Ureaplasma in women is an infectious inflammatory disease of the genitourinary organs caused by the pathological activity of ureaplasmas. In 70-80% of cases, the disease occurs in the form of asymptomatic carrier. It can manifest itself with nonspecific dysuric symptoms, an increase in the number of transparent vaginal secretions, pulling pains in the lower abdomen and a violation of reproductive function. Bacterial culture, PCR, ELISA, and PIF are used for diagnosis. Etiotropic treatment involves the appointment of antibacterial drugs — macrolides, tetracyclines and fluoroquinolones.
Ureaplasma was first isolated from a patient with non-gonococcal urethritis in 1954. To date, the pathogen is considered a conditionally pathogenic microorganism that exhibits pathological activity only in the presence of certain factors. 40-50% of sexually active healthy women are carriers of bacteria. The microorganism is detected on the genitals of every third newborn girl and in 5-22% of schoolgirls who do not live a sexual life. Although, according to the results of various studies, ureaplasmas were the only microorganisms found in some patients with infertility and chronic diseases of the urogenital sphere, ureaplasmosis is not included as an independent disease in the current International Classification of Diseases.
Causes of ureaplasma in women
The causative agent of the disease is ureaplasma — an intracellular bacterium without its own cell membrane, which has a tropicity to the cylindrical epithelium of the genitourinary organs. Of the 6 existing types of ureaplasmas, pathogenic activity was detected in two — Ureaplasma urealyticum and Ureaplasma parvum. Infection occurs during unprotected sexual contact or during childbirth. Convincing evidence about the contact-household method of transmission of ureaplasmosis does not exist today.
In most cases, the carriage of ureaplasmas is asymptomatic. The main factors contributing to the development of the inflammatory process are:
- Dishormonal states. The pathogen may exhibit pathogenic activity during pregnancy, with violation of the endocrine function of the ovaries.
- Decreased immunity. Inflammation of the urogenital tract occurs more often in women with diseases that reduce immunity, and against the background of taking immunosuppressive drugs (in the treatment of oncopathology).
- Vaginal dysbiosis. Violation of the normal vaginal microflora with irrational antibacterial therapy and hormonal imbalance activates conditionally pathogenic microorganisms, including ureaplasmas.
- Invasive interventions. Abortions, instrumental therapeutic and diagnostic procedures (hysteroscopy, urethro- and cystoscopy, surgical methods of treatment of cervical erosion, etc.) become the starting point for the development of ureaplasmosis in some cases.
- Frequent change of sexual partners. The bacterium is activated in association with other STI pathogens that penetrate a woman’s genitals during unprotected sex with casual partners.
The pathogenesis of ureaplasma in women is based on the adhesive-invasive and enzyme-forming properties of the microorganism. Upon contact with the mucosa of the genitourinary organs, the bacterium attaches to the shell of the cylindrical epithelium cell, merges with it and penetrates into the cytoplasm, where its reproduction takes place. The microorganism produces a special enzyme that cleaves immunoglobulin A, thus reducing the immune response to infection. With an asymptomatic course, local inflammatory and destructive changes are poorly expressed. An increase in the pathogenic activity of the pathogen under the influence of provoking factors leads to the development of inflammation — vascular reaction, increased tissue permeability, destruction of epithelial cells.
The main criteria for distinguishing clinical forms of ureaplasma in women are the nature of the course and the severity of pathological manifestations. In particular, specialists in the field of gynecology distinguish:
- The carriage of ureaplasmas. The majority of women, during the examination of which this microorganism is detected, have no signs of inflammatory processes.
- Acute ureaplasmosis. It is extremely rare, accompanied by clinically pronounced signs of damage to the genitourinary organs and general intoxication.
- Chronic ureaplasmosis. Signs of acute inflammation are absent or appear periodically in the presence of provoking factors, there may be violations of reproductive function and chronic inflammation of the organs of the urogenital tract.
In 70-80% of cases, there are no clinical manifestations indicating infection of the body with ureaplasmas. The disease has no specific symptoms and during periods of exacerbations is manifested by signs characteristic of inflammatory processes in the genitourinary system. A woman may complain of discomfort, pain, burning, painful sensations when urinating. The volume of transparent vaginal discharge increases slightly. With the upward development of infection with damage to the internal reproductive organs, aching or pulling pains in the lower abdomen may bother. In acute course and during periods of exacerbations, the temperature rises to subfebrile figures, the patient notes weakness, fatigue, decreased performance. Chronic ureaplasmosis may be indicated by treatment-resistant urethritis, vaginitis, endocervicitis, adnexitis, inability to get pregnant, spontaneous termination or pathological course of pregnancy.
With a long course, ureaplasma in women is complicated by chronic inflammatory processes in the uterus and appendages, which lead to infertility, miscarriages and premature birth. The situation is aggravated by the infection of a partner who may develop male infertility against the background of the disease. In some cases, inflammation, vascular and autoimmune processes in the endometrium cause primary placental and secondary fetoplacental insufficiency with a violation of normal fetal development, the risk of abnormalities and an increase in perinatal morbidity. Since pregnancy is a provoking factor for the activation of a microorganism, and the treatment of an infectious disease involves the appointment of drugs that can affect the fetus, it is important to identify the pathogen in a timely manner during reproductive planning.
The data of vaginal examination, bimanual examination and the clinical picture of the disease are non-specific and, as a rule, indicate the presence of an inflammatory process. Therefore, a key role in the diagnosis of ureaplasma in women is played by special research methods that allow detecting the pathogen:
- Tank. sowing for ureaplasma. When sowing biomaterial (secretions, smears) on the nutrient medium, colonies of ureaplasmas are detected, after which their sensitivity to antibacterial drugs is determined.
- PCR. With the help of a polymerase chain reaction, the genetic material of the pathogen can be detected in the patient’s biomaterial during the day.
- Serological examination. During immunofluorescence analysis (ELISA) and with direct fluorescence, antibodies to the bacterium are detected in the woman’s blood, their titer is determined.
In differential diagnosis, it is necessary to exclude infection with other pathogens — chlamydia, trichomonas, gonococci, mycoplasmas, etc. The basis for the diagnosis of ureaplasmosis is the presence of inflammatory processes in the genitourinary organs of a woman in the absence of any other STI pathogens other than ureaplasmas. Along with a gynecologist, a urologist is involved in consulting the patient.
Treatment of ureaplasma in women
The key objectives of therapy for ureaplasma infection are to reduce inflammation, restore immunity and normal vaginal microflora. Patients with clinical signs of ureaplasmosis are recommended:
- Etiotropic antibiotic therapy. When choosing a drug, it is necessary to take into account the sensitivity of the pathogen. Usually, a 1-2-week course of tetracyclines, macrolides, and fluoroquinolones is prescribed.
- Sanitation of the vagina. The introduction of candles with an antibiotic and an antifungal drug complements the antibacterial treatment.
- Immunotherapy. Immunomodulating and immunostimulating agents, including those of plant origin, are shown to restore immunity.
- Normalization of vaginal microbiocenosis. The use of probiotics topically and internally allows you to restore the vaginal microflora, which inhibits the pathological activity of ureaplasmas.
- Enzyme preparations. Enzymes have an anti-inflammatory effect and enhance tissue regeneration processes.
- Vitamin therapy. Multivitamin and vitamin-mineral complexes are used for the general strengthening purpose in the complex treatment of ureaplasma in women.
It is important to note that the indications for the appointment of etiotropic anti-ureaplasma treatment are limited. As a rule, antibiotics are used when ureaplasmas are detected in patients with treatment-resistant chronic inflammatory processes and reproductive disorders in the absence of other STI pathogens. Also, an antibacterial course is recommended for ureaplasma carriers who are planning pregnancy.
Prognosis and prevention
The prognosis of ureaplasma in women is favorable. Etiotropic treatment allows you to completely get rid of the bacterium, however, due to the lack of passive immunity and the high prevalence of the pathogen, re-infection is possible. Since ureaplasma is a conditionally pathogenic microorganism, rational sleep and rest, seasonal maintenance of immunity, reasoned appointment of invasive methods for the diagnosis and treatment of diseases of the female genital area, the use of barrier contraception are important for the prevention of inflammation. Preventive antibiotic therapy is recommended for women with ureaplasma carriers to prevent pathological activation of the pathogen during planned pregnancy.