E.coli – derived from Latin Escherichia coli (also known as “colon bacterium”, Escherichia coli). This bacterium has a rod-like shape and is a part of the normal microflora of the human gastrointestinal tract. A large number of species of a microorganism are known, among which more than a hundred (“assembled” into 5 large groups) can cause various diseases.
E. coli in men may also be present normally in the anterior part of the urethra (approximately in 25% of healthy males). If E. coli is detected, without any signs of pathology, it does not necessarily need therapy. E. coli is treated with antibiotics in the case of development of an infectious urogenital disease caused by this bacterium.
Causes of the Infection
The bacterium E.coli may be normally present in the male urethra, however, it can also be transmitted:
• sexually (especially upon anal-genital contact);
• if carried from the intestine because of poor hygiene, with blood and/or lymph flow;
• as a result of transplantation.
Sometimes, the mother may contaminate the newborn.
After the microorganism enters the urogenital tract, several conditions may develop, such as:
• temporary carriage, or transit (therefore, the E. coli is referred to transient microflora), when the bacterium “lives” in the urogenital organs for a while, namely, a couple of weeks/months, and eventually is eliminated by body defenses;
• persistent carriage, or positivity, when the bacterium is detected persistently, its growth restrained by the same protective factors;
• development of infection.
The bacteria can be transmitted to the sexual partner regardless the condition.
E.coli in men is the most common causative agent of urinary tract infections, such as:
• prostatitis (acute – Escherichia coli is the “culprit” of the disease in 64% of all episodes, while chronic prostatitis is caused by E. coli in 80% of cases) – inflammation of the prostate gland;
• urethritis – lesion of the urethra;
• orchitis (inflammatory process in the tissues of the testicles), epididymitis (inflammatory pathology of the epididymis), orchiepididymitis: in patients older than 35, these problems are predominantly induced by Escherichia;
• ascending infections of the kidneys, bladder (according to different sources of data, up to 95% of such diseases are caused by E.coli), etc.
Factors that prevent replication of the microorganism and the development of an infectious disease in the body of a man include the following:
• mechanical protection – a special element known as the valve navicular located at the entrance to the urethra prevents the penetration of bacteria, furthermore, there are glands, some of which release urethral mucus, while others exude a special secretion during ejaculation (such secretions help to remove bacteria from the urethra) ;
• slightly alkaline/neutral urethral environment;
• immunological local protection;
• prostate secretion.
The prostate secretion is a zinc-peptide complex, also called “antimicrobial factor” of the prostate gland, taking antimicrobial effect and maintaining an alkaline neutral medium.
If one or more protective factors “fail”, the disease will develop (the transient microflora is said to become pathogenic). In men, the factors that activate the pathological processes caused by E. coli include the following:
• chronic prostatitis: in this disease, the content of zinc in the prostatic secret decreases, which disrupts the function of the aforementioned zinc complex;
• gonococcal and/or chlamydial infections in the past history: such issues will cause scarring in the mucosa of the urinary tract, compromising the ability to provide the necessary immunity.
In boys (in children the vast majority of episodes of urinary tract infections is caused by the E. coli), the following risk factors can be distinguished:
• the first year of life;
• uncircumcised child (by various estimates, circumcised boys suffer this disease about 4-10 times less frequently);
• long-term catheterization of the urinary tract;
• congenital structural anomalies of urinary tract;
• an episode of a similar infection in the past;
• congestion of urine due to phimosis, kidney stones, etc.;
• hereditary background.
Symptoms of E.coli
Symptoms of the infection caused by Escherichia coli are not specific for this microorganism and depend on the site of location.
Urethritis is typically accompanied by the following clinical signs:
• frequent and painful urination;
• painful erection/ejaculation;
• permanent urethral pain – in some cases;
• urethral itching;
• urethral discharge;
• discomfort, irritation, redness, and changes in the shape/color of the external urethral opening, etc.
The patients suffering prostatitis may complain of the following:
• pain and discomfort in the perineum;
• pain in the testicles;
• feeling of pain in the urethra;
• feeling of burning after urination, ejaculation;
• various micturition disorders, e.g. a feeling of incomplete emptying of the bladder after urination, frequent urination, weak, intermittent flow;
• premature (or, conversely, unnecessarily extended sexual intercourse), painful ejaculation;
• indistinct orgasm;
• purulent-mucous discharge (in case of urethroprostatitis).
The main signs of acute form of orchiepididymitis are:
• dull severe pain in the scrotum;
• a visual increase in one (or both) of the testicles;
• redness of the scrotum skin in some cases;
• palpable sharp soreness, thickened enlarged testicle and/or epididymis;
• Prehn’s symptom (pain decreases when the scrotum is raised).
• with a chronic disease, the pain is moderately expressed (or absent at all), traces of blood in sperm.
Methods of Diagnostics
E. coli can be identified in various biological samples, viz. urine, urethral discharge, prostate fluid, etc. The presence of such microorganisms in the urine (the so-called bacteriuria) has a diagnostic value when 1 ml of the fluid contains more than 105 microbial bodies. Asymptomatic bacteriuria does not require treatment, but if there are signs of infectious pathology, then the quantitative diagnostic value can be reduced. The signs of infection include not only the patient’s complaints (which may be absent at all), but also an increased count of white blood cells in the urine, and/ or a change in other laboratory indicators.
Diagnosis of E. coli in men, determined by urogenital problems includes:
• inspection and survey;
• general urine and blood tests
• polymerase chain reaction (a very accurate technique, which makes possible the reliable detection of bacteria even in the absence of clinical manifestations);
• inoculation (also known as a culture-based technique);
• other laboratory tests, such as microscopic examination, enzyme immunoassay, etc., as well as instrumental examinations (urethroscopy, MRI, ultrasound, CT), which exclude other possible causes of pathology.
It is important to understand that the infection caused by E. coli can be combined with problems caused by other pathogens.
Treatment of E.coli in men
Doctor shall decide on the treatment option of E. coli-induced infection (drugs, regimen, duration of administration and dosage), based on the individual characteristics of the patient's condition and clinical signs of the disease. It is important that the expert be sure, on a basis of diagnostic data, that it is E. coli that caused the problem, since the bacterium is an opportunistic pathogen, which can be normally present (neither signs of the disease, nor detection of this pathogen in the tested samples always indicate that the symptoms are the consequence of the presence of this microbe).
If E. coli is detected by chance, treatment is indicated only if the patient has the typical complaints, plans surgical manipulations on the organs of the urogenital tract, and the like.
In men, E. coli is treated using antibacterial drugs, preferably, after the sensitivity of the pathogens to the drugs has been established (antibiotic resistance is determined based on a culture testing).
In the general case, oral forms of fluoroquinolones, such as Ofloxacin, Ciprofloxacin, etc., cephalosporins (II, III generations) - Cefixime, Cefuroxime, etc., are the drugs of choice for the treatment of acute prostatitis. Co-trimoxazole, Doxycycline also may be prescribed. An ordinary course of treatment should not be shorter than 4 weeks. Chronic prostatitis is to be treated longer (up to 12 weeks), mainly with fluoroquinolones.
Orchitis/epididymitis/orchiepididymitis are also treated by fluoroquinolones, cephalosporins of new generations, more rarely by Co-trimoxazole and ampicillin-based drugs. The therapy is conducted at least 4 weeks, with the form of administration determined by the severity of the disease.
Typically, to treat E. coli infection one drug is sufficient. The sexual partner is subject to treatment only if recommended by the physician. Over the course of the therapy, sexual intercourse (especially anal-genital) must be abstained from, or barrier contraceptives used.
Sometimes, a specialist can additionally prescribe enzyme and vitamin preparations, massage series and physiotherapy, etc.
In men, infections of the urogenital organs are often accompanied by complications (some experts consider the very fact of the urogenital infection to be a complicated infection). Complicated infections are most often caused by antibiotic-resistant Escherichia coli or by the association of several groups of bacteria. The development of complications is facilitated by:
• congenital or acquired structural abnormalities (kidney stones, foreign bodies, doubling of ureters, etc.);
• metabolic issues (diabetes mellitus, etc.);
• depression of protective functions of the body (age, post- transplantation, immunodeficiency conditions, etc.) and other factors.
Without competent treatment, the infection caused by E. coli in men can lead to:
• the spread of the inflammatory process;
• chronic pathology;
• development of male infertility;
• potency impairment such as indistinct orgasm or even anorgasmy, premature ejaculation;
• abscess, necrosis of the testicle (complications of epididymitis), etc.
To prevent the development of the infectious process, it is recommended:
• to observe the rules of hygiene;
• to stick to the rules of safe sex (regular sexual partner, use of barrier protections);
• timely treatment of gonococcal /chlamydial infections, chronic prostatitis;
• to treat adequately chronic diseases;
• to lead a healthy lifestyle.
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