Ureaplasmas are small microorganisms inhabiting the genitourinary tract of an individual, which do not have a rigid cell wall, which enables them to penetrate through minute, up to 0.22 microns, pores, and quickly become resistant to certain antibacterial drugs. Ureaplasma parasitizes on the cell membrane of spermatozoa, epithelium of the genitourinary organs.
There are several types of similar microorganisms. Two separate species parasitizing in humans are combined together under the name Ureaplasma species. Like Mycoplasma genitalium and Mycoplasma hominis, they belong to the group of genital mycoplasmas. That is why when diagnosing ureaplasmosis in men, examination for mycoplasmosis (mycoplasmal infection) also should be carried out.
The term “ureaplasmosis” is used to code inflammatory processes in the urogenital organs, when ureaplasma (in Latin - Ureaplasma urealyticum (species)) is detected in the absence of other pathogens. According to different research data, ureaplasma is detected in healthy men in 3-20% cases. Since the discovery of this causative agent in 1054, there have been persistent debates over its harm, association with STDs, need for treatment if symptoms are absent, etc.
Today, the term “ureaplasma infection” is generally accepted, and according to the WHO classification, the microorganism is referred to the agents causing sexual infections.
The main routes of ureaplasma contamination:
• the most common route is sexual contact, including oral-genital;
• to the fetus from the mother intrauterine, aborning;
• rarely – with organ transplantation.
The probability of infection through non-sexual contact (through bed linen, toilet seats, swimming pools, etc.) is not proved, although the corresponding microorganisms were found in the samples taken from the surfaces of public toilet seats.
Women, who have two or more sexual partners a year, represent the main ureaplasma “reservo
The more sexual partners a man has, the higher a chance to detect ureaplasma is: it increases with two or more sexual partners per year by almost 8 times, as compared with those who have one permanent partner.
It has been not established conclusively, which factors lead to the development of the disease in infected people. It is assumed that the following conditions can contribute to this process:
• immunodeficiency states, including those caused by HIV;
• failure of the local protective factors, for example, the prostatic antimicrobial factor and local immunity systems in men;
• concomitant infections.
Thus, men suffering chronic prostatitis, injuries of the urethra due to gonococcal/chlamydial infection, abusing local anesthetics, have a higher risk of ureaplasma infection.
Kinds and Symptoms of Ureaplasma
Symptoms of ureaplasma can radically differ, because the 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, flaccid course (about 30% of all episodes of non-gonococcal urethritis are caused by ureaplasma);
• epididymitis (inflammation of the epididymis), manifested by a slight increase and/or thickening of the epididymis in the absence or slight pain, without a rise in temperature;
• orchiepididymitis (with the inflammatory process spreading to the testicle);
• impairment of sperm quality manifested in reduced motility and/or sperm count (ureaplasma provokes self-destruction of spermatogenic cells, adheres to the neck of the spermatozoon, reduces its motility, releases substances that change sperm flow), etc.
Urethritis caused by ureaplasma is characterized by an incubation period from a week to 10 days, no severe symptoms, and rapid effect if timely treated with antibiotics.
Some people infected with ureaplasma may not show clinical symptoms at all. If this is the case, carriage or Ureaplasma positivity are referred to. This condition is detected in almost 20% of men who carry out intensive sexual activity. Ureaplasma positivity may 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 ureaplasmic infection under the following circumstances:
• the development of the disease in the future if the body's defenses are weakened;
• contamination of sexual partners;
• infection of newborns by the mother.
Methods of Diagnostics and Detection
To confirm male ureaplasma in vitro, the below tests are used:
• polymerase chain reaction (shortly, PCR);
• enzyme immunoassay (or ELISA);
• reactions of direct/indirect immunofluorescence
• inoculation (culture-based methods).
In this case, PCR is a faster and more sensitive method for detecting ureaplasma, as compared with inoculation. Presence/count of antibodies in the blood is not determined for diagnostic purposes. Quantitative determination of ureaplasma in the urethral smear is little informative.
To confirm the disease caused by ureaplasma, especially proceeding asymptomatically, the following procedures are prescribed:
• examination of the genitals;
• palpation of the scrotum (testicles, epididymis, spermatic cord);
• rectal examination of seminal vesicles, prostate gland;
• microscopy of the urethral smear;
• microscopy of the prostate secretion;
• microscopy of the urine sediment from a double-glass sample (when the urine is collected sequentially in two glasses, without interrupting the flow);
• Ultrasound of the organs of the scrotum and prostate.
Treatment of Ureaplasma
Detection of a disease caused by ureaplasma infection is an unconditional indication to treatment! Furthermore, urgent and adequate therapy is necessary when a married couple plans pregnancies, if the sexual partner is infected, after changing the sexual partner, and so on. The earlier the pathology is detected and the treatment is started, the higher the effectiveness is.
Ureaplasma in men is treated using a proven option, which is the use of antibacterial drugs, mainly of two groups: fluoro-/difluoroquinolones and macrolides. Due to the presence of resistant ureaplasma strains, tetracyclines, for example, doxycycline, are currently used less often. Taking 1 gram of azithromycin, which is a widespread method of therapy of urogenital infections, is also ineffective in ureaplasmic infection.
The following remedies can be prescribed (although the benefits of such options have not been proven, many patients note improvement from their use):
• local treatment;
• enzyme preparations;
• homeopathic remedies;
• traditional medicine.
In a certain period after the termination of therapy of an ureaplasma, a repeat diagnostic inspection is needed. Without a desired result, the doctor will prescribe a new course of antibiotics.
Both partners shall undergo treatment simultaneously (if ureaplasma has been detected in vitro) to eliminate the risk of reinfection. If the partner does not have symptoms of the disease and there is no pathogen in the samples, treatment is not necessary. In such a case, it is important to abstain from sexual intercourse for the entire period of therapy until a complete cure is confirmed by laboratory testing.
One should understand that ureaplasma and mycoplasma infections are often accompanied by other infectious pathologies, such as gonococcal, chlamydial, trichomonas, etc., which requires competent diagnosis and further prescription of appropriate medications.
The lack of adequate treatment of ureaplasma infection is fraught with the development of a number of problems such as
• chronic pathologies (prostatitis, pyelonephritis, etc.)
• meningitis (mainly in newborns, but the case was also reported in an adult man; doctors do not rule out that this was not a single case, since the analysis of cerebrospinal fluid for ureaplasma is complex to conduct in routine practice);
• arthritis (10-15% of all joint diseases associated with sexual infections are due to ureaplasma);
• subcutaneous abscesses, etc.
Serious complications are observed when a man contaminates a woman at the stage of planning pregnancies, with increasing risk of the following complications:
• ectopic pregnancy;
• premature termination of pregnancy;
• development of postpartum endometritis;
• low birth-weight baby;
• development of bronchopulmonary dysplasia, pneumonia, meningitis, and blood infection in newborns.
The main technique of preventing infection with ureaplasma is the abstaining from promiscuity. Unfortunately, effectiveness of a common prevention of sexual infections – condoms, in case of ureaplasmosis is relative only, with the rate of failure about 20%.
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