Mycoplasma. Diagnostics & Treatment

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Stoyanov
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Mycoplasma. Diagnostics & Treatment

#1 Post by Stoyanov » 02 May 2018, 23:35

Mycoplasmas are small microorganisms that inhabit the human upper respiratory tract, oropharynx and organs of the urogenital tract. Of the seventeen known types, only four of them will cause the disease. In a number of episodes, the causative agents of urethritis in men are genital mycoplasmas and ureaplasma (genital ureaplasma is a type of mycoplasma, however, the pathologies it causes are often isolated into a separate group called “ureaplasmosis” or “ureaplasma infection”).

Mycoplasmosis is a conventional name of an inflammatory pathology in the organs of the genitourinary tract, when, in the absence of other pathogens, mycoplasma is detected in vitro. It is mycoplasma in men that causes most of the cases of non-gonococcal urethritis.

Causes of Mycoplasmosis
Infection with genital mycoplasma can be resulted from the following:

• sexual intercourse, including oral-genital contact;
• transfer from the mother to the child during pregnancy/delivery;
• organ transplantation.
It has not been proved to date whether it is possible to get infected with genital mycoplasmas through linen, public toilets or swimming pools, although the survival of such microorganisms on the objects of external environment (in particular, WC toilet seats) has been evidenced.

A distinguishing feature of infection with mycoplasma in men is a possible, although quite rare, spontaneous healing.

In vitro analyses using the PCR define the common part of all types of mycoplasmas as Mycoplasma species. Such an analysis does not allow identifying a specific type of pathogen, so the cause of the disease is established by a positive result of a sample taken from the area of concern (which means that the detection of mycoplasma in the swab of the oropharynx with urethritis is not at all informative). In some cases, it may be necessary to perform a repeat/extension study, because, for example, respiratory and genital mycoplasmas are sensitive to different groups of antibiotics.

Risk Factors

Analysis for mycoplasma can show the presence of the microorganism in an absolutely healthy person. The exact reasons why this bacterium may cause the disease are still unknown.
It is proved that the following cohorts are most susceptible to the disease:
• those suffering immunodeficiency, including caused by HIV;
• those having hypogammaglobulinemia (decreased number of certain antibodies);
• those suffering chronic prostatitis.
Types and Symptoms of Mycoplasma
The period from getting infected to the development of symptoms usually takes 2-3 weeks on the average.
Genital mycoplasma in men can be manifested in the following forms:
• urethritis – inflammation of the urethra;
• epididymitis – inflammatory pathology of epididymis;
• degeneration of sperm due to bacterial damage to specific cells responsible for sperm production and/or parasitizing of microorganisms directly on spermatozoa.

Symptoms of the diseases caused by mycoplasma do not differ from similar pathologies caused by other pathogens. Thus, mycoplasma urethritis may be characterized by insignificant mucopurulent discharges, mild discomfort, slight itching in the urethra, and slight burning during urination. Mycoplasma epididymitis is not accompanied by severe pain or fever, manifested by an increase/thickening of the epididymis. When the pathology spreads over the testicle, orchid epididymitis will develop.

Some types of mycoplasmas, for example, M. penetrans, is found predominantly in homosexual men (in the rectum, urethra, and throat) in 40% of cases against 1% in heterosexual persons. There is an assumption that the presence of this microorganism can serve as a marker of HIV infection.

Mycoplasma is detected in vitro in about 2 to 5% of sexually active healthy men. This condition is called carriage, i.e. asymptomatic presence of a microorganism in the genitourinary tract (the absence of signs of the disease should also be confirmed by laboratory and instrumental diagnostics).

Diagnostics and Detection of Mycoplasma

The main methods of detection of mycoplasma are the culture test (also known as bacterial culture on the nutrient medium) and the polymerase chain reaction method (so-called PCR diagnostics). Diagnostic confirmation does not require determination of the presence and/or amount of antibodies in the blood.

For a general study, the following tests can be used:
• enzyme immunoassay (shortly ELISA);
• reactions of direct and indirect immunofluorescence
The latter techniques are widespread in the CIS countries, though, they are characterized by insufficient accuracy.

As supplementary survey methods to confirm the disease, especially in the absence of symptoms, the following methods can be applied to:
• examination of the genitals with palpation of the spermatic cord, testicles with epididymis;
• rectal examination of the prostate and seminal vesicles;
• studying the urethral smear, urinary sediment (from the urine obtained by collecting a sequential uninterrupted flow in two glasses, a so-called “two-glass” sample), and a prostate secretion under the microscope;
• ultrasound of the prostate, organs of the scrotum;
• studying the spermogram.

If mycoplasma is detected in one of the partners, the other partner must be examined as well.

Methods and Options of Treatment

Mycoplasma in men always needs urgent treatment. In the absence of symptoms, the treatment of mycoplasma is strictly necessary in the following cases:
• when the sexual partner has the disease caused by mycoplasma infection, to exclude the risk of reinfection;
• when there is a chance of changing the sexual partner (the so-called “epidemiological indications”);and/or
• when a couple plans pregnancies, to prevent possible complications and/or serious pathologies in a newborn, fetus.

When deciding on the need for therapy, the amount (test titer) of the pathogen does not matter at all, its presence and the above factors being sufficient to treat the disease.

The primary method of treatment of mycoplasmosis/pathologies caused by mycoplasma is antibiotic therapy. As a rule, preparations of fluorine/difluoroquinolones, doxycycline (group of tetracyclines) are used. Macrolide antibiotics, azalides (azithromycin is quite effective) are also used. Sensitivity of different types of mycoplasma to such medicines varies.

Additionally, the following preparations can be prescribed.
• enzymes;
• immunostimulants;
• vitamins;
• topical preparations such as ointments, bath tubes, instillations (infusion of liquid drug solutions into the urethra), etc.;
• physiotherapeutic procedures;
• homeopathic remedies;
• methods of traditional medicine (based on herbal decoctions, infusions, etc.).

For the period of therapy and until the absence of mycoplasmas is confirmed by laboratory analysis, a complete refusal of sexual contacts is required. When identifying the causative agent in a sexual partner, the latter also should follow therapeutic recommendations. Follow-up shall be carried out after a while (from two weeks to a month) after completion of the course of taking medications. For diagnostics, PCR is employed.

Recurrence of the disease is possible if the bacterium has not been completely destroyed, although modern techniques were unable to detect it in the check test samples. If there is no effect for a long time, the treatment regimen shall be revised, and sensitivity of the identified pathogen to antibacterial drugs shall be defined.

In many cases, mycoplasmal infection may be found side by side with other pathologies, e.g. gonococcal, chlamydial, ureaplasmic, trichomonas, etc. In this case, the assay will show a corresponding multitude of ills, for example, chlamydia and mycoplasma, ureaplasma and mycoplasma, and so on. This case requires the use of drugs effective against all pathogens, even if you need to take several medications at once.

Complications

Mycoplasmal infection is complicated by:
• infertility;
• arthritis – inflammatory lesions of the joints, the so-called, sexually-related arthritis;
• osteomyelitis – purulent-necrotic lesion of bones, bone marrow and adjacent tissues;
• abscesses – purulent inflammation of tissues;
• pyelonephritis – inflammatory pathology of the kidneys.

A serious problem is when the infection is introduced by a man, especially at the stage of planning pregnancies or even in any gestation period. The following outcomes are possible:
• premature termination of pregnancy (miscarriage, premature birth);
• inflammatory pathologies of the pelvic organs;
• postpartum complications (fever, endometritis);
• infection of the fetus (in utero, during delivery).

Infected babies may develop pneumonia, chronic lung disease, meningitis, sepsis (the so-called blood poisoning).

Preventive Treatment

The main methods of preventing mycoplasmal infection are:
• correct use of the condom (unfortunately, in the case of mycoplasmal and ureaplasmic infections, the ineffectiveness of this barrier method reaches 20%);
• abstention from promiscuous sexual behavior;
• adherence to the rules of hygiene and a healthy lifestyle;
• timely detection and treatment of concomitant chronic diseases, primarily chronic prostatitis.

Vaccines to protect against mycoplasmosis were developed, but have not proven effective.

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