Why during the treatment of ureaplasma. Ureaplasmosis. Causes, symptoms, modern diagnostics, effective treatment, disease prevention. Garlic tampons

Ureaplasmosis - symptoms and treatment

What is ureaplasmosis? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of Dr. V. P. Kovalyk, a urologist with an experience of 25 years.

Definition of disease. Causes of the disease

Ureaplasmosis- a group of inflammatory and dysbiotic diseases associated with ureaplasmas ( Ureaplasma species). Since 1995, two types of ureaplasmas have been distinguished: Ureaplasma urealyticum And Ureaplasma parvum. Genome U. urealyticum much bigger U.parvum. At present, it is impossible to state that any of the species is an obvious pathogen or vice versa - a saprophyte.

Ureaplasmas are conditionally pathogenic microorganisms that are often found on the mucous membranes of the genitourinary organs, upper respiratory tract and in the oropharynx.

For the first time, ureaplasmas were isolated in the USA from a dark-skinned patient with non-gonococcal urethritis in 1954.

The first hit of ureaplasmas in the male urethra, as a rule, causes urethritis - inflammation of the urethra. There is evidence that in women, ureaplasmas are associated with acute pelvic inflammatory disease (PID), as well as with bacterial vaginosis. The role of ureaplasmas in the occurrence of bronchopulmonary diseases in newborns (bronchitis, pneumonia) and postpartum chorionamnionitis has been proven.

The role of ureaplasmas in human pathology has not been fully established. The study of the pathogenetic relationship of these microorganisms with a wide range of diseases from different areas continues:

Ureaplasmas are often part of the normal microflora of the urethra and vagina. The frequency of detection of ureaplasmas averages 40% in the genitourinary organs in women and 5-15% in men. Wherein U.parvum found much more frequently than U. urealyticum(38% versus 9%).

Ureaplasmas are spread through sexual contact. The more sexual partners during a lifetime, the more often the colonization of the vagina or urethra by ureaplasmas. Ureaplasmas are transmitted to newborns when passing through the birth canal. In this case, the colonization of the mucosa of the vulva and vagina in girls and the nasopharynx in both sexes occurs. The frequency of detection of ureaplasmas in newborns can reach 30% or more, decreasing to a few percent by the first year of life.

Subsequently, an increase in the frequency of colonization by ureaplasmas begins from the moment of the onset of sexual activity (at 14-18 years).

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of ureaplasmosis

Symptoms vary depending on the underlying disease.

Urethritis can be manifested by scanty discharge and burning in the urethra, frequent urination. Without treatment, urethritis tends to resolve itself: the symptoms subside, the patient calms down. Past urethritis increases the likelihood of future inflammation of the prostate gland - prostatitis. In addition, complications of urethritis can be epididymo-orchitis - inflammation of the testicle and its epididymis, vesiculitis - of the seminal vesicle and, rarely, cooperitis - of the bulbourethral gland.

Acute salpingoophoritis, endometritis can be manifested by pulling pains in the lower abdomen, fever, weakness and discharge from the vagina. Inflammatory diseases of the pelvic organs in women are a natural consequence of bacterial vaginosis observed when ureaplasmas are detected. Symptoms of the disease can quickly worsen, often requiring hospitalization in a gynecological hospital.

In addition to inflammatory diseases, ureaplasmas, in addition to many other microorganisms, are associated with bacterial vaginosis.

bacterial vaginosis, as a rule, it is accompanied by discharge with an unpleasant odor, which, moreover, increases during intimacy.

The disease predisposes to obstetric and gynecological complications: premature birth, low birth weight.

The author of the article shares the views of world experts in the field of urogenital pathology ( Jenny Marazzo, Jorma Paavonen, Sharon Hillier, Gilbert Donders) on the lack of connection of ureaplasmas with the occurrence of cervicitis and vaginitis.

It should be noted here that the Russian guideline calls for the treatment of cervicitis and vaginitis, based on the etiological role of ureaplasmas in these diseases, which, of course, is a mistake.

The pathogenesis of ureaplasmosis

Ureaplasmas are conditionally pathogenic microorganisms, that is, their pathogenic properties are realized only under special conditions: high concentration on the mucosa, immunosuppression, and others.

Ureaplasmas are attached to the surface of the mucous membrane with the help of cytoadhesin proteins. In addition to the urethral epithelium, ureaplasmas are able to attach to erythrocytes and spermatozoa.

One of the main factors of pathogenicity are the enzymes phospholipase A and C, under the influence of which prostaglandin is produced in the body - a factor that triggers contractions of involuntary muscles, therefore, premature birth is possible. The inflammatory response is accompanied by the production of pro-inflammatory cytokines - IL 6, 8, 10.

Ureaplasmas have IgA-protease activity, destroying the local protective factor of the mucous membrane immunoglobulin A.

The inflammatory process in the urethra develops with a high concentration of ureaplasmas. So it is shown that 10 3 CFU / ml and above is associated with the detection of 12 or more leukocytes per ml in the urethral contents.

Special factors of pathogenesis are realized when bacterial vaginosis occurs. At the same time, the factors of local mucosal immunity are weakened, due to which such patients are more susceptible to infection with sexually transmitted infections (including HIV). The acidity of the vaginal contents (pH is normal 3.5-4.5) is reduced to a neutral environment (pH 6.5-7 and above). Thus, the natural protective barrier against pathogens is weakened.

Classification and stages of development of ureaplasmosis

According to the duration of the course, they distinguish spicy And chronic urethritis. Acute urethritis - up to 2 months, chronic - more than 2 months. In the latter case, one distinguishes recurrent And persistent urethritis.

Chronic recurrent urethritis a disease is considered in which leukocytes in the urethra returned to normal by the end of treatment, and after 3 months their rise was again observed over 5 in the field of view (with an increase of x1000). Chronic persistent urethritis- when an increased content of leukocytes was observed at the end of treatment and after 3 months.

PID involves the fallopian tubes, ovary, and their ligaments being involved in the process. Inflammation of the appendages can be unilateral or bilateral, acute or chronic. The main symptoms: pain in the lower abdomen, in the lower back, discharge from the genital organs, temperature of 38 ° C and above.

Complications of ureaplasmosis

In men, complications of urethritis are balanoposthitis - inflammation of the head and foreskin of the penis. Prostatitis is also possible, less often - epididymo-orchitis and cervical cystitis. At the same time, ureaplasmas are not considered as an independent agent that causes inflammation of the prostate gland. Probably, this chain of complications occurs through posterior urethritis and is realized with the help of urethroprostatic reflux, i.e., the reflux of the contents of the posterior urethra into the acini of the prostate and the vas deferens.

In women, PID may be complicated by tubo-ovarian abscess, and occasionally peritonitis and sepsis occur. In the long term, serious complications are possible that have social consequences: chronic pelvic pain, and infertility.

It is unlikely that only the presence of ureaplasmas in the vaginal biocenosis will lead to such complications. These microorganisms realize their pathogenic potential together with other microorganisms, leading to dysbiotic changes - bacterial vaginosis.

Diagnosis of ureaplasmosis

Indications for the appointment of studies to identify ureaplasmas are clinical and / or laboratory signs of an inflammatory process: urethritis, PID. Routine studies should not be performed on all patients, incl. without signs of any disease.

To detect ureaplasmas, only direct detection methods are used: bacteriological and molecular genetic. Determination of antibodies: IgG, IgA, IgM is not informative. The material for the study can be the discharge of the genitourinary organs, urine, vaginal secretions, etc.

Bacterial vaginosis is verified using the Amsel criteria:

1. creamy discharge on the walls of the vagina with an unpleasant odor;
2. positive amine test (increased "fishy" smell when 10% KOH is added to the vaginal secretion);
3. an increase in the pH of the vaginal contents above 4.5;
4. the presence of key cells on microscopy of vaginal contents.

In the presence of any 3 of the 4 criteria, the diagnosis is established. However, due to the complexity of implementation, the impossibility of measuring pH, the evaluation of the Amsel criteria is difficult. There are commercial research panels based on quantitative molecular genetic methods (Florocenosis, Inbioflor, Femoflor), which determine the diagnosis of bacterial vaginosis.

Treatment of ureaplasmosis

Treatment is indicated only in cases where, as a result of the examination, an obvious connection between ureaplasmas and the inflammatory process was revealed. In the case of a healthy carriage of ureaplasmas, treatment is not indicated. It is a vicious practice to prescribe therapy to all persons who have ureaplasmas.

Treatment is indicated for sperm donors and infertility, when no other causes have been identified.

Recent bacteriological studies have shown high activity against ureaplasmas of doxycycline, josamycin and a number of other antimicrobial drugs.

• Doxycycline monohydrate 100 mg 1 tab. 2 times a day;
• or Josamycin 500 mg 1 tab. 3 times a day.

With the persistence of the inflammatory process, the course can be extended up to 14 days.

When bacterial vaginosis is detected, vaginal preparations are prescribed:

It is important to note that the goal of treatment is not to "cure ureaplasmas", complete eradication of these microorganisms is not required. It is only important to cure the disease: urethritis, bacterial vaginosis, PID. In most cases, treatment of the sexual partner is not required.

Forecast. Prevention

Limiting the number of sexual partners, the use of barrier methods of contraception reduce the colonization of ureaplasmas. In cases where there is already a carriage of ureaplasmas, a preventive examination and consultation with specialized specialists is necessary before:

Bibliography

1. Shepard MC. The recovery of pleuropneumonia-like organisms from Negro men with and without nongonococcal urethritis. Am J Syph Gonorrhea Vener Dis. 1954 Mar;38(2):113-24
2. Waites K. et al, Mycoplasmas and ureaplasmas as neonatal pathogens. Clinical microbiol review, Oct 2005, 757-789
3. Zhou YH, Ma HX, Shi XX et al. Ureaplasma spp. in male infertility and its relationship with semen quality and seminal plasma components. J Microbiol Immunol Infect. 2017 Jun 22
4. Leli C, Mencacci A, Latino MA et al. Prevalence of cervical colonization by Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis and Mycoplasma genitalium in childbearing age women by a commercially available multiplex real-time PCR: An Italian observational multicentre study. J Microbiol Immunol Infect. 2017 Jun 28

Initially, it was attributed to mycoplasma, but today it is equated with a class of bacteria, since it breaks down urea.

The appearance of ureaplasmosis is promoted by microorganisms that do not have DNA and cell membranes.

There are 2 types of ureaplasma:

1. parvum;
2. workshop.

Also a type of ureaplasma is urealiticum. These are bacteria with a poorly defined cell membrane, which allows them to quickly penetrate the mucous membranes of the genitourinary system.

The main danger of ureaplasma urealiticum can be considered its easy introduction into the mucous membranes, sperm and blood, which leads to devastating consequences. Therefore, if effective treatment is not carried out, this bacterium will greatly weaken the immune system.

Often, ureaplasma is transmitted during childbirth from mother to child. And adults can become infected with it through unprotected sexual contact. Domestic infection is almost impossible.

It is noteworthy that in some newborns who were infected at birth, ureaplasma disappears on its own without antibiotic treatment. Women are often considered carriers of the infection. In men, it is not often detected, in addition, the level of self-healing among the male is much higher.

How to treat ureaplasma?

It is not always easy to cure ureaplasmosis, since the causative agent of the disease is resistant to various types of antibiotics that affect the synthesis of the microbial wall. However, the infection is sensitive to inhibitors of the synthesis of cell membrane proteins and intracellular proteins. Thus, before treatment with antibiotics, these drugs should be tested for sensitivity or resistance of bacteria to them.

Ureaplasma urealiticum, workshop and parvum can be cured according to certain therapeutic regimens in 10-14 days. However, for patients with immunodeficiencies, the duration of treatment may be extended.

There are generally accepted criteria that require specific treatment for ureaplasmosis:

• The presence of clinical manifestations of the infectious process in the genitourinary system and various organs.
• Carrying out a comprehensive preliminary bacteriological analysis with the determination of quantitative and qualitative characteristics of the pathogen.
• Identification of infertility in women caused by ureaplasmosis.
• All kinds of invasive interventions, in particular gynecological, in women with hidden carriage in order to prevent the prevalence of ureaplasma.

Drugs used to combat ureaplasma can be classified. Antibiotics include azalides (Azithromycin) and tetracyclines (Doxycycline, Minocycline).

Macrolides (Clarithromycin, Erythromycin) are alternative drugs. They also include fluoroquinolones such as Lomefloxacin and Ofloxacin. However, these tablets are prescribed only if antibiotic and macrolide treatment has failed.

Thus, ureaplasma can be destroyed with azalides, macrolides and tetracyclines.

The first scheme means V oral administration of doxycycline (100 mg twice a day) for 10 days. Doxycycline is an alternative to Azithromycin. The initial dose is 1 gram, and for the next 7 days the tablets are taken at 0.5 g each, and the scheme may differ slightly.

The second scheme is that during the week, Josamycin is taken orally in an amount of 0.5 g twice a day. But for the first time, you should drink 1 g of the drug. An alternative is Claricar based on clarithromycin, which should be taken for a week at 0.5 g 2 times a day.

During pregnancy, Josamycin is also prescribed. It must be drunk for at least 7 days, 0.5 g twice a day.

Erythromycin tablets can be considered an alternative solution for the treatment of ureaplasmosis with antibiotics. The drug is drunk four times a day for 0.5 g for 10 days. Azithromycin can also be prescribed in an amount of 0.5 g once a day, which should be drunk for a week.

With domestic and intrauterine infection, treatment of ureaplasma is carried out taking into account age-related characteristics. So, newborns weighing less than 2 kg are prescribed Erythromycin four times a day with the calculation of 20 mg per 1 kg for 7 days. If the weight is more than 2 kg, then the dose is 30 mg per 1 kg, which must be drunk in 4 doses per day. The course of therapy is one week.

How many days should patients take drugs from ureaplasma, aged from 1 week to 1 month? The drug Erythromycin should be drunk for 10 days four times a day, 40 mg per 1 kg of weight.

For patients under 9 years of age, Erythromycin is prescribed 4 times a day with the calculation of 50 mg per 1 kg of body weight. The duration of treatment is 10 days.

An alternative to Erythromycin is Clarithromycin tablets, which should be taken 2 times a day at 10 mg/kg. In addition to the above antibiotics, some doctors prescribe Azithromycin, it should be drunk for at least 5 days in an amount of 8-10 mg / kg. It is worth noting that the dosage for patients older than 9 years is the same as for an adult.

Doxycycline with ureaplasma infection is rational to take only when treatment with other drugs has been ineffective. After all, this antibiotic immediately has 3 adverse effects on the body:

1. Ototoxic - with prolonged use, deafness may develop.
2. Nephrotoxic - a violation of the excretory function of the kidneys.
3. Hepatotoxic - liver damage, in which the process of destruction of toxins is disrupted.

Today, in addition to antibiotics, in order to quickly cure ureaplasmosis, drugs are used to correct the immune system. Thanks to extracorporeal methods in infectious foci, it is possible to create the desired concentration of therapeutic substances without involving enzyme systems in the body. It is noteworthy that such therapeutic regimens bring good results, especially for patients with immunodeficiencies.

So, methods of treating ureaplasmosis involve not only taking antibiotics, but also drugs that trigger immune processes. Immunomodulators stimulate the body's defenses, which allows it to quickly defeat pathogens. With ureaplasma, preference is given to drugs such as Neovir and Cycloferon.

After immunomodulatory therapy, it is necessary to carry out restorative treatment, including the following:

1. enzymatic agents (Wobenzym);
2. adaptogens (Estifan);
3. biostimulants (aloe extract, Plazmazol);
4. drugs that restore the mucous membranes of the urinary organs (methyluracil);
5. antioxidants (antioxycaps).

How long does this treatment take? The duration of restorative therapy is from 10 to 14 days.

To find out the results of the therapy, laboratory tests are done 14 days after the end of treatment. Even if the therapy was successful and the concentration of ureaplasma in the body is not exceeded, the patient still needs to undergo a medical examination 2 times during the year.

Ureaplasma is a conditionally pathogenic flora (bacteria live in the body without causing harm). In low titers, it can also be detected in healthy women. Despite different statistics, ureaplasma, nevertheless, remains the most common infection. Due to the presence of bacteria in the normal flora, in practice it is not included in the list of STIs (sexually transmitted infections), although it is transmitted through sexual contact. But this does not mean at all that it does not need to be treated. When complicated, the disease can cause large-scale harm. Below we will tell you what secret danger the opportunistic flora carries.

Principles of treatment of ureaplasma

Usually, when an infection or virus is detected, the disease itself is treated, and not just the symptoms. But in this case, it's the other way around. Since microorganisms are conditionally pathogenic flora, then with ureaplasma it is necessary to treat immunity, symptoms, an inflammatory process against the background of the disease, to carry out restorative therapy, i.e. treat the body as a whole. As in the treatment of other infectious diseases, the main principle of treatment is the treatment of both partners, especially if pregnancy is planned. Indeed, in the case of a pregnant woman, even such conditionally pathogenic flora can be quite dangerous.

What drugs to treat ureaplasma

Antibiotic regimen

Before treating, it is necessary to identify the type of ureaplasma. The main species are Ureaplasma parvum (Ureaplasma parvum) and Ureaplasma urealyticum (Ureaplasma urealyticum). Both of these species cause the disease - ureaplasmosis. But ureaplasma parvum in women is more pathogenic and has a more complex treatment structure. And therefore, in this article we will mainly talk about the treatment of ureaplasma parvum, but remember that the treatment of ureaplasma urealiticum is almost the same.

be careful

Among women: pain and inflammation of the ovaries. Fibroma, myoma, fibrocystic mastopathy, inflammation of the adrenal glands, bladder and kidneys develop. As well as heart disease and cancer.

The treatment regimen for ureaplasmosis is prescribed after a complete examination, diagnostic studies (bacterial analysis, scraping for PCR, blood donation for antibodies to infection, ultrasound of the pelvic organs and the bladder), and the results of all tests performed. Age, general condition, complexity of the clinical picture, allergic history, and the presence of other infections are taken into account.

The scheme includes complex therapy, consisting of antibacterial therapy, immunomodulatory agents, restoration of intestinal and vaginal microflora, local therapy, restorative therapy, physiotherapy procedures. Preparations for the treatment of ureaplasmosis in women are selected only by your doctor. It is impossible to cure ureapalasma on its own.

Antibacterial drugs:

• macrolides - erythromycin (eracin, zinerit), josamycin (vilprafen), azitrmoicin (sumamed), clathromycin (clacid, calabax), rovamycin, midecamycin (macropen);
• tetracyclines - minocycline, unidox-solutab, vibramycin;
• fluoroquinolones - ciprofloxacin (tsifran, cyprinol), ofloxocin, levofloxacin (levolet), pefloxocin, gatifloxacin (tebris, gatibact), moxifloxacin (avelox),
• lincosamides - dalacin, clindamycin;
• aminoglycosides - gentamicin is mainly prescribed.

In practice, antibiotics from a number of macrolides are used. These drugs are the most effective and well tolerated. According to statistics, sensitivity to macrolides is about 90%, which indicates almost 100% recovery.

Antibiotic treatment can be started with titres of more than 10 * 3 and the presence of a clinical picture, in other cases, treatment is not required. Often ureaplasmosis is accompanied by other infections, in which case the doctor may prescribe two or three antibiotics in one regimen. Treatment lasts at least 10 days.

Immunomodulating and restorative therapy

Ureaplasma depends on the state of immunity, so the normalization of immunity is the main method of treatment. Rehabilitation therapy should also be carried out.

1. Immunomodulating agents:

• cycloferon;
• polyoxidonium;
• interferons (genferon, viferon);
• ureaplasma-immune;
• immunal;
• immunomax;
• licopid;
• Groprinosin - antiviral and immunomodulatory therapy.

1. Restoration of the intestinal flora:

• Linex;
• Bififor;
• Baktisubtil;
• Hilak Forte;
• Bificol;
• Lactobacterin;
• Bifidobacterin.

1. Restoration of the vaginal flora - these drugs contain live lactobacilli (normal microflora bacteria), are prescribed only after the main and local therapy:

• lactagel;
• lactoginal;
• vagilak;
• lactanorm.

1. Liver recovery:

• hepatoprotectors - hepral, carsil;
• galavit is an immunomodulatory drug that protects the liver.

local therapy. Using Candles

With local therapy, I use special ointments and suppositories with antibacterial, anti-inflammatory, antimicrobial and immunomodulatory effects. Local therapy is carried out along with the main therapy. The duration of treatment is 10-14 days. In special cases, the doctor may prescribe two or three drugs at the same time. All candles are inserted overnight and stored in the refrigerator.

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Other medicines

Along with antibiotic therapy, other drugs are prescribed to improve the effectiveness of treatment.

1. Antifungal drugs: These drugs are usually prescribed along with antibiotics to avoid intestinal and vaginal dysbiosis.

• fenticonazole - lomexin,
• bifonazole - bifosin,
• clotrimazole - kagdid-B,
• polyenes - nystatin, levorin, pimofucine,
• oronazole;
• ketoconazole (sebozol);
• itraconazole (irunin, orungal, tecnazol, orungal, orunite);
• fluconazole (flucostat, diflucan, fungolon, diflazon, mycosyst).

1. Adaptogens - ginseng, Rhodiola rosea, Echinacea purpurea;
2. Enzymes - Wobenzym, Serta.
3. Vitamins - any multivitamin complexes will go here: pikovit, complivit, centrum, alphabet, vitrum, milife, biomax; vitamin C, B vitamins.

Treatment of ureaplasmosis in pregnant women

As we have said, any infection for a pregnant woman is dangerous. Caring for a pregnant woman with a disease is of course much more difficult than others. The doctor will consider each step, choosing the right drugs, especially with antibiotic therapy. Antibiotics from a number of macrolides, such as erythromycin, josamycin, rovamycin, are considered the safest today. The course of treatment lasts 2-3 weeks and starts from 20-22 weeks of pregnancy, in some cases from 16 weeks. Along with antibiotic therapy, the following are also prescribed:

1. Enzymes (mezim, festal, pancreatin, wobenzym).
2. Immunomodulating drugs (if necessary).
3. Antifungal - the most suitable pimofucine.
4. Minerals - thymalin, T-activin.
5. Sanitation of the genital tract.
6. Hepatoprotectors (if necessary) - Hofitol.
7. Vitamins - any multivitamin complexes for pregnant women - mother complements, elevit pronatal, femibion, pregnavit.
8. Protection and restoration of the intestinal flora (normaze).

During the treatment period, both partners need to follow some important rules:

1. Sexual rest (sexual contact can be started after the main treatment with antibiotics, during the act it is necessary to protect yourself with condoms);
2. Compliance with the diet (exclude fatty, sweet and spicy foods);
3. Avoid alcohol intake;
4. Compliance with personal hygiene.

We have described the treatment of ureaplasma in women as detailed as possible, but let's not forget that both partners should be treated, otherwise there is no point in this treatment. Treatment should be prescribed by your doctor. Self-medication can be very dangerous, given that it is quite difficult to treat ureaplasma. It is also necessary to strictly follow the rules and recommendations of the doctor, which will increase the success of the recovery process.

How and how to treat ureaplasma in women?

Ureaplasma in women- a sexual infection that occurs in a latent form in most women. It is widely believed that the causative agent of ureaplasmosis is part of the conditionally pathogenic flora for the female body, which, being activated with a decrease in immunity, causes inflammatory pathologies of the genitourinary organs.

Ureaplasmas attach to leukocytes, epithelium, spermatozoa, after which they destroy the cell membrane, entering the cytoplasm. Acute and chronic infections are possible.

The clinical picture is rather blurred, usually the infection is combined with trichomonas, chlamydia, gardnerella, which makes it difficult to assess their significance in the pathological process (an accompanying agent or the main cause of the disease).

• Mycoplasma genitalium;
• Mycoplasma pneumonia;
• Ureaplasma species - ureaplasma spices (includes Ureaplasma parvum - ureaplasma parvum, Ureaplasma urealyticum - ureaplasma urealiticum).

During the examination, two out of three women who are sexually active, this pathogen is detected, and the patient does not always have complaints.

Ureaplasma is usually referred to as conditional pathogens, which means that in theory it can constantly be in the reproductive system in a small amount, but under adverse conditions it actively multiplies, provoking an inflammatory process and other changes.

The most relevant issue is the detection of infection during pregnancy, since against the background of a decrease in immunity, ureaplasma, as a conditional pathogen, can cause dangerous complications - infection of the fetus, water leakage.

How is it transmitted

There is no incubation period as such for this pathogen. Infections are found in scrapings in 10% of girls and adult women who are not sexually active. This is another evidence that ureaplasma can be considered part of the normal flora.

This infection is characterized by the following modes of transmission:

1. Sexual- ureaplasma is transmitted through a traditional act, anal, oral and other types of sexual relations.
2. Vertical- through the placenta from mother to child, as well as during childbirth and through the cervical canal.
3. WITH blood and organs- the infection is transmitted during organ transplantation or even during blood transfusion.

The following household methods of transmission of ureaplasma have not been proven:

• in the sea, pool and other bodies of water;
• in a shared toilet;
• through bed towels, accessories;
• through the dishes.

Interestingly, despite the fact that children can become infected during the passage of the birth canal, childhood is characterized by self-healing, when the ureaplasma disappears from the body on its own without therapy.

If the infection affects an adult, then sooner or later the pathogen provokes the development of acute or even chronic inflammation of the urinary organs or genitals.

Causes

A feature of ureaplasma in women is that the disease rarely has an acute course. The infection can remain inside the cells (leukocytes, integumentary epithelium of the organs of the genitourinary system) for a long time without harming the woman's body.

The starting factors for pathology are usually:

• Diseases And conditions that undermine the immune system.
• Hormonal changes. These may not necessarily be pathological changes; an exacerbation of the disease can be triggered by pregnancy or menstruation.
• Frequent change of sexual partners, since each new partner is a potential source of pathogenic and conditionally pathogenic bacteria that can have a negative impact on the female microflora and thereby cause the activation of ureaplasma.
• all sorts of diagnostic and therapeutic procedures on the urinary system. These include the installation / removal of coils, abortions, cervical surgery, bladder catheterization, diagnostic procedures (ureteroscopy, hysteroscopy, cystoscopy, cystography), etc.

Symptoms

As mentioned above, this disease can occur in women without symptoms. If the symptoms appear, then they are exclusively non-specific - which do not differ from the manifestations of other STDs.

These signs include:

• atypical vaginal discharge (abnormal amount, smell, or texture);
• pain in the lower abdomen is periodically noted;
• burning during urination.

Many patients note the connection between these manifestations of ureaplasma and menstruation, diagnostic procedures performed, stressful situations, etc.

Ureaplasma during pregnancy

The first thing a woman needs to do when planning a pregnancy is to undergo an examination to detect ureaplasma. There are two reasons for this:

• Even the smallest amount of pathogens in the genitourinary system during childbearing can lead to the development of ureaplasmosis.
• Treatment of ureaplasmosis is contraindicated in early pregnancy, since the antibiotics used in this case have a negative effect on the proper development and growth of the fetus. Therefore, it is recommended to determine the presence of infection in advance, before pregnancy and undergo a course of treatment.
• Also, this disease is dangerous because it can be transmitted to the child during the passage of the birth canal.

If a woman has become infected with ureaplasmosis already in a state of pregnancy, then she should definitely contact a specialist to make a diagnosis and draw up a treatment plan.

To prevent infection of the child during childbirth, postpartum infection of the mother's blood, and to reduce the risk of spontaneous miscarriage or premature delivery, a pregnant woman with this disease is prescribed antibiotic therapy after 22 weeks of pregnancy.

Medicines are selected by the doctor. In addition to antibiotics, drugs are prescribed to increase immunity in order to reduce the risk of relapse.

Danger

Ureaplasmosis can last for years without causing any harm to her health. However, often in association with other bacteria, ureaplasmas cause:

• recurrent thrush;
• pathologies of the cervix (including dysplasia);
• inflammation of the pelvic organs;
• nonspecific inflammatory process in the vagina.

An active inflammatory process in a woman can cause infertility due to the occurrence of pathological forms and death of the egg during the passage of the genital tract. In this case, it is possible to get pregnant only after undergoing a course of treatment.

How is it going

Ureaplasmas can be detected in absolutely healthy women, but with a combination of certain factors, microbes can cause the following pathological conditions:

• cystitis, urethritis. Inflammation of the bladder and urethra is accompanied by itching, burning in the area of ​​the opening of the urethra, frequent and painful urination. Urethritis and chronic cystitis are often associated with ureaplasma.
• Vaginosis, vaginitis. These microorganisms can be the cause of bacvaginosis and dysbiosis. At the same time, women complain of a “fishy” smell and abundant mucus secretion. In addition, nonspecific colpitis (with greenish, yellow, non-abundant discharge) or relapses of thrush may be noted.
• cervicitis. This is an inflammatory process that occurs on the surface of the cervix and in its canal, especially against the background of ectopia or erosion. Ureaplasmas together with chlamydia, HSV (herpes simplex virus) I and II types and HPV (human papillomavirus) can cause malignant degeneration of cells and cervical dysplasia.
• endometritis. It is noted when the infection is activated in the uterine cavity after diagnostic procedures (hysteroscopy or curettage), as well as after termination of pregnancy or childbirth.
• adnexitis. Like other conditional pathogens, ureaplasmas can cause inflammation of the appendages against the background of immunodeficiency. However, they do not cause such serious consequences as, for example, chlamydia (can lead to infertility).

Diagnostics

The most common method for diagnosing a disease is the study of biomaterial taken from the urethra and vagina by PCR. Also, to confirm the diagnosis and select appropriate drugs, urethral and vaginal scrapings are cultured.

An examination is necessary in such cases:

• pregnancy planning;
• chronic colpitis, adnexitis, endocervicitis, salpingitis and other inflammatory pathologies of the genital organs;
• problems with pregnancy and conception;
• chronic inflammatory pathologies of the urinary tract;
• menstrual disorders.

The diagnosis of "ureaplasmosis" is made only if an inflammatory process is observed in the urinary or genital organs of the patient, and only ureaplasma was identified among the possible pathogens.

Indications for starting treatment

Not all women with ureaplasmas found in the organs of the reproductive system are prescribed special antibacterial drugs. For such an appointment, solid evidence is needed that it was this microorganism that caused the pathological process.

Such a conclusion is possible in situations:

• If a woman fails to become pregnant for a long time and fails to detect the causes of infertility, and tests give a positive result for ureaplasmosis.
• If a woman with inflammation of the genital organs found ureaplasma.
• If a patient with ureaplasmosis has previously had miscarriages and is planning a new pregnancy.
• Also, treatment is prescribed in preparation for an upcoming pregnancy for patients who had no previous problems with bearing a child, but PCR diagnostics gave a positive result for ureaplasma (in such cases, antibiotic therapy is carried out to prevent pregnancy complications).

At the same time, in order to avoid recurrent infection, examination and treatment is required for the patient's sexual partner. This recommendation is especially relevant for couples who suffer from infertility, as there is evidence that ureaplasma gets inside the spermatozoon, making it unviable. In addition, the infection can lead to male prostatitis and other health problems that affect the ability to have a child.

Treatment

Treatment is a long process and requires perseverance and patience from the patient, since it is impossible to eliminate ureaplasmas in one course of therapy. In addition, it is important to follow the recommendations of the attending physician regarding lifestyle and nutrition.

Patients who have been diagnosed with ureaplasmosis are usually prescribed complex treatment by gynecologists. It may include:

• sanitation of the vagina;
• antibacterial therapy;
• immunostimulating drugs;
• vitamin therapy;
• enzyme agents that have an anti-inflammatory effect;
• the use of special preparations (probiotics) topically and orally in order to restore normal flora.

Physiotherapy treatments are also prescribed. With ureaplasmosis, experts prefer electrophoresis and magnetotherapy. Gynecological massage, mud therapy and laser intravenous blood irradiation are highly effective.

Antibacterial drugs are chosen based on the results of tests for the sensitivity of the infection to antibiotics. Patients are most often prescribed drugs from the group of fluoroquinolones, tetracyclines or macrolides.

If the patient is given drugs blindly, then there is a high risk that the therapy will be ineffective, pathogenic microorganisms will survive and become resistant to the drugs used.

Sanitation of the vagina is carried out with the help of complex preparations (usually they are used in the form of vaginal suppositories), which include antifungal agents and antibiotics.

Of great importance in the treatment of ureaplasmosis is immunostimulating therapy, the restoration of the normal flora of the genital organs. This is important, because the presence of an inflammatory process indicates vaginal dysbacteriosis and a decrease in immunity.

As immunostimulating drugs in the treatment of gynecological pathologies, stimulators of the synthesis of endogenous interferon (such as Cycloferon) or directly interferon preparations (such as Genferon) are used.

Probiotics are administered orally or vaginally (using agents such as Vagilak). Also, the treatment regimen may include multivitamin complexes and the enzymatic anti-inflammatory drug Wobenzym.

It is clear that patients are not prescribed all of the above drugs at the same time. For each woman, the treatment regimen is selected individually (it depends on the results of the tests and the clinical situation). At the same time, not only compliance with the dosage is important, but also the sequence of using drugs (for example, one drug must be taken for 4 days, the other from day 5 to 10), otherwise the effectiveness of treatment will be reduced.

To achieve the maximum effect of drug therapy, during the entire period of medication, the patient is recommended to adhere to the following simple rules:

• do not abuse fatty, spicy, sweet, smoked;
• do not drink alcohol;
• abstain from sexual intercourse.

Prevention

Preventive measures against this disease are not particularly different from the prevention of other sexually transmitted infections:

1. Abstinence from unprotected sex with casual partners is strongly recommended.
2. You should regularly undergo examinations by a gynecologist and be checked for STIs.
3. Also, for the prevention of this disease, it does not hurt to take additional care of increasing the overall immune system and maintaining the microbial background of the genital organs in the normal range.

To do this, you need to follow the rules of hygiene, eat well, play sports, treat such pathological conditions as bacterial thrush, vaginosis in a timely manner, and in general it is recommended to lead a healthy lifestyle.

relapse

Sometimes ureaplasma bacteria, after prolonged treatment, are again found in a woman's body. The reasons for the recurrence of ureaplasmosis may be as follows:

• activation of "their" ureaplasmas- occurs when prescribing drugs to which bacteria are insensitive, and also if the patient violated the treatment regimen;
• reinfection- it is possible if the sexual partner did not follow the recommendations of the attending physician or did not undergo a course of therapy at all;
• false positive result- if the time interval after treatment and before re-analysis was not observed;
• "own flora"- in the event that ureaplasma is the norm for a woman, it is very difficult to “remove” it from the body.

Summarizing the above, it should be noted that ureaplasma is not an aggressive pathogen, but still it can cause inflammation in the genitals.

Symptoms of the presence of this infection in a woman are nonspecific, so in most cases the infection is detected by chance. Given that the bacterium can affect the course of pregnancy, it is recommended to take a course of antibiotics before conception.

An individual comprehensive treatment program for ureaplasma is selected by a doctor and may include several drugs.

Ureaplasmosis is an infectious disease of the genitourinary system, which is of a bacterial nature and is provoked by a pathogen called ureaplasma. The latter belongs to the category of conditionally pathogenic microorganisms, i.e. it can be present in the human body without causing any problems and inconveniences.

This can continue until the occurrence of certain provoking factors, for example, a decrease in protective functions, artificial termination of pregnancy, unsuccessful use of intravaginal contraceptives, and even simply against the background of common general diseases or normal menstruation.

What it is?

Ureaplasma (Ureaplasma urealyticum) is a special type of microbe that, in terms of its properties and size, occupies an intermediate position between protozoa and viruses. These bacteria freely penetrate the cells of the genitourinary system and multiply there. Thanks to this unique ability, they easily elude the human immune system.

Ureaplasma is classified as a conditionally pathogenic flora of the vagina - this type of microbe is found in smears in about 60% of clinically healthy women. If ureaplasma in women does not give symptoms, then treatment is not required - this is not a disease, but a variant of the norm.

Causes of ureaplasmosis

The direct cause of the onset of the disease is the entry into the body by any means of a conditionally pathogenic microorganism - ureaplasma, which, after infection, very quickly penetrates into the integumentary epithelium or leukocytes, and can remain in the cells for an indefinitely long time.

Provoke the manifestation of infection can:

• hormonal changes - menstruation, childbirth, abortion;
• any conditions that can lead to a decrease in the tension of the general immunity of the body;
• frequent change of sexual partners - in this case, the probability of penetration into the body of unconditionally pathogenic microflora increases several times, which can provoke the development of ureaplasmosis;
• manipulations on the genital or urinary organs - the establishment or removal of an intrauterine device, surgical treatment of the pathology of the female reproductive system (cauterization of erosion, removal of genital warts and cysts) or manipulations on the urinary organs (catheterization, cystoscopy, cystography).

For a long time, the disease can be asymptomatic - manifestations of the disease occur only in the later stages, at the moment when irreversible changes have already occurred in the body. In this case, adhesions in the pelvis can form in women, which can cause infertility or provoke the development of an ectopic pregnancy.

Classification

In fact, medicine knows several types of this infection, but at the present time, the main types of ureaplasma in women are distinguished:

• parvum (ureaplasma parvum);
• urealyticum (ureaplasma urealyticum).

These two types can be combined into one common species called ureaplasma spices. It is simply necessary to identify a certain form of infection, since in most cases they are associated with other diseases.

If ureaplasma parvum was found in women, then it does not require special therapeutic measures, since normally in a woman these microorganisms are present in the normal flora of the urogenital area. Medical care may be required only when the number of bacteria exceeds several times, as this is a threat to the onset of the inflammatory process.

Symptoms

Symptoms of ureaplasma (see photo) in the female body are sometimes detected by chance, through the diagnosis of another disease. Under other circumstances, signs of ureaplasmosis are recognized without problems.

Here are the main ones:

1. Painful sensations. As a rule, they are localized in the lower abdomen, appear as a cutting type. In this case, ureaplasmosis with a high degree of probability gave complications to the appendages and uterus.
2. Vaginal discharge. Usually quite scarce, odorless and colorless. Along with this, if the inflammatory process is already running, the discharge can take on a sharp unpleasant odor and change color to greenish or yellow.
3. Problems with sexual function. It becomes painful and uncomfortable for the patient to have sex. Unpleasant sensations appear during sexual intercourse and persist after completion of such.
4. Problems with urination. The urge to empty the bladder becomes more and more frequent, accompanied, at the same time, by painful sensations, pain, burning.
5. Lzhangina. If the infection occurred during oral sex, s: plaque on the tonsils (tonsils), pain in the oropharynx, difficulty swallowing, etc.

If ureaplasma does not cause discomfort, pain, it still needs to be eradicated. A timely appeal to a specialized specialist will not allow an infectious disease to develop, will help to avoid complications, including chronic ureaplasmosis (requires long and complex therapy). You need to monitor your health constantly.

Diagnostics

A disease such as ureaplasmosis can be diagnosed by the following methods:

1. Serological method (detection of antibodies). This diagnostic method is prescribed to identify the causes of miscarriage, infertility, as well as inflammatory diseases in the postpartum period.
2. Molecular biological method. With this diagnosis, you can find out whether the presence or absence of ureaplasma in the test sample. But this diagnostic method cannot determine the amount of this microorganism.
3. Bacteriological (cultural method). Such a diagnosis is based on the cultivation of ureaplasmas in an artificial nutrient medium. For research, it is necessary to take a smear from the vaults of the vagina, the mucous membrane of the urethra. Only the presented research method will determine the amount of ureaplasma, which is sufficient for the development of this disease. The bacteriological method is considered decisive when deciding on the treatment of ureaplasmosis.

Ureaplasma during pregnancy

When planning a pregnancy, the first thing a woman needs to do is to be examined for the presence of ureaplasma. This is due to two reasons. Firstly, the presence of even a minimal amount of ureaplasmas in the genitourinary system of a healthy woman during the period of bearing a child leads to their activation, as a result of which ureaplasmosis develops.

Secondly, in the early stages of pregnancy, ureaplasmosis cannot be treated (by the way, during this period it is most dangerous for the fetus), since antibiotics adversely affect the growth and proper development of the fetus. Therefore, it is better to identify ureaplasmas, if any, in advance, before pregnancy, and be cured. This disease is also dangerous for the fetus because during childbirth the infection is transmitted to the child through the birth canal. If a pregnant woman has become infected with ureaplasmosis, it is imperative to consult a doctor to clarify the diagnosis.

To prevent infection of the baby during childbirth, postpartum infection of the mother's blood, as well as to reduce the risk of premature delivery or spontaneous miscarriages in the early stages, a pregnant woman with this disease is given antibiotic therapy after twenty-two weeks of pregnancy. The drugs are selected by the attending physician. In addition to antibiotics, drugs are prescribed to increase the body's defenses in order to reduce the risk of a secondary infection.

Consequences

Due to this fact, and the fact that the disease very often occurs in a chronic form, ureaplasmosis is expressed by imperceptible symptoms. Women are more likely to seek help only when the following complications have already occurred:

1. Oophoritis -.
2. Violation of the regularity of the menstrual cycle.
3. - an inflammatory process that captures the uterine appendages (ovaries, fallopian tubes, ligaments).
4. Ascending is detected when pathogens ascend above the bladder to the kidneys.
5. (inflamed bladder) and chronic urethritis (chronic inflammation of the urethra) result from ascending infection.
6. - a complication that causes inconvenience and pain during intercourse.
7. Secondary infertility, which is the result of a prolonged inflammatory process in the cervix and fallopian tubes. Even after adequate treatment of ureaplasmosis, the doctor may find that the fallopian tubes are impassable for eggs.

In addition to the above, ureaplasma bacteria can damage the shell and structure of the egg, which makes it impossible to conceive a healthy child.

How to treat ureaplasmosis in a woman?

Effective treatment of ureaplasmosis is a long process that requires patience and perseverance from a woman, since it is impossible to eliminate ureaplasmas in one short course of drug therapy. In addition, it is very important that a woman adheres to the doctor's recommendations regarding nutrition and lifestyle.

Gynecologists usually prescribe complex treatment for patients with ureaplasmosis, including:

1. Sanitation of the vagina.
2. Immunostimulating drugs.
3. Antibacterial therapy.
4. Vitamin therapy.
5. Enzymes with anti-inflammatory action.
6. Restoration of normal microflora through the use of special drugs (probiotics) inside and out.
7. Physiotherapy procedures. Of the physiotherapeutic procedures for ureaplasmosis, gynecologists give preference to magnetotherapy, electrophoresis. Intravenous laser blood irradiation, mud therapy and gynecological massage also have good efficiency.

Antibiotics for ureaplasma

How to cure ureaplasmosis in women? With antibiotics only:

Important! With unexpressed inflammation, the course of therapy is treated with only one antibacterial drug, and if it is complicated, then the treatment regimen will be tandem, for example, alternating macrolides and tetracyclines.

Probiotics

To avoid candidiasis, along with antibacterial drugs, it is necessary to take probiotics - drugs containing "beneficial" microorganisms that are part of the normal microflora or contribute to its restoration.

The most effective modern probiotics include:

• Laktovit.
• Bifidumbacterin.
• Lactobacterin.
• Linex.
• Narine.
• Biovestin.

In the acute form of the disease, the appointment of systemic antibiotics against the background of probiotics is often sufficient for successful treatment. In the subacute form, it is advisable to supplement such treatment with topical antibiotics (vaginal tablets, douching).

Disease prevention

Preventive measures to prevent female ureaplasmosis:

• the use of barrier methods of protection;
• refusal of casual intimacy with different partners;
• strict adherence to the rules of intimate hygiene;
• constant maintenance of immunity in proper condition (hardening, vitamins, healthy nutrition);
• ureaplasmosis must be treated not only in a woman, but also in a permanent sexual partner.

The probability of getting sick depends on the state of the immune system and the presence of concomitant infections in the body. With a latent course, it is impossible to determine this disease, so it is necessary to undergo an examination by a specialist. When planning a pregnancy, both partners should be responsible for the medical examination.