. So, the ureaplasma should be considered the causative agent of urethritis and prostatitis if more than 10 000 CFU or more than 1000 CFU per 1 ml of urine is detected in 1 ml of the prostate secretion. In the opinion of R. Werni and E.A. Mardh (1985), the diagnosis of ureaplasma injury can be recognized as reliable. If ureaplasma is detected in the crops in the absence of another pathogenic flora and a characteristic increase in antibody titer in paired sera is established.

[10], [11], [12], [13]

Treatment of the urethritis caused by mycoplasmas and ureaplasms

Most strains of mycoplasmas and ureaplasma are sensitive to antibiotics of the tetracycline series (doxycycline) and macrolides (azithromycin, josamycin, clarithromycin, roxithromycin, midecamycin, erythromycin, etc.). Selecting drugs for the treatment of nonspecific urethritis, we must take into account the possibilities of nitrofurans, especially furazolidone. Preparations of this group are prescribed in large doses and for a long time, doxycycline - for the first dose of 200 mg. Then 100 mg per day for 10-14 days.

Recommended immunomodulatory treatment and local treatment of urethritis, caused by mycoplasmas and ureaplasmas. After completion of the course with tetracycline drugs, in the absence of effect, it is advisable to conduct a course of treatment with drugs of the macrolide group. Given the existence of a latent form and ureaplasmic carriage of the urogenital organs in men and women, treatment of both partners is an indispensable condition. Relapses usually occur in the first 2 months. After ineffective therapy, in connection with which is shown monthly for 3-4 months. After the end of the course of treatment to carry out a control examination of patients.