Mycoplasma in men is an inflammatory disease of the genitourinary tract related to sexually transmitted infections. More often it is asymptomatic, less often with manifestations in the form of cuts, pain when urinating with irradiation in the groin, discharge from the penis, fever. Laboratory diagnostics of mycoplasma is based on the detection of pathogens in biological fluids, serological studies are allowed. Treatment of infection is always complex, with the use of etiotropic, pathogenetic, symptomatic therapy, non-drug methods.
A49.3 Infection caused by mycoplasma, unspecified localization
Mycoplasma in men is one of the most common causes of damage to the genitourinary system. The causative agent of the disease was first identified in 1980. The proportion of mycoplasma infection among non-gonococcal and non-chlamydial urethritis in the male population is about 10-35%, among healthy individuals, the allocation of mycoplasmas ranges from 1 to 3.3%. The tendency to persist infection was noted in 40% of patients, while men over 35 years of age are most often affected. Studies in sub-Saharan Africa have shown that prolonged untreated mycoplasma leads to an increased risk of HIV infection.
The causative agent of mycoplasma is the bacterium M. Genitalium. The source is a sick person, often with a latent course of the disease, having erased symptoms. The transmission of pathogens in men is usually carried out by direct contact of the mucous membranes of the genitals during anogenital, oral-genital and vaginal methods of sexual penetration. Often there is a mixed infection with ureaplasmas, trichomonas, etc. Main risk factors:
- unprotected sexual intercourse, especially homosexual
- regular hypothermia
- non-compliance with the rules of intimate hygiene
- abuse of alcoholic beverages, narcotic substances, smoking.
At risk are people with weakened immunity, endocrine diseases, after organ transplantation, commercial sex workers.
The pathogenesis of mycoplasma has not been fully studied. It is known that M. Genitalium, adhering to the surface of the host cell, triggers a pro-inflammatory cascade of chemokines through highly expressed innate immune sensors, including Toll-like receptors 2, 6, binding of which to M. Genitalium and its lipoproteins leads to the induction of genes involved in cell protection. These pro-inflammatory signals lead to the attraction of leukocytes to the focus of mycoplasma presence.
The incubation period of infection can range from 4 weeks to 60 days, on average, about a month; at the same time, the disease in men is mostly asymptomatic. In the presence of a clinic, patients may complain of low fever (up to 38 ° C), decreased performance, moderate headaches, weakness, chills, the appearance of excessive translucent discharge and itching in the area of the glans penis, burning sensation, discomfort during urination.
Painful, pulling sensations occur in the groin area, libido decreases. Sexual intercourse can be interrupted due to sharp pain, symptoms of erectile dysfunction occur. Further development of mycoplasma in men – redness, swelling, pain in the scrotum; increased urination, especially at night, turbidity of urine, cutting sensations, soreness above the pubis, in the perineum and anus, increased fever and weakness.
The most common complications of mycoplasmic urethritis include ascending inflammatory diseases of the genitourinary system: prostatitis, cystitis, pyelonephritis. It is possible to defeat the testicles and appendages, with untreated epididymitis, infertility is often subsequently diagnosed. Symptoms of proctitis may occur: fever, sharp pain in the sitting position, rectal purulent discharge.
Infertility in mycoplasma among men has a complex nature: the occurrence of the condition is directly affected by the inflammatory process in the reproductive tract, as well as the ability of mycoplasmas to fix on spermatozoa and limit their mobility. Chronic infection reduces the function of the prostate gland, forms connective tissue bridges that interfere with the normal progress of seminal fluid.
Diagnosis of mycoplasma among men and its treatment in most cases is carried out by urologists. Doctors of other specialties consult if there are indications. A thorough examination of all sexual partners of the patient is necessary, especially when practicing unprotected sexual contacts. The main clinical, laboratory and instrumental examinations for mycoplasma include:
- Physical data. Often an objective examination with mycoplasma is uninformative, the symptoms are minimal. Soreness, hyperemia, swelling of the scrotum organs, discharge from the penis head, sensitivity to palpation in the suprapubic region, perineum, finger examination of the prostate may be detected. With an ascending infection, it is possible to determine a positive symptom of pounding. Be sure to visually assess the urine, the nature of the discharge.
- Laboratory tests. In the general blood test, there is a slight leukocytosis, acceleration of ESR, among the biochemical parameters in the presence of complications, an increase in the activity of CRP, creatinine, and urea is detected. In the general clinical analysis of urine, leukocyturia, erythrocyturia, and an increase in the density of urinary sediment are determined. A smear from the urethra reveals a large number of white blood cells.
- Identification of infectious agents. The data of bacterioscopy of the urogenital smear are not informative enough to search for pathogens. The most informative is PCR-a method of examining a smear from the urethra, prostate secretions, urine. The “gold standard” for the diagnosis of mycoplasma is culture sowing, but it is not used in routine practice due to the high cost. Serological (ELISA) tests are carried out with paired serums and an interval of at least two weeks.
- Instrumental methods. They are necessary for differential diagnosis. Ultrasound examinations of the genitourinary apparatus, small pelvis, if necessary, radiography, CT, MRI of the lumbosacral spine, kidneys, genitals, puncture biopsy of the prostate gland with histological examination are carried out. Colonoscopy and irrigoscopy are used less often.
Differential diagnosis of mycoplasma in men is carried out with ureaplasmosis and other non-gonococcal urethritis, while the pathology is verified by laboratory methods due to the similarity of clinical manifestations. Urethritis of a different etiology has a history of indicating traumatic, temperature or chemical damage, but any non-infectious causes must be confirmed by negative studies for the presence of microbial pathogens.
Treatment is often carried out on an outpatient basis. Inpatient stay is recommended for patients with decompensated chronic diseases, severe infection, complications requiring round-the-clock monitoring. The general, less often semi-bed mode is shown. The diet is considered as a treatment: acidic, spicy, pickled dishes, alcohol, coffee, nicotine are completely excluded.
For the period of treatment, it is recommended to refrain from sexual relations or necessarily use barrier methods of contraception (condom). When the symptoms of mycoplasma are detected in a partner, joint treatment is carried out; preventive administration of etiotropic drugs has no reliable benefit. The risk of infection of a healthy person during treatment, even with adequate therapy, without the use of contraceptive methods is more than 30%.
The standard treatment of mycoplasma in men takes 7-14 days, but 15-25% of patients have persistent or recurrent symptoms. During the period of taking medications and pronounced symptoms, athletic physical activity is excluded, resumption is allowed during the period of convalescence. The most common therapeutic measures for mycoplasma are carried out:
- By etiotropic means. The drugs of choice can be tetracyclines, macrolides and fluoroquinolones. However, doxycycline is now recommended as a second and even third line of therapy; there is also a growing resistance of mycoplasmas to azithromycin. High efficacy of mycoplasma therapy in men was noted when taking pristinamycin and moxifloxacin.
- Pathogenetic drugs. Painkillers, antispasmodics, anti-inflammatory drugs are used. In order to provoke a sluggish infection, local (rectal) immunostimulants are sometimes used. Intravenous detoxification with polyionic solutions is indicated in case of severe course, with complications.
- By symptomatic means. It is possible to use diuretics, desensitizing, hormonal agents. In some cases, local application of antibiotic-containing ointments, courses of vitamin and mineral complexes is recommended.
Treatment of manifest urethritis with mycoplasma in men is accompanied by regular irrigation of the penis head with anti-inflammatory solutions after each urination, using baths with infusions of oak bark, chamomile, calendula, sage. The appointment and administration of herbal preparations (water-alcohol extracts of the grass of the golden millet, rosemary leaves, etc.) has no convincing clinical efficacy in the treatment of mycoplasma.
American urologists widely practice local treatment with the introduction of antiseptic drugs into the urethra (collargol), as well as methods of physiotherapy, such as:
- magnetic therapy
- UHF therapy
- laser therapy of the posterior surface of the penis
- prostate massage
- therapy intravenous laser irradiation of blood
- galvanotherapy of the urethra area
- heliotherapy and others.
A repeated course of antibacterial therapy is necessary for recurrent mycoplasma in men. Non-drug treatment methods are also recommended, such as a special muscle training program to strengthen the pelvic floor, the use of cosmetic hypoallergenic products for daily intimate hygiene, a ban on prolonged hypostatic positions, the exclusion of many hours of breaks between acts of urination.
Prognosis and prevention
The prognosis with timely detection and treatment is favorable, no fatal cases of mycoplasma have been recorded in men. Specific protective pharmacological formulas have not been developed; non-specific preventive measures are of great importance: rejection of any unprotected sexual practices, compliance with personal hygiene rules, a healthy lifestyle and annual laboratory preventive examination.