Mycoplasma in women is a urogenital infection caused by Mycoplasma genitalium/hominis and occurring in women in the form of urethritis, vaginitis, cervicitis, endometritis, salpingitis, adnexitis. It may have a latent course or be accompanied by itching of the genitals, burning when urinating, transparent non-abundant whites, pain in the lower abdomen and lower back, intermenstrual bleeding, habitual miscarriage, infertility. The decisive importance in the diagnosis of mycoplasma in women belongs to laboratory studies: culture, PCR, ELISA. In the treatment of mycoplasmosis, antibiotics (tetracyclines, fluoroquinolones, macrolides), local therapy (candles, douches), immunomodulators are used.
General information
Mycoplasma in women is a group of infections of the genitourinary tract, the causative agents of which are mycoplasma genitalium and mycoplasma hominis. According to various researchers, carriers of M. hominis are from 10 to 50% of the population. At the same time, mycoplasmas are found in 25% of women suffering from habitual miscarriage, and 51% of women who have given birth to children with intrauterine malformations. The highest incidence of mycoplasmosis is observed among sexually active women of fertile age. To date, in the structure of STIs, ureaplasmosis and mycoplasmosis prevail over classical venereal diseases (gonorrhea, syphilis). The tendency to increase the prevalence of mycoplasma infection in the population and the potential threat to reproductive health make this problem relevant for a number of disciplines: gynecology, urology, venereology.
Causes
The initiators of mycolasmal infection are the smallest microorganisms occupying an intermediate stage between viruses and bacteria. They are brought closer to viruses by their small size (150-450 nm), which is why they cannot be seen in a light microscope, the absence of a nucleus and their own cell wall, parasitism on host cells. The similarity with bacteria lies in the ability of mycoplasma to grow in a cell-free environment. Of all the diversity of representatives of the Mycoplasmataceal family (and there are about 200 known), 16 species inhabit the human body: six of them colonize the genitourinary tract, the rest – the oral cavity and pharynx. The following species are pathogenic to humans:
- M. rheimopiae (causes acute respiratory infections, atypical pneumonia)
- M. hominis (participates in the development of bacterial vaginosis, mycoplasmosis)
- M. genitalium (causes urogenital mycoplasma in women and men)
- M. incognitos (causes poorly studied generalized infection)
- M.fermentans and M. renetrans (associated with HIV infection)
- Ureaplasma urealyticum/parvum (causes ureaplasmosis)
The leading route of transmission of mycoplasma infection is sexual (unprotected genital, oral-genital contacts). Mycoplasmosis coinfections in women are often other urogenital diseases – candidiasis, chlamydia, genital herpes, trichomoniasis, gonorrhea. Of less importance is contact and household infection, which can be realized through the use of common bed linen, towels and washcloths, toilet seats (including in public toilets), non-sterile gynecological and urological instruments. The possibility of non-sexual intrafamilial infection with mycoplasmosis is confirmed by the fact that M. hominis is detected in 8-17% of schoolgirls who do not live a sexual life. The vertical pathway leads to intrauterine infection of the fetus. In addition, transmission of infection is possible during childbirth: M. hominis is detected on the genitals of 57% of newborn girls born to women with confirmed mycoplasmosis.
Mycoplasmas can live on the mucous membranes of the genitals without causing disease – such forms are regarded as mycoplasma-bearing. Women are asymptomatic carriers of mycoplasmas more often than men. Factors that increase the pathogenicity of microorganisms and the likelihood of mycoplasma in women may be infection with other bacteria and viruses, immunodeficiency, bacterial vaginosis (changes in vaginal pH, a decrease in the number of lacto- and bifidumbacteria, the predominance of other opportunistic and pathogenic species), pregnancy, hypothermia.
Symptoms
In about 10% of cases, mycoplasma in women has a latent or subclinical course. Activation of infection usually occurs under the influence of various stress factors. However, even a latent infection poses a potential threat: under unfavorable conditions, it can initiate severe septic processes (peritonitis, post-abortion and postpartum sepsis), and intrauterine infection of the fetus increases the risk of perinatal mortality.
The incubation period lasts from 5 days to 2 months, but more often it is about two weeks. Mycoplasma in women can occur in the form of vulvovaginitis, cervicitis, endometritis, salpingitis, oophoritis, adnexitis, urethritis, cystitis, pyelonephritis. The disease does not have clearly defined specific signs, the symptoms of urogenital mycoplasma infection depend on its clinical form.
Mycoplasma vaginitis or cervicitis is accompanied by excessive transparent discharge from the vagina, itching, burning sensation when urinating, pain during sexual intercourse (dyspareunia). With inflammation of the uterus and appendages, the patient is worried about pulling pains in the lower abdomen and lower back. Symptoms of cystitis and pyelonephritis are an increase in body temperature to 38.5 ° C, painful urination, abdominal pain, lower back pain. Mycoplasmic endometritis is also manifested by menstrual irregularities and intermenstrual bleeding. Infertility in women becomes a frequent complication of this form of infection.
Mycoplasmosis is a great danger for pregnant women. Infection can provoke spontaneous miscarriages, gestosis, fetoplacental insufficiency, chorioamnionitis, polyhydramnios, early discharge of amniotic fluid, premature birth. Premature pregnancy in women infected with mycoplasmas is observed 1.5 times more often than in clinically healthy pregnant women. Intrauterine mycoplasmosis in children can occur in the form of generalized pathology with polysystemic lesion, mycoplasma pneumonia, meningitis. Among infected children, the percentage of birth defects and stillbirths is higher.
Diagnostics
It is not possible to diagnose mycoplasma in women only on the basis of clinical signs, anamnesis, examination data on a chair, smear on flora. It is possible to reliably confirm the presence of infection only with the help of a complex of laboratory tests.
The most informative and fastest method is molecular genetic diagnostics (PCR detection of mycoplasma), the accuracy of which is 90-95%. Scrapings of the epithelium of the urogenital tract or blood can serve as a material for analysis. Bacteriological sowing for mycoplasmosis allows to detect only M. hominis, differs in complexity and longer terms of readiness of the result (up to 1 week), but at the same time allows you to get an antibioticogram. For microbiological analysis, a discharge of the urethra, vaginal arches, and cervical canal is used. A shooting range of more than 104 CFU/ml is considered to be diagnostically significant. The determination of mycoplasma by ELISA and RIF methods, although quite common, is less accurate (50-70%).
Ultrasound methods are of auxiliary importance in the diagnosis of mycoplasma in women: ultrasound of the OMT, ultrasound of the kidneys and bladder, because they help to identify the degree of involvement in the infectious process of the genitourinary system. Mycoplasmosis examination must necessarily be performed by women planning pregnancy (including with the help of IVF), suffering from chronic VZOM and infertility, having a burdened obstetric history.
Treatment and prevention
The question of the treatment of asymptomatic carriage of M. hominis remains debatable. At the present stage, more and more researchers and clinicians are of the opinion that mycoplasma hominis is a component of the normal microflora of a woman and under normal conditions in a healthy body does not cause pathological manifestations. Most often, this type of mycoplasma is associated with bacterial vaginosis, so treatment should be aimed at correcting the vaginal microbiome, and not eliminating mycoplasma.
Targeted treatment of mycoplasma in women is justified in case of detection of M. genitalium and the presence of signs of urogenital inflammation, detection of mycoplasmas in women planning pregnancy or having an unfavorable obstetric history in the past, suffering from infertility. It is also recommended to undergo a medical course before upcoming gynecological operations or minimally invasive intrauterine interventions (abortion, IUD installation).
Etiotropic treatment of mycoplasma in women is prescribed taking into account the maximum sensitivity of the pathogen. Tetracycline antibiotics (tetracycline, doxycycline), macrolides, fluoroquinolones, cephalosporins, aminoglycosides, etc. are most often used. Sometimes antimicrobial agents are administered as part of the plasmapheresis procedure. For local treatment, vaginal creams and tablets containing clindamycin, metronidazole are used. Instillations of the urethra, douching with antiseptics are carried out. Along with antibiotic therapy, antifungal agents, immunomodulators, multivitamin complexes, and eubiotics are prescribed. Ozone therapy and magnetolaser therapy are performed.
Mycoplasmosis treatment should be performed not only by a woman, but also by her sexual partner. The standard course lasts 10-15 days. 2-3 weeks after the completion of the course, a culture study is repeated, a month later – PCR diagnostics, on the basis of which conclusions about recovery are made. Resistance to treatment is observed in about 10% of patients. During pregnancy, mycoplasmosis treatment is carried out only if the infection poses a danger to the mother and child.
Prevention of mycoplasmosis among women consists in the use of barrier methods of contraception, regular gynecological examinations, timely detection and treatment of urogenital infections.