Streptococcus in Men. Diagnostic and Treatment

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Stoyanov
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Streptococcus in Men. Diagnostic and Treatment

#1 Post by Stoyanov » 07 May 2018, 22:56

Streptococci include more than 20 species of bacteria. Some of these microorganisms are normally contained in human microflora, while some other will cause diseases (streptococcal infection), and these are pathogenic to the body. The bacteria are very small, spherical, they remain in the dust and on the objects for a long time, well tolerate low temperatures, and perish for half an hour at 56°C.

Types of Streptococci, Causes of Streptococcal Infection

Streptococcus mitis, a representative of a-hemolytic streptococci, normally inhabits the anterior urethral portion in men, with a detection rate of about 25%. The same area may also accommodate
• Staphylococcus epidermis (50-100%);
• Saprophytic staphylococcus aureus (25%);
• Enterobacteria (Escherichia coli E. coli) – 25%;
• Blue pus bacillus (Pseudomonas aeruginosa) – up to 5%;
• Fecal enterococcus – 25%;
• Protei (Proteus sp.) – 25%;
• Corynebacteria – 25%;
• Neisseria (Neisseria sp.) - 25%;
• Bacteroides (Bacteroides sp.) - 25%

Male urethral microflora does not depend on age, but varies with the influence of other factors. Some microorganisms “inhabit” the urethra permanently, while some others – for a short time only. Unlike female, the male urethral microflora does not exercise any specific functions.

Additionally, the so-called transitory (also called opportunistic pathogenic) microflora is distinguished. It includes microorganisms, which presence in and individual is atypical, and which provoke inflammation under favorable circumstances; these can be transmitted through sexual intercourse. As a rule, such bacteria live in the urogenital tract not long, and can be eliminated by the body defenses. Female body defense is acidic vaginal environment, lactobacilli.

The following types of male defenses can be distinguished:
• mechanical: the valve of navicular, which separates the entrance to the urethra from the anterior portion, prevents penetration of microbes, the glands effusing secretion of the urethral mucus and a special substance during the ejaculation promote the “washout” of bacteria from the urethra;
• neutral/slightly alkaline urethral environment: this interferes with the reproduction of some bacteria in the urethra;
• local immunological defense: is implemented by means of special cells and substances produced by the prostate and the urethral mucosa;
• prostate antimicrobial factor: this is a zinc-peptide complex with antimicrobial properties, produced by the prostate gland (in the prostatic secret, zinc content exceeds this amount in other organs by a factor of 100).

If the defenses fail, transient microflora leads to the development of an infectious process, i.e. streptococcal infection. In the case of genital-oral contact, contamination of the urogenital tract with respiratory microorganisms (inhabitants of the upper respiratory tract, pharyngeal cavity, mouth), such as beta-hemolytic group A streptococcus, is possible.

Another type, group B streptococcus (Streptococcus agalactiae) is not normally found in men, but is often detected in women (and it can cause infectious processes, which pose especial danger to newborns). It should also be noted that this type of microorganism in men can develop in the presence of another infection of the genital tract, so the presence of streptococcus group B requires a more thorough examination for other pathogens.

The main ways of transmission of transient infections, including streptococci are as follows:
• sexual contact (including oral and anal-genital);
• intrauterine transmission from the mother to the child, with blood, the parturient canals are passed through;
• upon organ transplantation.

Streptococcus in men can be the cause of such problems as:
• urethritis (inflammatory lesion of the urethra);
• balanitis, balanoposthitis (balanus, prepuce);
• prostatitis (prostate gland);
• epididymitis (epididymis);
• impaired sperm quality, etc.

Infection develops as a result of activation of transient microflora:
• against the background of a decrease in immunity (with HIV, after severe illnesses);
• in the presence of chronic pathologies of a different nature (for example, with diabetes);
• with chronic prostatitis, presumably due to a reduction in the prostatic secretion of zinc content;
• with the transfer of sexual infections, which lead to the scarring of the mucous organs of the urogenital tract and the resulting decreased immunity;
• upon burning of the urethra due to abuse of antiseptics, etc.

Treatment of streptococcus in men depends on the type of microorganism and clinical signs of the disease.

Symptoms of Streptococcal Infection

In most cases, streptococci causing transient infections, when getting into the organs of the urogenital system, can survive only a few hours/weeks to be destroyed by the body defenses (so-called temporary carriage). Streptococcus detected in this period is not an indication for therapy if there no clinical signs. However, it should be borne in mind that a transient carrier is likely to contaminate the sexual partner.

With persistent carriage, the insignificant count of the microorganism is constantly present in the urogenital system (there are no symptoms at that), and in case of a “malfunction” in the body it will be manifested by a violent inflammatory reaction. In such a situation, the sexual partner may get infected as well. If streptococci confirming the patient's persistent carriage are revealed, with moderately pronounced changes in the prostate, it is time to apply for more thorough diagnosis and treatment.

If the body stops restraining the growth of streptococci, inflammatory processes will set on, with the symptoms depending on localization.

Typical signs of urethritis:
• unpleasant sensations, irritations, redness in the urethra;
• frequent and painful urination;
• urethral discharge.

If the prostate is affected, swelling, pain in the testicles, problems with urine production, traumatic pain in the inguinal region, etc., may occur.

There are no manifestations specific for streptococcus, which requires the diagnosis of the nature of pathology.

Methods of Diagnostics

Diagnosis of streptococcus in the urogenital system in men includes:
• common urine and blood tests;
• analysis of smears, secretion of the prostate by polymerase chain reaction (it is PCR only that can reveal pathogens with transient carriage);
• culture-based method (secretions, prostate secretions, etc.);
• other in vitro techniques (ELISA, IFA, etc.) and instrumental methods (ultrasound, MRI, CT) to exclude other causes of the symptoms observed, i.e. non-streptococcal infections, tumor formations, etc.

Methods of Treatment of Streptococcus

The need for treatment of streptococcus is determined by severity of the symptoms. In the absence of clinical signs (streptococci have been detected accidentally during the routine examination), expectant management is applied, with the temporary carrier often spontaneous disappearance of the microorganism. If the streptococcus, which does not represent normal microflora, was found against the background of the issues with the urogenital tract, specific antibiotic therapy is carried out. It is preliminary necessary to determine the sensitivity of the detected pathogenic microorganisms to certain antibacterial drugs. Most often, penicillins (e.g., Ampicillin), macrolides, fluoroquinolones are prescribed. For the patients with streptococcal infection of the urogenital tract and allergy to penicillins Clindamycin, Cefazolin may be prescribed. Unfortunately, recently there have been reported cases of drug resistance of streptococcal infection. If the prescribed antibiotic is ineffective, a new drug is prescribed taking into account the sensitivity.

It is important to take into account high probability of a mixed infection, especially with Streptococcus agalactiae detected in men. In this case, several medications may be required.

In addition to the main therapeutic course, the doctor can recommend: the following measures:
• physiotherapy;
• massage (if there is inflammation of the prostate);
• immunomodulating agents;
• enzymes;
• local treatment (infusion into the urethra of solutions of various drugs);
• traditional medicine (baths with decoctions of medicinal herbs, for example, chamomile, drinking cranberry juice, and so on), etc.

Complications of Streptococcus

Inadequate therapy for streptococcal urogenital infection in men can cause:
• transition to a chronic form;
• spread of the inflammatory process to other organs and tissues (damage to the testicles, seminal vesicles, epididymis);
• infertility and impotence, etc.

Infection of women during pregnancy can cause serious pathologies in newborns, for example, the development of sepsis – blood poisoning.

Preventive Treatment

Preventive treatment against a streptococcal infection consists in the following:
• safe sex with barrier methods used;
• normalization of the way of life, e.g. the work and rest schedule, healthy diet, and moderate physical activity, avoiding stress factors;
• cold water treatment;
• timely detection and adequate treatment of sexual infections;
• prevention of the development of chronic diseases or repair by medicines, etc.

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