Ureaplasma in men is an inflammatory disease of the genitourinary tract. This disease refers to sexually transmitted infections. Symptoms are usually absent; the most frequent manifestations are fever of varying severity, urinary disorders, sexual dysfunction and infertility. Diagnosis is based on the detection of the pathogen in the scraping of the urethra, urine or prostate secretions; the use of serological methods is allowed. Etiotropic treatment – antibacterial drugs; also pathogenetic and symptomatic agents.
General information
Ureaplasma in men is a bacterial infection with a predominant lesion of the reproductive and urethra. Symptoms were first described as a cause of male infertility in 1967. The prevalence of ureaplasmosis in the group of non-gonococcal urethritis is approaching 16%. The frequency of isolation of pathogens from sperm and vas deferens among infertile men is 5-58%, in fertile males 3-31%. It is believed that ureaplasmosis increases the likelihood of HIV infection; the role of bacteria in the aggravation of immunodeficiency and the progression of HIV infection to the AIDS stage is likely.
Causes
The causative agent of the disease is the bacterium Ureaplasma, the main pathogenic species of U. parvum, including 4 serovars, and U. urealyticum (10 serovars). The source of infection is a sick person, most often with a latent form of pathology, since ureaplasmas are part of the normal flora of reproductive organs with a colonization frequency of 40-80%. Transmission of the causative agent of nosology in men occurs sexually.
The main risk factors are: early onset of sexual activity, a large number of sexual partners, non-use of barrier contraceptives, symptoms of chronic inflammatory processes of the genitourinary apparatus. Weakening of the immune status (taking glucocorticosteroids, oncopathology, HIV infection, etc.) and a deficiency in the intake of vitamins and nutrients multiply the likelihood of ureaplasmosis.
Pathogenesis
Once in the body, the bacterium attaches to the cells of the mucous membrane with the help of cytoadhesive proteins. Ureaplasmas are able to express phospholipases A and C, generating proinflammatory prostaglandins. Then an increase in the level of IL-6, IL-8, IL-10, brain neurotropic factor, granulocytic macrophage colony stimulating factor, monocytic chemotactic protein-1, macrophage inflammatory protein is recorded.
Ureaplasma produces IgA proteases, which enhances colonization by microorganisms of the mucous membrane by degradation of the local immune system. The virulence and persistence of ureaplasmas are also affected by the ability of microorganisms to form biofilms. This property increases the persistence of the body and increases the tendency to chronic inflammation, but biofilm formation has little effect on the permeability to azithromycin or other antibiotics.
Symptoms of ureaplasma in men
The incubation period of ureaplasma in men can be about three weeks or more. Given the tendency of the disease to an asymptomatic course, it is often impossible to determine the time of infection. Often, the detection of bacteria occurs during an examination to determine the cause of male infertility. The first symptoms of the disease are burning, discomfort when urinating, up to excruciating cuts, acute pain during sexual intercourse.
Patients note an increase in body temperature, usually up to 38 ° C, weakness, chills, aching pains over the pubis, frequent urge to urinate, especially at night, rapid ejaculation, erectile dysfunction, decreased libido. Sometimes there are scanty transparent secretions that spontaneously stop. In the future, painful symptoms may develop, a feeling of bursting in the testicles, acute pain in the perineum in a sitting position.
Complications
The most common complications of ureaplasma in men are balanitis, balanoposthitis, epididymitis, orchitis, prostatitis, less often urethral strictures and symptoms of acute urinary retention. Often the occurrence of impotence associated, among other things, with psychogenic factors of pathology (dyspareunia, decreased libido, etc.). Patients with ureaplasmosis are a risk group for the occurrence of autoimmune rheumatic diseases.
Infertility in this disease is associated with the ability of ureaplasmas to fixate on spermatozoa, which leads to a violation of their maturation, a decrease in motor activity, often lysis of male germ cells and aspermia. With a prolonged course of ureaplasmosis, the secretory activity of the prostate gland decreases, which also worsens the quality of seminal fluid.
Diagnostics
Diagnosis of ureaplasmosis among men and its treatment is carried out by urologists, less often by venereologists. Other medical specialists are involved according to indications. It is important to actively identify and examine the patient’s sexual partners, especially when practicing unprotected sexual relations. The main clinical, instrumental and laboratory symptoms of ureaplasmosis:
- Physical data. An objective examination reveals: hyperemia, pasty of the external opening of the urethra, foreskin, glans penis, scrotum, testicular enlargement, their soreness during palpation; pain when sitting, perineal palpation, finger examination of the prostate. Less often, mucosal non-abundant discharge from the vas deferens is detected.
- Laboratory tests. For the period of exacerbations of chronic untreated, or acute ureaplasmosis, leukocytosis, acceleration of ESR are characteristic in the general clinical blood analysis, and an increase in the concentration of CRP in biochemical parameters. When examining a urethral smear, a large number of leukocytes are visualized. In the general analysis of urine, leukocyturia is determined, less often microhematuria.
- Identification of infectious agents. Detection of ureaplasmas is carried out by PCR; urine and scraping from the urethra are more often used, less often prostatic secretions. The “gold standard” of diagnostics is the cultural method, however, due to the high cost and complexity, it is practically not used. Conducting serological diagnostics and microscopy of the material is impractical due to the low diagnostic value.
- Instrumental methods. To exclude an ascending infection, ultrasound of the prostate gland, bladder, kidneys, scrotum, penis is recommended. In some cases, for the purpose of differential diagnosis, uroflowmetry, radiography, MRI, CT of the lumbosacral spine, irrigoscopy, colonoscopy, prostate biopsy with histological examination are performed.
Differential diagnosis of ureaplasma in men is carried out by laboratory verification with other urethritis of gonococcal and non-gonococcal nature. The syndrome of chronic pelvic pain (prostatodynia, abacterial prostatitis) is confirmed with repeated negative results of research on microbial pathogens, traumatic urethritis occurs with temperature, force, chemical, radiation damage to the penis.
Treatment of ureaplasma in men
Treatment is usually outpatient, hospitalization is necessary for severe course, decompensation of existing chronic diseases. A general regimen is prescribed, for patients with severe pain syndrome – bed or semi-bed. Patients with ureaplasmosis should avoid hypothermia, overheating, stressful situations, and carefully observe daily hygiene of the external genitalia.
Diet plays an important role in the treatment of ureaplasmosis – it is necessary to give up spicy, sour, fatty dishes, carbonated drinks, sweets. Salt and the use of marinades, seasonings should be limited. It is recommended to increase the drinking regime due to boiled water, decoction of cranberries, cranberries. Alcohol and smoking while taking medications are contraindicated; sports are excluded during the acute period of ureaplasmosis, with exacerbation, possible after the clinical manifestations subside.
Conservative therapy
The standard course of treatment of the disease usually does not exceed two weeks; clinical improvement occurs within 12-48 hours. During the therapy period, it is recommended to abandon sexual relations, and in the future use barrier contraception until negative results of tests for the presence of the pathogen are obtained. Treatment of a partner is necessary only after confirmation of his diagnosis. The most common therapeutic measures are carried out:
- By etiotropic means. Efficacy against ureaplasmas was noted among tetracycline-type drugs, fluoroquinolones, macrolides. Azithromycin, josamycin, is most often prescribed, since there is a growing drug resistance of bacteria to doxycycline.
- Pathogenetic drugs. The use of antispasmodics (drotaverine), painkillers (analgin) and nonsteroidal anti-inflammatory drugs (nimesulide), local immunostimulants (more often in the form of rectal candles) has been shown. Intravenous infusion of solutions – with pronounced general intoxication symptoms.
- By symptomatic means. With severe inflammation with an allergic component, antihistamines are used, less often glucocorticosteroids. It is allowed to prescribe diuretic pharmaceuticals, a course of multivitamin, mineral complexes.
Often, doctors practice local treatment with the introduction of antiseptic drugs into the urethra (collargol), as well as physiotherapy methods such as: magnetotherapy, laser therapy of the posterior surface of the penis, prostate massage, ozone therapy, UHF therapy, galvanotherapy of the urethra, heliotherapy and others. In case of chronic course, balneological and mud treatment is recommended.
Treatment of persistent ureaplasma pathology often requires a repeated course of antibacterial therapy. The reserve drugs include moxifloxacin, as well as pristinamycin. Non–drug methods of treatment are used – pelvic floor muscle training, the use of hypoallergenic cosmetics for daily intimate hygiene, a ban on prolonged hypostatic positions, long breaks between urination.
Prognosis and prevention
The prognosis for life is favorable, no fatal cases have been recorded. However, the risk of male infertility is high (76% among patients with ureaplasmosis). Infection prevention measures include: refusal of unprotected sexual intercourse, promiscuity, taking nicotine, alcohol, drugs, a balanced diet, regular physical activity, correction of immune deficiency (for example, taking antiretroviral drugs for HIV infection).
