Among the reasons for the increasing role of mycoplasma infection in increasing the number of inflammatory diseases of the human genitourinary system, experts determine the change in the forms of sexual behavior of the population and the increase in the frequency of cases of resistance of the pathogen to traditional drugs. Since M. genitalium occurs not only as a monoinfection, but also in combination with other STI pathogens, the control of M. genitalium to counteract the spread of STIs in the population is relevant.
Back in the early 1990s, domestic scientists predicted that in the near future in Ukraine, among the predominantly sexually transmitted infections (STIs), both in the structure of morbidity and in the list of causal factors in the development of reproductive disorders, pathogens groups of pathogenic mycoplasmas (family Mycoplasmataceae). This prognosis was based on the difficulties of diagnosis at that time, the phenomenon of high prevalence in the population and the inadequacy of antibiotic therapy in patients with signs of an inflammatory lesion of the lower genitourinary system.
Although since then some of these problems have been eliminated or studied and studied in more detail, this forecast remains relevant today. Thus, lesions of the genitourinary system of mycoplasmal etiology have recently been more common and account for about 40% of inflammatory diseases of the human genitourinary system. A similar situation is observed not only in Ukraine, but also at the global level, especially among people of young reproductive age.
Today, among the reasons for the growth of the role of mycoplasma infection in the increase in the number of inflammatory diseases of the human genitourinary system, experts identify several other factors: changes in sexual stereotypes, forms of sexual behavior of the population and an increase in the frequency of cases of pathogen resistance to traditional drugs used in specialized clinics .
Features of urogenital mycoplasmosis
A significant number of specialists unite inflammatory diseases of the human genitourinary system caused by pathogenic mycoplasmas under the same name "urogenital mycoplasmosis". This includes inflammatory lesions of the urogenital organs that occur against the background of the detection of M. genitalium, M. hominis and U. urealyticum (and since 2000, U. parvum, which was isolated from the genus U. urealyticum as a separate genus). The use of this term, as well as the question of the role of individual mycoplasmas as etiological factors in the development of inflammatory diseases of the human genitourinary system, is debatable.
Although the logic of using the term "urogenital mycoplasmosis" can be traced (by analogy with the common term "urogenital chlamydia" in the case of an inflammatory lesion of the genitourinary system C. trachomatis), but then it is correct to use it only if a patient with symptoms of urethritis is diagnosed as monoinfection M. genitalium or, in some cases, U. urealyticum.
This opinion is based on the following facts. In the list of STI pathogens defined by the World Health Organization (WHO) in the core document Global Strategy for the Prevention and Control of Sexually Transmitted Infections 2006-2015, only M. genitalium and U. urealyticum are named from the group of mycoplasmas. At the same time, the name of the disease that they cause by analogy with chlamydial infection is not indicated. At the same time, despite a large number of scientific studies, the role of M. hominis, U. parvum and U. urealyticum as etiological factors in the occurrence of inflammatory diseases of the genitourinary system has not been proven.
There are a significant number of published studies, the results of which can be considered as direct or indirect evidence of the pathogenicity of these types of mycoplasmas for the human body and their direct impact on reproductive function. A study in Belgium in 2000 in 228 women in the first trimester of pregnancy with bacterial vaginosis, Mycoplasma hominis and Ureaplasma urealyticum, found an association between the presence of these infections and an increased risk of miscarriage up to 20 weeks. Similar results were obtained during a study in the same year in Italy: the role of Ureaplasma urealyticum colonization in the development of premature rupture of membranes was revealed. In a study conducted in 2001 in Denmark, when examining 484 pregnant women, it was found that that neither bacterial vaginosis nor Ureaplasma urealyticum colonization was associated with the development of preterm birth.
Today, the vast majority of specialists - both dermatovenerologists and urologists and gynecologists - believe that Ureaplasma urealyticum, Ureaplasma parvum and Mycoplasma hominis are opportunistic pathogens, and M. genitalium is an obligate pathogen of the genitourinary tract in men and women .
Specificity of urogenital mycoplasmosis
It is indicative that according to the results of the consensus of specialists from various specialties in the Russian clinical guidelines for the diagnosis and treatment of STIs, in particular those caused by urogenital mycoplasmas of both 2010 and 2012, there are clear indications for prescribing antibiotic therapy in case of detection of Ureaplasma urealyticum, Ureaplasma parvum and Mycoplasma hominis. The detection of M. genitalium is a direct indication for the treatment of the patient, as well as his sexual partners, even in the absence of signs of an inflammatory process. Thus, of all members of the mycoplasma group, only M. genitalium can be clearly identified as the causative agent of human urogenital infections.
M. genitalium is not only the most pathogenic representative of the mycoplasma group, but also the “youngest”. Although this type of mycoplasma was first described by British researchers as early as 1981 when it was isolated from two men with clinical manifestations of nongonococcal urethritis (NGU), even now American scientists in their scientific publications call M. genitalium a new causative agent of STIs. Given the localization, this microorganism was named "genitalium".
For a long time, large-scale epidemiological studies on M. genitalium in the world were practically not carried out due to significant difficulties in isolating it on nutrient media. Since 1991, when polymerase chain reaction (PCR) was first used to diagnose M. genitalium, this problem has been eliminated. Today, it is PCR that remains the most accessible and effective method for identifying this STI pathogen for both researchers and practitioners. It was thanks to the introduction of molecular methods for the diagnosis of M. genitalium that sexual transmission of the infection was proven, and this infectious agent was included in the list of causative agents of STIs.
Place and significance of M. genitalium among STI pathogens
M. genitalium is thought to be a single etiological agent of acute and persistent NGU in men and is responsible for 20-35% of all cases of non-chlamydial NGU. This significantly distinguishes M. genitalium from other representatives of this group of microorganisms (M. hominis, U. parvum and U. urealyticum), which are mainly involved in the development of inflammatory processes in the human genitourinary system in association with other STI pathogens.
The association of M. genitalium with other STIs in the presence of inflammatory lesions of the genitourinary system in men and women remains debatable. Thus, some researchers believe that M. genitalium is almost never associated with bacterial vaginosis in women and the number of sexual partners, others are convinced that the frequency of detection of M. genitalium, on the contrary, correlates with the number of sexual partners.
Analysis of more than 40 independent studies among women in the general population in various countries of the world (more than 13 thousand patients examined) showed that the infection rate among women with a low risk of infection is about 2.0%, which is intermediate between the frequency of detection of N gonorrhoeae (0.4%) and C. trachomatis (4.2%), respectively. At the same time, in similar studies among women in high-risk populations (sex workers, patients of specialized clinics with signs of inflammatory diseases of the genitourinary system, etc.), a significantly higher incidence of infection of the urogenital tract with M. genitalium was recorded - 7.8%.
An interesting scatter of scientists' opinions about the association of M. genitalium with C. trachomatis as one of the most common STI pathogens today. Thus, there is a well-founded opinion that M. genitalium exists independently of C. trachomatis and occurs in clinical practice with approximately the same frequency as chlamydial infection. This statement is explained by the existence of competition between these pathogenic microorganisms for the same target cells, nutrients and other co-factors of the full existence of M. genitalium and C. trachomatis in the human body.
On the other hand, IUSTI (International Union against Sexually Transmitted Infections) experts consider it mandatory to order an examination for the presence of M. genitalium in patients who
Thus, a relatively high level of M. genitalium infection has been proven both in the general population and among representatives of high-risk groups of infection, and a significant role of this infection in the occurrence of inflammatory diseases of the lower genitourinary system has been determined. Since M. genitalium occurs not only as a monoinfection, but also in combination with other STI pathogens, the issue of combating M. genitalium in the system of combating the spread of STIs among the population is relevant.
M. genitalium as a factor in reproductive health disorders
Today, there is no doubt about the influence of M. genitalium on the development of inflammatory lesions of the lower genitourinary system in men. This has been proven by a number of experiments in animal models, as well as studies of men with NGU. Scientists have not come to an unambiguous conclusion about the role of M. genitalium in causing urethritis in women, although there are a number of studies, the results of which prove the connection of microscopic signs of inflammation of the urethra in women with M. genitalium infection.Regarding the development of cervicitis on the background of infection with M. genitalium, the etiological influence of microorganisms on the development of this lesion of the lower genitourinary system in women is considered practically proven. At the same time, according to scientists, the degree of increased risk of developing cervicitis when infected with M. genitalium is similar to the degree of risk when infected with the generally recognized pathogens of this disease (N. gonorrhoeae and C. trachomatis).
At the same time, there are significant differences in the clinical course of inflammatory lesions of the lower genitourinary system caused by M. genitalium and C. trachomatis. So, in particular, urethritis caused by M. genitalium in an acute manifest form occurs more often than urethritis of chlamydial etiology. In general, asymptomatic urethritis caused by M. genitalium is not typical. This is confirmed by the results of a study of the frequency of detection of M. genitalium in men in different countries of the world. Thus, studies by various authors have shown that M. genitalium was found in 13-42% of men with NGU, in 18-46% of patients with non-gonococcal and non-chlamydial urethritis, and only in 9% of patients with asymptomatic urethritis.
It is not yet possible to give an unambiguous answer to the question of the effect of M. genitalium on the development of inflammatory diseases of the upper genitourinary system in men and women and on infertility. Thus, there is little information about pathological lesions of the genitourinary system in men caused by M. genitalium, which can cause infertility. There are practically no reports that the presence of M. genitalium can cause the development of orchitis, there are single reports that M. genitalium causes the formation of prostatitis as a complication of chronic recurrent NGU. Although there is no clear answer regarding the etiological influence of M. genitalium on the development of acute and chronic prostatitis. At the same time, there are reports that M. genitalium can attach to spermatozoa and reduce their activity,
The issues of inflammatory lesions of the upper reproductive tract in women today are covered somewhat more in the scientific literature. But, despite the presence of a number of studies in various countries of the world, the relationship between M. genitalium infection and the development of inflammatory diseases of the pelvic organs has not been reliably proven. Thus, some researchers indicate that infection with M. genitalium is significantly associated with the presence of endometritis, and the frequency of its detection is 3 times higher than in patients not infected with M. genitalium. Other scientists, conducting studies among women at high risk of infection (sex workers), did not reveal such a relationship.
Furthermore, to date, it has not been possible to reliably prove the existence of a direct relationship between infection with M. genitalium and the occurrence of ectopic pregnancy, preterm labor and other adverse pregnancy outcomes.
The question of the role of M. genitalium in the development of secondary infertility in women can be considered clarified. A number of studies have confirmed the existence of an association between infection with M. genitalium and the development of tubal infertility in women, which has been proven in experimental studies in animal models.
Thus, M. genitalium is not only the youngest member of the urogenital mycoplasma group, but also the most dangerous of them in terms of its impact on human reproductive health. This microorganism is an obligate pathogen for humans and the causative agent of STIs.
M. genitalium causes inflammatory diseases of the lower genitourinary system in both men and women, its detection is a direct indication for the treatment of the patient and his sexual partners. M. genitalium infection can cause secondary infertility in both men and women.
The urgency of introducing measures to control the spread of M. genitalium in the population is constantly growing; there is a need to focus the attention of practicing physicians of various specialties (venereologists, urologists, obstetricians-gynecologists, family physicians, and others) on the issues of timely diagnosis of M. genitalium and treatment of patients infected with the STI pathogen in order to preserve the reproductive health of the population.
According to http://health-ua.com
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