Mycoplasmosis, also called mycoplasmal infection, is an infectious disease of people and animals that cause mycoplasma. In the human body, 16 species of mycoplasmas have been identified, six of which live on the mucous membranes of the genital organs and urinary tract. The remaining ten 10 species live on the mucous membranes of the mouth and pharynx.
The most common types of pathogens are:
- Mycoplasma hominis
- Ureaplasma urealyticum
- Mycoplasma genitalium
Mycoplasma hominis and Mycoplasma genitalium are the immediate pathogens of mycoplasmosis. These microorganisms are related to urogenital mycoplasmosis. Like all typical representatives of sexually transmitted infections, they cause such diseases: cervicitis, vaginitis, prostatitis, pyelonephritis and other diseases of the genitourinary system. There are several opinions of medical scientists on the role of mycoplasmas. Some believe that mycoplasmas are absolutely pathogenic, according to another point of view, these are harmless bacteria. In addition, mycoplasmas are very common – in a population of up to 35%. Because of these factors, doctors do not have a single point of view as to whether people with an infection should be treated and, if so, how to do it correctly.
In recent years, cases of infections caused by chlamydia, viruses, mycoplasmas, or mixed infections have become much more frequent. It is very difficult to combat them, as they are very resistant to the action of antibiotics, and also because of the specific reactions of the body in response to therapy. Such infections today predominate over classical venereal diseases, for example, gonorrhea and syphilis. To a wide prevalence are several factors: the difficulty in detecting mycoplasma infection, the possibility of transmission by sexual and domestic methods, inadequate treatment.
Epidemiology of mycoplasmosis
Mycoplasmosis is very often found in representatives of all strata of the population – as claimed by different authors, in 10-50% of people. According to American statistics, ureaplasmas were detected in 80% of women who consulted a doctor with signs of genital infection, as well as 51% of women with impaired fertility. According to our statistics, ureaplasmas and mycoplasmas are much more often sown in patients suffering from candidiasis, herpes and gardnerellez. In addition, they often affect the body of women and in much higher titles. All this indicates infection with mycoplasma infections during sexual intercourse.
There is still a vertical path of infection, leading to infection of the unborn child in the womb. Recent studies indicate that a contact-household pathway of mycoplasmosis is also possible. You can get infected either from a sick person or from a healthy carrier. In the adult population, cases of sexual transmission are more frequent. In addition, open orogenic contacts are very important, as more than 50% of men are infected, as mycoplasma does not die for a long time in the oral cavity.
Mycoplasmas can be infected from the mother during childbirth. Doctors detect on the genitals almost 57% of newborn girls Mycoplasma hominis, checking children if they suspect a mother’s disease. As for boys, the incidence of such infection is much less.
If we are talking about the contact-household method, the transmission of infection most often occurs:
- through linen, both lower and bed;
- when using hygiene items together, in particular, through a loofah and a towel;
- during use of the toilet without special linings;
- through an unsterile instrument with gynecological examination.
Men do not often get infected by domestic means, and women suffer in 15-20% of cases. A much smaller number of people are infected with a household contact than with a sex worker. This is explained by the fact that mycoplasmas are viable in an external warm and humid environment only 2-6 hours. But this is enough to cause a non-sexual contamination of family members. Therefore, it is important, if mycoplasmas are detected in one of the family members, immediately to conduct a survey not only of the wife or husband, but also of all who live in the house, this is especially relevant for women and girls.
Statistics argue that schoolgirls who do not have sex life, Mycoplasma hominis detect only in 8-17% of cases (with vertical and contact-household infection). People who have sex are more likely to get infected with Mycoplasma hominis – carriers are considered to be 20-50% of women. In men, infections are detected less frequently. In addition, it is important to consider that Mycoplasma hominis is much more common than Mycoplasma genitalium.
Clinical picture of mycoplasmosis (symptomatology)
The diagnosis of “urogenital mycoplasmosis” is difficult, since the disease does not have unique symptoms. Approximately in 40% of cases of the disease, mycoplasmosis has a latent course, the patient does not suspect its condition. Microorganisms are activated. If the body is under stress, mycoplasmas become very active, signs begin to appear, but they are common, typical for almost all infections of the urogenital system.
When mycoplasma affects the body of a man, the following symptoms appear: morning ungrowth clear discharge from the urethra, drawing pain in the groin, slight pain and burning sensation during urination. If mycoplasma affects the prostate gland, there are signs of prostatitis: pain with frequent acts of urination, pain in the lower abdomen and in the perineum, decreased erection and potency, soreness with erased early orgasm.
When the epididymis epididymis is infected, there is often an unsettling traumatic pain in the groin, in the perineum, in the scrotum. After a while, the appendages become larger, the reddening of the skin of the scrotum is noticeably red. Very dangerous changes, which as a result of mycoplasmosis appear in spermatozoa. Mycoplasma hominis badly affects the reproductive function of men, can lead to the death of the tissues of the seminiferous tubules. In the study of prostate secretion in patients, approximately 30-45% of ureaplasmas are detected. In addition, if their number of colony forming units (CFU) is from 10 000 to 100 000 per ml, this indicates their etiological role in the occurrence of prostatitis.
Male infertility is often provoked by inflammatory processes, although often its cause is a violation of the formation of mature spermatozoa. As a result of ureaplasmic infection, the mobility of spermatozoa decreases, immature or morphologically altered cells appear – their spirals occur, “fluffy tails” appear, formed due to adsorption of a large number of ureaplasmas on the posterior part of the spermatozoon. The danger of ureaplasma is also that they prevent the sperm from penetrating into the egg cell. From three to five years, the inflammatory process passes asymptomatically, but it leads to the formation of scars in the epididymis and in the prostate (in particular, in the vas deferens), which interferes with the movement of spermatozoa and causes obstructive infertility.
Mycoplasmosis in female patients also manifests itself as other infections of the urogenital system. We list the main signs of the presence of mycoplasmas: transparent vaginal discharge of varying intensity, a feeling of itching and burning during urination, inflammation in the uterus and appendages – pain in the lower abdomen and during sexual intercourse. Mycoplasmosis is especially severe during pregnancy, it can lead to spontaneous abortion and early childbirth. During the very process of the birth of a child, amniotic fluid can too early to withdraw, fever occurs after childbirth, meningitis and pneumonia develop in the infant.
Mycoplasmosis, in varying degrees of intensity, begins to manifest itself 3-5 weeks after infection. In most cases, the disease manifests itself not very significant symptoms, patients, especially women, they practically do not bother. For this reason, if a partner has signs of inflammation, both need to be fully examined in order to identify hidden infections.
The following factors may aggravate the course of the disease:
- concomitant infection of any nature;
- disorders of the hormonal background associated with the phases of the menstrual cycle;
- pregnancy and childbirth;
- changes in the body’s immune system.
On the peculiarities of the disease development, the latitude and prevalence of ureaplasma is more influential than the fact of infection itself. It is also important that in our time doctors do not have enough information about the differential pathogenicity of different serotypes, as well as their effect on the body in various combinations with each other. If ureaplasmas penetrate the distant parts of the genitourinary system, urethral syndrome may occur. Since ureaplasmas are found in urinary stones in patients with urolithiasis, doctors have concluded that 67% of the appearance of kidney stones in young patients is provoked by ureaplasmas.
In the medical literature, there are descriptions of cases of acute hemorrhagic cystitis, to which the mycoplasmas have been brought. The inflammatory process involved both the upper and lower parts of the genito-urinary tract. There is evidence that in patients with acute abacterial pyuria, mycoplasmas are also found.
The most dangerous mycoplasma and ureaplasma for pregnant women. They are very often found and cause pathologies of the urogenital tract, and in the early stages of development of the fetal egg cause its severe lesions. Perhaps the main cause and the most serious consequence of placental insufficiency, which develops from the first trimester of pregnancy, is believed to be changes in hemostasis. In pregnant women, the incidence of mycoplasmas increases by one and a half to two times. In patients with repeated miscarriages, even outside of pregnancy, mycoplasmas are found in 24-30% of cases, and this percentage increases with a fetus in the womb.
This infection is a social hazard, because there is confirmed evidence that its presence in the body of a woman and men is the cause of spontaneous abortions in 70-80% of cases. This is important to consider when very expensive reproductive technologies are used. If the female body is afflicted by M. hominis, then the pregnancy will be accompanied by serious complications: the threat of miscarriage, late toxicosis, polyhydramnios, premature detachment of the placenta, anomalies of its attachment. There is also a danger for the outcome of pregnancy – one and a half times more often, when compared with a control group, a woman can not report the child.
With ascending infection, mycoplasma is sown from the amniotic fluid. Thus, in the case of amniocentesis in pregnant women infected with chorioamnionitis, the frequency of M. hominis sowing is 35% vs. 8% in uninfected women. Intrauterine mycoplasmosis occurs very often. As follows from the materials of foreign studies, they are observed in 5.5-23% of children. Russian statistics are slightly higher.
In premature infants mycoplasma infection is detected 3 times more often than in term infants. In the case of intrauterine mycoplasmosis, the generalized pathological process develops, when the respiratory system is disrupted, eyes, liver, kidneys, central nervous system, fetal skin suffer. Intrauterine mycoplasmal pneumonia occurs, for the most part, as interstitial pneumonia accompanied by circulatory disorders, hemorrhages to the alveoli, thrombi and hyaline membranes are formed.
According to the medical literature, in 50% of stillborn and dead newborns with mycoplasmal infection, congenital malformations were observed 3 times more often than in healthy children. The pathology of central nervous system development was most often diagnosed.
Female infertility is also often provoked by infection of the urogenital tract, caused by mycoplasmas. Infection of the endometrium causes the infection of the fetus and spontaneous abortion at an early stage. Doctors believe that it can also be induced by induction of M. hominis synthesis of prostaglandins and their precursors. According to a number of researchers, strains of ureaplasma, which were sown from women with spontaneous abortion, provoked chromosomal abnormalities in lymphocytes and sex cells. In 1965, published information about chromosomal changes in the cell caused by mycoplasmas.
It is important that the changes at the cellular level, provoked by M. hominis, are similar to the pathologies that are observed in Down’s syndrome. The appearance of chromosomal abnormalities is observed in leukocytes in case of infection with U. urealiticum infection, which is isolated from a woman whose pregnancy has been spontaneously interrupted several times. This is important to take into account, as it is known for certain that ureaplasma collects on spermatozoa and is often found in women with miscarriages, and chromosome changes are present in the fetus in 20% of cases.
The most important factor in the pathogenicity of mycoplasmas is that they can very closely connect with the cell membrane of the cell. This leads to their intermembrane interaction and the exchange of certain membrane components. Most often this happens with people with III (B) blood group – its agglutinogens are genetically similar to the structure of mycoplasma walls. As a result – a violation of the process of recognition of antigens and the start of production of antibodies to their own cells and tissues. All this in certain cases becomes the cause of autoimmune forms of infertility, the development of reactive arthritis of the joints of the legs.
Diagnosis of mycoplasmosis
Since mycoplasmas are very common, and the diseases caused by them, occur without pronounced symptoms, this can serve as the basis for twice a year to regularly check for the presence of infections that are transmitted through sexual contact to all people who do not have a permanent partner. Family couples should take the necessary tests once a year. It is very important to check all women who are of childbearing age and who are diagnosed with diseases of the genitourinary system. Especially if they are chronic infections, the origin of which is unclear.
It is necessary to conduct targeted examinations of pregnant women, if there is an obstructed obstetrical anamnesis, and the very course of pregnancy is unfavorable. The risk group should include patients with pyelonephritis or those suffering from kidney stones. Mandatory routine examination of patients with prostatitis, urethritis or infertility is necessary.
To identify urogenital mycoplasmosis, physicians use a variety of methods for diagnosing:
- direct immunofluorescence,
- indirect immunofluorescence,
- linked immunosorbent assay,
- method of genetic probes,
- polymerase chain reaction method.
One of the most effective is the detection of mycoplasmosis by sieving to ureaplasma, and mycoplasma is detected by PCR or ELISA. In order to conduct a microbiological analysis, you need to take samples from the mucous membrane of the urethra, from the vaginal vaults, from the cervical canal and from the periurethral area. As for the study of urine samples, they do not provide exhaustive information. If a man is examined, it is better to take the secret of the prostate for analysis.
Treatment of mycoplasmosis
For a favorable outcome, complex therapy is prescribed, aimed not only at fighting infection, but also to improve immunity. In addition, it is important to protect the patient’s liver from the action of antibiotics. When choosing a drug, the decisive role is played by the determination of the characteristics of the vital activity of one or another type of mycoplasma. For this, culture studies are carried out. For the treatment of mycoplasmas, antibiotics of the tetracycline series, macrolides and fluoroquinolones are effective. To avoid the emergence of candidiasis, the appointment of antifungal medicines is indicated. If both mycoplasma and gadernella are diagnosed, antiprotozoal medicines are prescribed.
Treatment of mycoplasmosis involves improving the functioning of the immune system, physiotherapeutic procedures, local treatment, as well as a set of measures against concomitant diseases, inflammatory processes in the pelvic organs. While the course of treatment is underway, it is important to follow the prescribed diet prescribed by the doctor, excluding consumption:
- fatty and spicy dishes,
- fried food,
- smoked products.
It is important to perform a set of exercises to strengthen the muscles of the pelvic floor. Although the term of replication of infection is only 6 days, antibiotics are effective if taken for at least two weeks. The most commonly suggested regimens for antibiotics, calculated for 18-22 days, with alternating reception of 2-3 drugs belonging to different groups. If there is a relapse, especially carefully it is necessary to conduct a study to identify gardnerellez and trichomoniasis – they create cavities in which the mycoplasmas then multiply. These are cysts of appendages and ovaries (in men and in women, respectively). When the course of therapy is over, a control examination is necessary in 2-3 weeks.
With intensive treatment of urogenital mycoplasmosis, a dispensary examination and treatment of people who had sex with the patient or had a common life with him was necessary. In most cases, one to two treatments are needed to suppress infection. But in order to avoid a recurrence of the disease you need a medical control for another 2-3 months. When the second half of the course of therapy comes, a premim of multivitamins and eubotics, which contain bifidobacteria and lactobacilli, is shown. Proteolytic enzymes dissolve inflammation and adhesions and open access to drugs to the pathogen. In addition, they destroy proteins that block the interferon system.
Treatment should be performed by all patients who have mycoplasma in the genitals, even if there is no inflammation, and people who have had sex with them. It is necessary to examine and all members of the family who live in the same house with the ill, regardless of gender and age. In many cases, people who were infected or were carriers became infected by household means. The drugs prescribed and the regimens for their administration are individual and depend on the form and severity of the disease.
Various kinds of mycoplasmal infections, in particular, mixed forms, are very common. Recent studies have reassessed their ability to influence the process of hematopoiesis, a role in provoking leukopenia. Mycoplasmas can induce immunosuppression, accelerate autoimmune reactions, lead to irreversible changes in chromosomes, and affect the sex cells. Therefore, it is likely that the carriers of this infection are a group of increased risk – they can develop a neoplastic (oncological) process. But these data require further study.
Summarizing the above, we assert that young people and people of mature age need to diagnose and treat mycoplasmosis – this is necessary in order to avoid or get rid of the inflammatory processes of the genitourinary system, infertility, autoimmune diseases, the appearance of kidney stones and the development of oncological pathologies.