Treatment of chronic mycoplasmosis in men. Symptoms and treatment of mycoplasmosis in men. Local therapy and FTL

It is an acute infectious disease that develops when infected by special microorganisms - mycoplasmas. To date, about seventy subspecies of mycoplasmas have been identified, but only a few of them are considered dangerous. Let's take a closer look at the symptoms of mycoplasma in men and methods of treating this disease.

Human cells can harbor up to eleven types of mycoplasmas, but only one subspecies of this microorganism, called Mycoplasma genitalium, can cause mycoplasmosis.

A man can accidentally contract mycoplasma through unprotected sexual contact with a carrier/carrier of mycoplasmosis.

Infection through oral sex or everyday life is extremely unlikely. There are no cases officially described by the media, but there is medical data indirectly indicating domestic infection.

Genital mycoplasmas include:

Ureaplasma urealyticum;
Mycoplasma spermatophilum;
Mycoplasma primatum;
Mycoplasma penetrans;

What cannot be said about the presence of mycoplasma genitalium, for which, even in the absence of symptoms, mandatory treatment is required.

Often the disease is asymptomatic; mycoplasma is detected only in tests. That is why it may take quite a long period of time before the disease is detected. But, since the necessary medical care is not provided during this period, patients, as a rule, go to a specialist with a pronounced picture of the disease. Mycoplasma infection produces clear or yellow discharge from the urethra.

Pain often occurs during urination and sexual intercourse. In addition, the color changes urethra, he becomes hyperemic, itching and discomfort appear in the genitals. As the disease progresses and spreads to other organs, pain in the groin, lower back and rectum is possible, and the skin may become covered with a rash, since mycoplasma can cause an allergic reaction.

Consequences

In the absence of timely drug therapy, mycoplasmosis can lead to the following complications in the condition of a male patient:

Due to the proliferation of mycoplasmas and lack of proper treatment, the body may develop urethritis. The disease is an inflammation that affects the mucous membrane of the urethra. Characteristics Urethritis is an itching, burning sensation that intensifies during bowel movements and sexual intercourse. During ejaculation, severe pain and stinging may be present.
Often against this background it develops prostatitis. The disease is an inflammatory process that affects the prostate gland. In this case, pain is noted in the groin area, which intensifies with pressure. In addition, prostatitis contributes to pain and decreased potency during sexual intercourse, making it almost impossible. Some doctors consider the connection between the occurrence of prostatitis and mycoplasmosis to be unproven.
Mycoplasmosis is a provocateur of inflammation of the testicles - orchitis. In this case, pain appears in the scrotum area, which intensifies with pressure.
Infertility In men, mycoplasma bacteria is the most common problem. Caused by a decrease in the volume and quality of sperm released. Obstructive form of infertility due to obstruction of the vas deferens by inflammatory infiltrate.
When the testicles and prostate are affected, problems with potency. At the same time, sexual intercourse is practically impossible, since the erection is short-lived or completely absent due to pain.
Work is often disrupted bladder, and at the same time, diseases develop that affect the kidneys and provoke the development of a chronic or acute form pyelonephritis.
Prostate abscess, a rare complication and occurs with a fairly significant decrease in a man’s immunity;
Chronic urethritis, prostatitis, orchiepididymitis, pyelonephritis and cystitis.
Perhaps even joint damage.

What is the role of mycoplasma infection of the prostate gland (PG) and in the development of prostate cancer (PCa)?

One of the most common etiological agents of infection of the male reproductive system is mycoplasma. To determine the role of mycoplasmas in the development of prostate cancer, a study was conducted on 250 men with suspected prostate cancer (PCa). In this regard, all patients underwent ultrasound-guided pancreatic biopsy. In addition to the main columns of prostate tissue sent for morphological examination, two additional ones were taken from the peripheral zone of both lobes to search for mycoplasmas in them.

In 127 patients, prostate tissue was examined for the presence of mycoplasmas using the standard qualitative PCR method. Subsequently, to obtain more accurate results, Mycoplasma hominis DNA was determined in 123 patients with suspected prostate cancer using the Real-time PCR quantitative diagnostic method. Thus, according to the results of the study, it was established that mycoplasma infection of the prostate is more common in patients with PIN VS and prostate cancer. The very fact of the presence, persistence and damaging effect of this infection in the tissue of the peripheral zone of the prostate gland has been established, which was not previously established and was questioned.

Symptoms and signs

Like many sexually transmitted infections, mycoplasma has a “silent” course and may not make itself felt at all for quite a long time.

When a person’s immune state weakens (under stress, respiratory illness, etc.), the patient may observe the following signs of the disease:

Weakness and disability;
Discomfort and discomfort during sexual intercourse;
Soreness and burning, cutting during urination;
Frequent urge to urinate, false urge to urinate;
Pain in the perineum and lower back;
Redness of the urethra;
The appearance of yellowish, transparent, glassy discharge from the urethra;
Morning discomfort in the groin and pain in the lower abdomen. Pain in the groin, perineum, testicles of a pulling, aching nature;
A characteristic rash in the genital area;
Redness and swelling of the urethral sponges, as well as their sticking together in the morning;
Itching of the genitals.

Moreover, if the mycoplasma infection occurred long ago, then these pathogens can reach the man’s prostate gland and cause its inflammation. This in turn will lead to prostatitis. Less common is testicular inflammation and swelling.

Photo

It is difficult to diagnose mycoplasma by external signs; a precise diagnosis can only be made after PCR. However, the selection may look like this:

Treatment regimens for mycoplasmosis in men

The types of pathogens - hominis, genitalium, pneumo - differ in properties, but are treated the same.

All antibiotic options:

Doxycycline– a semi-synthetic bacteriostatic agent from the group of tetracyclines. Penetrates inside the cell and inhibits the protein synthesis necessary for the microorganism. Does not affect bowel function. Daily dosage- 100 mg 2 times. Duration of treatment - 10 days.

Clarithromycin– macrolide antibacterial drug. Affects bacteria located inside and outside the cell. Binds to the microorganism and disrupts protein formation. Amount per day - 250 mg twice. The course of treatment is 1-2 weeks.

Josamycin– the bactericidal effect is aimed at destroying the membrane of gram-negative and gram-positive bacteria and fungi. Morning intake - 1 gram, lunch and evening 500 mg. Duration of treatment - 10 days.

Levofloxacin– antimicrobial fluoroquinolone, which blocks the DNA of the pathogen, disrupts the structure of the cytoplasm and cell membrane of the microorganism. Take 250 mg once a day. Continue treatment for 3 to 10 days. The dosage for the chronic form of bacterial prostatitis is increased to 0.5 grams 1-2 times a day. The course of treatment is 3 months.

Azithromycin– 1 g once or 0.5 g once a day, course 3-5 days. The drug is taken 1 hour before meals or 2 hours after.

Clindamycin– 200-400 mg every 6 hours, course 7 days. — Erythromycin 500 mg 4 times a day, course 10-14 days. — Ofloxacin 200–400 mg once.

To cure mycoplasmosis, it is necessary to give up sexual relations, take drugs to strengthen the immune system, B vitamins and ascorbic acid, and sorbents that cleanse the intestines. It is important to follow a diet and exclude smoked and fatty meats, spicy and hot dishes from the diet; alcohol is strictly prohibited.

Unfortunately, due to mild symptoms, mycoplasmosis is detected in an already quite advanced state, when the disease has caused complications. For this reason, the diseases described above are not uncommon and, along with mycoplasmosis, a man needs to be treated for other diseases of the kidneys or reproductive system.

You can add drugs based on natural immunomodulators:

Echinacea purpurea;
lemongrass;
ginseng;
Eleutherococcus

After treatment:

Monitoring of cure using PCR is carried out in patients a month after the course of drugs. Treatment of mycoplasmosis in men is considered effective if the number of mycoplasmas remains within normal limits for 4 weeks.

If studies have shown the presence of mycoplasmas or ureaplasmas, a new culture is carried out on IST medium to determine the sensitivity of microorganisms to antibiotics. After this, a second course of therapy is prescribed using an antibacterial drug from a different group.

Prevention:

To reduce the likelihood of contracting mycoplasmosis, it is important for men to adhere to the following doctor’s recommendations:

Every six months, undergo a full examination by a urologist and be tested for sexually transmitted diseases, including mycoplasmosis. Also, the sexual partner should also visit a gynecologist and undergo preventive tests.
Have one permanent (proven) sexual partner in whom you are confident.
If you have casual sex, you must use a barrier method of contraception (use condoms).
A man needs to lead a healthy lifestyle to maintain a normal immune state.
Stop drinking alcohol, smoking and taking drugs.
Avoid severe physical fatigue. 7. Have proper sleep and rest. 8. Strengthen your body with sports and regular physical activity. 9. Spend more time outdoors.
Avoid stress and strong psycho-emotional stress, as they suppress immune system.
Eat right. In this case, the diet should be well balanced and rich in vitamins.
It is very important to discuss with your sexual partner the possibility of infection with mycoplasmosis on her part, because a man who has one sexual partner has no other option. For this reason, a woman is to a certain extent responsible for the health of her sexual partner. Moreover, the issue of safe sex is especially acute if a couple wants to have healthy children in the future.

Today, mycoplasmosis is an intractable disease. The success of general therapy largely depends on timely diagnosis and initiation of treatment.

Hardware treatment of blood mycoplasma

What physiotherapy techniques are used in the treatment of ureaplasmosis and its complications?

Leserotherapy. Depending on the irradiation technique, stable and labile laser therapy techniques are distinguished. A stable technique is carried out without moving the emitter, which is in a fixed (usually contact) position during the entire procedure. With the labile technique, the emitter is randomly moved across the fields into which the irradiated zone is divided (field irradiation). A transurethral effect is applied to the urethra with a urethral attachment. A general effect on the sinocarotid zones, projections of the liver, perineum, coccyx area, and suprapubic region is possible. Low-intensity laser radiation has a pronounced anti-inflammatory effect, stimulates general and local immunity, improves microcirculation in the area of inflammation, affects the permeability of the vascular wall, and has an analgesic effect;
Extracorporeal hemocorrection. A modern method of purifying the blood composition outside the patient’s body with its subsequent return. The essence of the procedure is based on the removal of inflammatory mediators, cell breakdown products, toxins, removal of cholesterol, antibodies and antigens from connective tissue, restoration of natural blood microcirculation.
Often used thermotherapy: transurethral or transrectal microwave thermotherapy or hyperthermia. Superficial heating of the mucous membrane of the urethra and prostate gland to a depth of no more than 5 mm is required in order to sanitize the urogenital tract or provide better conditions for subsequent local drug therapy. Warming up is necessary with a gradual rise in temperature from 39 to 45 ° C and automatic control directly in the urethra or rectum. For urethritis and prostatitis, urethral and rectal heating are used simultaneously against the background of exposure to a running magnetic field. It is possible to combine heating of the urethra with laser therapy and electrophoresis for ureaplasmosis. This opportunity allows you to optimize the impact and reduce treatment time with a maximum percentage of favorable outcomes even in advanced cases. As a result of treatment, in sick men with prostatitis, pain and swelling of the prostate disappear, the number of leukocytes in the secretion of the gland decreases, the number of lecithin grains increases, and the linear velocity of blood flow improves;
Using magnetic therapy, can be impacted on the problem area or introduced using magnetic fields medicines to the lesion site. Efficiency is questionable. The Intramag device is intended for the treatment of inflammatory diseases of the genitourinary tract in men and women, including urogenital infections using a running magnetic field in combination with local drug therapy. The therapeutic properties are based on the pronounced anti-inflammatory, anti-edematous, analgesic and phoretic effects of the traveling magnetic field excited in the emitter, as well as the ability to carry out local drug therapy with simultaneous heating. In addition to intraurethral effects medicine Rectal exposure is possible with a special rectal irrigator catheter, which, like a urethral catheter, allows you to combine magnetophoresis with electrophoresis;
Electrophoresis- this is a method of physiotherapy, which is used in this case for chronic inflammation of the urethra and female genital organs. With the help of electrophoresis, not only a therapeutic effect is achieved, determined by the administered drug, but also stimulation of skin capillaries, metabolism, a pronounced analgesic effect, a pronounced effect of eliminating the inflammatory-edematous process, improving tissue nutrition and regeneration abilities not only at the level of the skin, but also in deep layers, tissue micromassage is performed. The advantages of medicinal electrophoresis are: the possibility of creating a skin depot with medications, the possibility of painless administration to any place, creating a high concentration of the substance in the pathological focus, administering the drug in ionic form, which allows you to reduce the dose, direct current increases the sensitivity of tissues to the drug. Medicinal electrophoresis of abdominal organs is widely used: vagina, rectum, urethra. Using electrophoresis, various antibiotics, microelements, and enzymes are administered, both according to a general method and locally. Galvanic mud therapy has proven itself well;
Effect ozotherapy is achieved using autohemotherapy with ozone, rectal insufflations with an ozone-oxygen mixture and the use of ozone irrigation in overalls connected to an ozonizer. The therapeutic effects of ozone are based on the known mechanisms of its biological action. When applied externally at high concentrations of ozone, its high oxidative potential provides a bactericidal, fungicidal and virusicidal effect against the main types of gram-positive and gram-negative bacteria, viruses, fungi, as well as a number of pathogenic protozoa. The effect of parenteral administration of ozone in pathologies accompanied by hypoxic disorders is based on the activation of oxygen-dependent processes. Ozonides formed as a result of ozonolysis of unsaturated fatty acids improve the condition of cell membranes, provide intensification of enzyme systems and thereby enhance metabolic processes production of energy substrates. The immunomodulatory effect of ozone makes it possible to gently correct immunodeficiencies; a decrease in blood viscosity leads to improved microcirculation and gas exchange at the tissue level;
To enhance immunity, intravenous laser irradiation of blood is used ( ILBI), this is the most effective and universal method of laser therapy. Unlike local laser therapy procedures, the therapeutic effect is due to the activation of systemic healing mechanisms of the whole body, increasing the efficiency of the functioning of the blood supply, immune, and other organs and systems, as well as the entire body as a whole. ILBI is used as an analgesic, antioxidant, desensitizing, biostimulating, immunostimulating, immunocorrective, detoxifying, vasodilating, antiarrhythmic, antibacterial, antihypoxic, decongestant and anti-inflammatory.

Prevention of mycoplasmosis

Avoid casual sex, especially without a condom;
Before starting sexual activity with a certain person, a complete mutual examination for sexually transmitted diseases;
Refusal of paid sexual services;
Annual screening for sexually transmitted infections.

What do we know about the significance of Ureaplasma urealiticum and Mycoplasma hominis?

Mycoplasma genitalium is a pathogenic microorganism that can cause urethritis, cervicitis, and inflammatory diseases of the pelvic organs;
M.genitalium is the leading causative agent of nongonorrheal urethritis in men;
M.genitalium more often causes acute urethritis in men, but low-symptomatic recurrent or asymptomatic forms also occur;
It has been established that M.genitalium is the cause of mucopurulent inflammation of the cervix in women;
There is evidence of a relationship between M.genitalium infection and fertility and pregnancy.

Mycoplasma pneumoniae. Pathogenic microorganisms that cause respiratory mycoplasmosis in men under 35 years of age, mycoplasma pneumonia, and symptoms of the inflammatory process of the respiratory system. They primarily affect the trachea and bronchi and become a source of atypical pneumonia, pharyngitis, asthma and bronchitis. They penetrate the cell and provoke autoimmune diseases. They can cause meningitis, encephalitis, otitis, and anemia.

Mycoplasma hominis. Found on mucous membranes and tissues of the genitourinary system. It affects the urethra and foreskin, worsens the quality of sperm and makes it unsuitable for conception, impairs erection, and contributes to the development of pyelonephritis.

Ureaplasma urealyticum. It provokes the development of herpes, genital candidiasis, urethritis, and reduces sperm activity.

What are the best products to use? Which drugs and in what cases will be most optimal?

Mycoplasma in men: is treatment really necessary?

Many patients ask the doctor about when to treat mycoplasma in men? After all, even among specialists there is still no consensus on this matter.

This is explained by the fact that mycoplasmas are natural inhabitants of the mucous membranes of the genital tract, nasopharynx, and oral cavity. These microorganisms are classified as conditionally pathogenic.

What does it mean?

This means that an infection can develop in a person if his immunity is greatly weakened. In a healthy person without pathologies of the immune system, symptoms of pathology are very unlikely to form.

So, when might a treatment regimen for mycoplasma in men come in handy?

First of all, representatives of the stronger sex who have developed symptoms of an inflammatory reaction, such as:

appearance in the morning (usually in small quantities);
various dysuric phenomena, including increased urination, etc.;
heaviness or discomfort in the lower abdomen, etc.

Also, you should definitely consult a doctor if the analysis reveals that the content of microorganisms exceeds the normal threshold. Even if there are still no symptoms.

Basic principles of treatment of mycoplasma in men

Drugs for the treatment of mycoplasma in men should be selected only by a doctor.

In this case, therapy should help achieve the following effects:

elimination of all symptoms of the infectious process that affect the patient’s normal life;
normalization of laboratory parameters, according to which the number of microorganisms will not exceed 10 to 3 degrees CFU per ml;
in some cases, they try to achieve complete disappearance of the microorganism from analyzes;
prevention of adverse consequences, among which primarily are the development of infertility and infection of the sexual partner.

Treatment of mycoplasma in men with antibiotics

is the modern gold standard of therapy. Not only has a small amount side effects, but also gives good results. Among all antibacterial drugs, preference is recommended to be given to antibiotics belonging to the tetracycline series.

Since the sensitivity of the microorganism to them is currently minimal. In addition to the tetracycline series, you can use other drugs that have proven their effectiveness.

Approved for use, for example:

Doxycycline course of 5 days, 100 mg once a day;
Levofloxacin three-day course once a day, 250 mg;
Josamycin duration is similar to Doxycycline, but the dose is 500 mg twice a day;
Ofloxacin in a large dosage of up to 400 mg at a time, etc.

It is important to remember that it is best not to start antibiotic therapy right away. And get tested and find out which medications the pathogenic microorganism is sensitive to.

The use of drugs to which the infection is most sensitive is the modern method of choice. I wonder what drugs for the treatment of ureaplasma and mycoplasma in men similar. This is explained by the fact that infections most often occur in parallel and show sensitivity to the same drugs.

Treatment of mycoplasma genitalium in men

can be difficult, especially when it comes to an old infection. A few words about mycoplasma genitalium.

Newly identified pathology that has not yet fully blossomed can be successfully treated with Doxycycline. According to a scheme similar to that used when infected with a hominis type infection. However, it is important to remember this. If the patient has previously been treated for a similar infectious disease and was treated with the same drugs, the microorganism may become resistant to therapy.

Inflammatory disease of the genitourinary tract, related to sexually transmitted infections. More often it is asymptomatic, less often with manifestations in the form of cutting, pain when urinating with radiation to the groin, discharge from the penis, fever. Laboratory diagnostics mycoplasmosis is based on the detection of pathogens in biological fluids; serological tests are allowed. Treatment of infection is always comprehensive, using etiotropic, pathogenetic, symptomatic therapy, and non-drug methods.

ICD-10

A49.3 Mycoplasma infection, unspecified localization

General information

Mycoplasmosis in men is one of the most common reasons lesions of the genitourinary system. The causative agent of the disease was first identified in 1980. The proportion of mycoplasma infection among non-gonococcal and non-chlamydial urethritis in the male population is about 10-35%; among healthy individuals, the isolation of mycoplasmas ranges from 1 to 3.3%. A tendency to persistent infection was noted in 40% of patients, with men over 35 years of age most often affected. Studies in sub-Saharan Africa have shown that long-term, untreated mycoplasmosis leads to an increased risk of HIV infection.

Reasons

The causative agent of mycoplasmosis is the bacterium M. Genitalium. The source is a sick person, often with a latent course of the disease, having erased symptoms. Transmission of pathogens in men usually occurs through direct contact of the mucous membranes of the genital organs during anogenital, oral-genital and vaginal sexual penetration. Often a mixed infection occurs with ureaplasma, trichomonas, etc. The main risk factors:

unprotected sexual intercourse, especially homosexual
regular hypothermia
failure to comply with intimate hygiene rules
abuse of alcohol, drugs, smoking.

At risk are persons with weakened immune systems, endocrine diseases, post-organ transplant, commercial sex workers.

Pathogenesis

The pathogenesis of mycoplasmosis is not fully understood. It is known that M. Genitalium, adhering to the surface of the host cell, triggers a pro-inflammatory cascade of chemokines through highly expressed innate immune sensors, including Toll-like receptors 2, 6, the binding of which with M. Genitalium and its lipoproteins leads to the induction of genes involved in cell protection. These proinflammatory signals lead to the attraction of leukocytes to the site of mycoplasma presence.

Symptoms of mycoplasmosis in men

The incubation period of infection can range from 4 weeks to 60 days, on average about a month; In this case, the disease in men is predominantly asymptomatic. If a clinic is available, patients may complain of low fever (up to 38°C), decreased performance, moderate headaches, weakness, chills, the appearance of light translucent discharge and itching in the glans penis, burning sensation, discomfort during urination.

Painful, pulling sensations occur in the groin area, and libido decreases. Sexual intercourse may be interrupted due to severe pain, and symptoms of erectile dysfunction may occur. Further development of mycoplasmosis in men is redness, swelling, pain in the scrotum; increased frequency of urination, especially at night, cloudy urine, cutting sensations, pain above the pubis, in the perineum and anus, increased fever and weakness.

Complications

The most common complications of mycoplasma urethritis include ascending inflammatory diseases of the genitourinary system: prostatitis, cystitis, pyelonephritis. Damage to the testicles and appendages is possible; with untreated epididymitis, infertility is often subsequently diagnosed. Symptoms of proctitis may occur: fever, sharp pain when sitting, rectal purulent discharge.

Infertility due to mycoplasmosis among men has a complex nature: the occurrence of the condition is influenced both by the direct inflammatory process in the reproductive tract and by the ability of mycoplasmas to attach to sperm and limit their mobility. Chronic infection reduces the function of the prostate gland and forms connective tissue bridges that interfere with the normal movement of seminal fluid.

Diagnostics

Diagnosis of mycoplasmosis among men and its treatment in most cases is carried out by urologists. Doctors of other specialties provide consultations if indicated. A thorough examination of all sexual partners of the patient is necessary, especially when unprotected sexual intercourse is practiced. Basic clinical, laboratory and instrumental examinations for mycoplasmosis include:

Physical data. Often an objective examination for mycoplasmosis is uninformative, symptoms are minimal. Pain, hyperemia, swelling of the scrotal organs, discharge from the head of the penis, sensitivity to palpation in the suprapubic region, perineum, and digital examination of the prostate may be detected. With an ascending infection, it is possible to determine the positive symptom of tapping. Be sure to visually evaluate the urine and the nature of the discharge.
Laboratory research. IN general analysis blood - slight leukocytosis, acceleration of ESR; among the biochemical parameters in the presence of complications, an increase in the activity of CRP, creatinine, and urea is detected. A general clinical urine test determines leukocyturia, erythrocyturia, and increased density of urinary sediment. A smear from the urethra reveals large number leukocytes.
Identification of infectious agents. Data from bacterioscopy of a urogenital smear are not very informative for searching for pathogens. The most informative method is the PCR method for examining a smear from the urethra, prostate secretion, and urine. The “gold standard” for diagnosing mycoplasmosis is culture, but it is not used in routine practice due to its high cost. Serological (ELISA) tests are performed with paired sera and an interval of at least two weeks.
Instrumental methods. Necessary for differential diagnosis. Ultrasound examinations of the genitourinary apparatus, pelvis, and, if necessary, radiography, CT, MRI of the lumbosacral spine, kidneys, genitals, and puncture biopsy of the prostate gland with histological examination are performed. Colonoscopy and irrigoscopy are used less frequently.

Differential diagnosis of mycoplasmosis in men is carried out with ureaplasmosis and other non-gonococcal urethritis, while verification of the pathology is carried out by laboratory methods due to the similarity clinical manifestations. Urethritis of other etiologies have a history of traumatic, thermal or chemical damage, but any non-infectious causes must be confirmed by negative tests for the presence of microbial pathogens.

Treatment of mycoplasmosis in men

Treatment is often carried out on an outpatient basis. Inpatient stay is recommended for patients with decompensated chronic diseases, severe infection, complications requiring round-the-clock monitoring. General, less often semi-bed rest is indicated. The diet is considered as a treatment: sour, spicy, pickled foods, alcohol, coffee, nicotine are completely excluded.

During the period of treatment, it is recommended to abstain from sexual intercourse or be sure to use barrier methods of contraception (condom). If symptoms of mycoplasmosis are detected in a partner, joint treatment is carried out; prophylactic use of etiotropic drugs has no reliable benefit. Risk of infection healthy person during treatment, even with adequate therapy, without the use of contraceptive methods is more than 30%.

Conservative therapy

Standard treatment for mycoplasmosis in men takes 7-14 days, but 15-25% of patients have persistent or recurrent symptoms. During the period of taking medications and severe symptoms, sports activities are excluded. physical activity, renewal is permitted during the period of convalescence. The most common therapeutic measures for mycoplasmosis are:

Etiotropic means. The drugs of choice may be tetracyclines, macrolides and fluoroquinolones. However, doxycycline is now recommended as second and even third line therapy; There is also increasing resistance of mycoplasmas to azithromycin. High effectiveness of therapy for mycoplasmosis in men was noted when taking pristinamycin and moxifloxacin.
Pathogenetic drugs. Painkillers, antispasmodics, and anti-inflammatory drugs are used. In order to provoke a sluggish infection, local (rectal) immunostimulants are sometimes used. Intravenous detoxification with polyionic solutions is indicated in cases of severe disease and complications.
Symptomatic means. It is possible to use diuretics, desensitizing agents, and hormonal agents. In some cases, local use of antibiotic-containing ointments and courses of vitamin and mineral complexes are recommended.

Local therapy and FTL

Treatment of manifest urethritis due to mycoplasmosis in men is accompanied by regular irrigation of the head of the penis with anti-inflammatory solutions after each urination, using baths with infusions of oak bark, chamomile, calendula, and sage. Prescribing and taking herbal preparations (hydroalcoholic extracts of centaury herb, rosemary leaves, etc.) does not have convincing clinical effectiveness in the treatment of mycoplasmosis.

Russian urologists widely practice local treatment with the introduction of antiseptic agents (collargol) into the urethra, as well as physical therapy methods, such as:

UHF therapy
laser therapy on the posterior surface of the penis
ozone therapy
intravenous laser blood irradiation (ILBI)
galvanotherapy of the urethra area
heliotherapy and others.

A repeated course of antibiotic therapy is necessary for recurrent mycoplasmosis in men. Non-drug treatment methods are also recommended, such as a special muscle training program to strengthen the pelvic floor, the use of cosmetic hypoallergenic products for daily intimate hygiene, a ban on long-term hypostatic positions, and the elimination of many-hour breaks between urination.

Prognosis and prevention

The prognosis with timely detection and treatment is favorable; no fatal cases of mycoplasmosis have been recorded in men. No specific protective pharmacological formulas have been developed; great value have nonspecific preventive measures: refusal of any unprotected sexual practices, adherence to personal hygiene rules, a healthy lifestyle and annual laboratory preventive examination.

Mycoplasma hominis genitalium is a mycoplasma that affects the urogenital tract in both women and men. It is transmitted only sexually from a sick person or carrier to a healthy one.

Mycoplasma in men is more often found in the form of carriers, but representatives of the stronger sex are not immune from the development of pathology.

Causes

The incubation period is up to 25 days. Symptoms of the disease appear no earlier than 3 weeks after infection (see photo). The disease is transmitted sexually through genital, anal or oral sex.

The vitality of mycoplasma is so great that it is practically impossible to cure them, especially since they are conditionally pathogenic in approximately every second male body, very often showing no signs even in a latent form.

However, as soon as the immune system loses its vigilance a little, these tiny bacteria begin to infect the body’s cells by extracting vital substances from them; during this period, mycoplasmas begin to successfully spread to all organs in the body, affecting the body in its scale.

The disease affects the genitourinary and respiratory system. This disease often leads to various complications, such as and others. That is why it is so important to diagnose the symptoms of mycoplasma in men as early as possible and begin treatment with medications on time.

What are the symptoms of mycoplasma in men?

In case of infection with mycoplasma, the microbe does not cause any specific symptoms in men. As with other infections, a person may be bothered by:

clear, glassy discharge from the urethra;
periodic pain when urinating;
redness and swelling of the urethral sponges, as well as their sticking together in the morning;
pain in the groin, perineum, testicles of a pulling, aching nature.

These signs may disappear and appear again when the patient’s immunity decreases once again. Also, mycoplasmosis in men can affect certain organs, thereby provoking various diseases:

urethra, ();
prostate gland ();
seminal vesicles();
scrotal organs (orchiepididymitis);
seminal tubercle (colliculitis)
scalp and foreskin ().

Accordingly, the specific symptoms will depend on the organ affected by the infection.

Diagnostics

In addition to symptoms, for accurate diagnosis, use modern method detection of mycoplasma using the PCR method. It is based on identifying the DNA of a microorganism.

The search for antibodies to the pathogen in the blood is often unsuccessful, since the body’s immune response to mycoplasma is quite weak, and in some cases is completely absent. Therefore, the best method for diagnosis was and is a scraping from the urethra, which helps determine the cause of the pathology.

Complications

Mycoplasmosis in combination with other sexually transmitted infections in men often causes such consequences as:

prostatitis;
vesiculitis;
orchitis

In addition, the mycoplasma itself reduces motility and damages male reproductive cells, reducing the likelihood of conception. That is why those married couples who could not conceive a child for many years usually become happy parents after treatment for mycoplasmosis.

Prevention

The most effective preventive measures against mycoplasmosis in men are:

minimal alcohol consumption;
getting rid of such a habit as smoking;
protected sexual intercourse;
permanent sexual partner.

It is also advisable to get tested for STIs once a year.

Treatment of mycoplasma in men

When mycoplasma is detected in men, the most important point in treatment is the use of antibiotics. It is better to prescribe antibacterial drugs taking into account the results of culture for mycoplasmas and the sensitivity of these bacteria to antibiotics.

Mycoplasmas are sensitive to the action of:

Tetracyclines – tetracycline or doxycycline.
Fluoroquinolones – levofloxacin, ofloxacin, ciprofloxacin, lomefloxacin, etc.
Macrolides – azithromycin, roxithromycin, clarithromycin, etc.

To completely cure this disease, it is necessary to completely improve and strengthen the patient’s immunity. Patients are prescribed a course of multivitamins. They are able to stimulate the human immune system to develop the body’s natural defenses against viruses and bacteria, as well as other diseases.

Chronic form

In case of chronic mycoplasmosis (especially complicated ones), antibiotic therapy is longer, often combined (several antibiotics are used). In addition, they prescribe additional treatment(immunotherapy, urethral instillations, physiotherapy, etc.).

Mycoplasmosis is one of the most common sexually transmitted infections of bacterial origin.

Treatment of ureaplasma and mycoplasma in men with drugs involves the prescription of antibiotics, as well as drugs that increase the effectiveness of antibacterial therapy.

When is mycoplasma treatment needed in men?

Around the world, debate continues over the advisability of treating mycoplasma in men.

There are two diametrically opposed points of view.

First, all patients who have mycoplasma DNA isolated need to be treated.

Second, no one needs to be treated, since mycoplasmas are harmless bacteria that live peacefully in the urethra and do not cause symptoms in most patients.

All other opinions are in the middle.

There is no doubt that mycoplasma is pathogenic and can cause inflammatory processes in the urogenital tract and cause complications.

On the other hand, symptoms do not appear in all men in whom the DNA of this bacterium is detected.

As a result, whether a man needs treatment or not, doctors make a decision on their own, guided by many criteria.

The main ones:

1. Does the man have signs of urethritis or laboratory symptoms indicating inflammation of the urogenital tract.

2. Are there any signs of prostatitis?

3. Are you planning to change your partner in the near future?

4. Is pregnancy planned, or the patient’s family has already implemented all their reproductive plans.

5. What is the concentration of mycoplasma in the smear.

6. What kind of mycoplasma is it: hominis or genitalium.

7. Are there any signs of inflammation of the testicles or prostate gland?

8. Is the titer of antibodies to mycoplasma in the blood high, does it increase over time or decrease.

9. Are there any concomitant sexually transmitted infections?

10. Are there risk factors that increase the risk of exacerbation of mycoplasmosis or its complications (immunodeficiency, upcoming genital surgery, taking immunosuppressants).

Currently, most venereologists believe that if genital mycoplasma is detected, the disease should be treated immediately and without unnecessary questions.

It does not matter whether there are signs of inflammation, risk factors for complications, and in what concentration the microorganisms are contained.

They are more pathogenic than Mycoplasma hominis.

If you are a carrier of mycoplasma genitalium and there is no urethritis today, then tomorrow it will definitely appear.

At the same time, the attitude towards mycoplasma hominis is not so clear.

Treatment may not be carried out if a man:

has no active signs of inflammation
does not suffer from concomitant STDs
has no plans to change partners in the near future
does not plan to have a child
has no risk factors that increase the likelihood of complications of mycoplasmosis

Thus, if the likelihood of infecting other people is low, and if the risk of developing inflammation and complications is low, the disease may not be treated.

But such people usually do not go to doctors.

The most common reasons for contacting are:

symptoms of inflammation of the urogenital tract
wife planning pregnancy
preventive examination due to a vigorous and varied sex life
searching for the causes of infertility
upcoming surgeries or invasive procedures

No one comes to the doctor without any reason just to be examined for mycoplasmosis out of curiosity.

Therefore, in practice, most situations where this bacterium is found in the urogenital tract require treatment.

Features of the use of antibiotics

The main group of drugs for the treatment of mycoplasma are antibiotics.

The problem with mycoplasmosis therapy is that these bacteria are resistant to many drugs.

Therefore, it is optimal to carry out treatment not empirically, but after performing a bacteriological examination.

Material from the urethra is sown on a nutrient medium.

After mycoplasma colonies grow, antibiotic sensitivity testing is carried out.

As a result, the doctor finds out which drugs the bacterium is sensitive to and which it is resistant to.

But only for the treatment of mycoplasma hominis in men, drugs that are highly likely to work can be selected in this way.

The problem of the effectiveness of treatment of infections caused by mycoplasma genitalium remains not fully resolved.

Because culture for this bacterium is not carried out.

It grows on nutrient media poorly and for a long time.

As a result, the treatment of mycoplasma in men has to be prescribed antibiotics empirically.

That is, choose those to which the bacterium is most often sensitive.

But still, there are different strains of mycoplasmas.

Therefore, this treatment does not always work.

Options to solve the problem:

simultaneous use of antiseptics that can destroy mycoplasmas in the urethra
the use of enzymes that improve the penetration of antibiotics into tissues
using two antibiotics at the same time

Regimen for empirical treatment of mycoplasmosis

There are many antibiotic treatment regimens for mycoplasma in men.

The following groups of drugs are mainly used:

macrolides
fluoroquinolones
tetracyclines

Research indicates that the most effective drugs against mycoplasma genitalium are macrolides.

Erythromycin, azithromycin, and josamycin can be used for therapy.

Fluoroquinolones have a good effect, but only of new generations.

Sparfloxacin or levofloxacin are used.

However, tetracyclines are less effective.

A study by Horner P.J. showed that when using doxycycline, treatment was unsuccessful in 50% of patients.

They tested positive for mycoplasma genital DNA after treatment.

And the symptoms of urethritis returned 2-3 weeks after the therapy.

At the same time, there are other studies showing the opposite results.

While azithromycin was ineffective in 18% of patients.

The difference was in the dosages used.

In the first case, doxycycline was used on the first day, 200 mg, then for another 5 days, 100 mg per day.

The second study used a 7-day 100 mg regimen.

In two out of three patients, fluoroquinolones are effective.

However, studies show that even if Mycoplasma genitalium is found in the urethra, in almost all patients this does not lead to a return of urethritis symptoms.

In Russia, three main treatment regimens for mycoplasmosis are used:

doxycycline 100 mg, once a day, for a course of 3 days
josamycin - a course of similar duration, 500 mg per day
azithromycin - 0.5 grams on the first day, then 250 mg for another 2 days.

It is believed that macrolides are more effective than tetracyclines.

But this opinion is based largely on the experience of doctors.

It has not yet been confirmed by large studies.

Confirmation of cure for mycoplasmosis

After discontinuation of antibacterial drugs, the patient is examined again.

To do this:

conduct an examination, evaluate symptoms
take a smear from the urethra for microscopic examination
PCR is performed 2-4 weeks after drug withdrawal

In most cases, after a course of therapy, symptoms go away.

But this does not indicate recovery, since small amounts of bacteria could remain in the urogenital tract.

To check the etiological cure, the doctor takes a scraping from the urethra and sends it for molecular biological diagnostics.

If the test results are negative and the person has no complaints or objective symptoms, further monitoring is not required.

But there are situations when bacterial DNA is found in a urethral smear.

Then a repeat course of therapy is carried out.

Reasons for failure in the treatment of mycoplasmosis

Treatment of mycoplasma genitalium in men is not always successful.

It happens that after a course of antibacterial therapy, the bacterium is detected in the urogenital tract again.

This rarely happens in our clinic.

There are several reasons for this:

1. We use antibiotics that can accumulate inside cells.

Once inside cells, they become immune to certain antibiotics.

2. We use adequate regimens and doses.

We give preference to treatment regimens that have shown maximum effectiveness in studies.

3. We use additional drugs and procedures.

We use antiseptics for urethral lavage, physiotherapy, and prostate massage.

We prescribe immunomodulators and enzyme preparations.

These measures help enhance the effect of antibiotics.

As a result, the likelihood of success is much higher.

And yet, there are cases when treatment is unsuccessful.

Main reasons:

1. The man did not fully comply with the doctor’s orders.

2. The bacteria turned out to be insensitive to the antibacterial drug.

3. The patient became infected with mycoplasma again from an untreated partner.

In addition, there are cases when mycoplasma DNA is not detected, but the symptoms of urethritis return.

This most likely indicates that the patient was underexamined.

Signs of inflammation can be provoked by concomitant pathogenic flora.

To exclude such situations, during the patient’s initial visit, we immediately examine him for all common sexually transmitted infections.

What to do if treatment for mycoplasmosis fails?

If the course of treatment is unsuccessful, it is worth finding out why this happened.

Very often, therapy does not work because the patient does not fully comply with medical recommendations.

A feature of the treatment of mycoplasmosis is the need to use mainly bacteriostatic drugs.

They are used over a long period of time.

Some medications are taken 1 or 2 times a day.

In addition, the patient is treated on an outpatient basis.

Already in the first days, if successful, he gets rid of all symptoms.

All this leads to insufficiently high compliance (the patient’s willingness to follow the doctor’s recommendations).

Most common mistakes that patients do:

forget to take another pill from time to time
want to save money and purchase a cheap analogue of the prescribed antibiotic
reduce doses if side effects occur or in an effort to prevent their occurrence
stop therapy ahead of schedule because they notice the disappearance of symptoms

Undertreatment is one of the common causes of failure.

Many patients, if they are prescribed antibiotics for 5-7 days, do not complete the course.

After a few days of use, clinical recovery often occurs.

But it is not synonymous with microbiological recovery.

If there are very few bacteria left in the urogenital tract, they no longer cause symptoms.

But they are still able to reproduce if they are not completely destroyed.

Therefore, after premature discontinuation of antibiotics, the disease usually recurs.

Mycoplasma in men often becomes insensitive to the drug used.

This makes further treatment of the disease difficult.

If the patient perfectly complied with medical prescriptions, but was not cured, this is most likely due to the primary resistance of the mycoplasma to the antibiotic used.

No drug works 100% of the time.

Therefore, empirical treatment is always somewhat risky.

If the first course does not bring results, a repeat course is required.

The doctor either prescribes a different drug pharmacological group, or conducts bacteriological culture.

Repeated therapy of mycoplasmosis after culture

Treatment that is carried out after performing a culture test is more effective.

The frequency of treatment failures in this case is reduced by three times.

But the method is not applicable in case of mycoplasma infection of the genitalium.

It does not grow well on nutrient media.

Therefore, in clinical practice, culture is not used to diagnose this infection.

But mycoplasma hominis can be cultured.

After this, the sensitivity of this bacterium to various antibiotics is assessed.

Based on the results of the study, the doctor receives an antibiogram.

It lists antibiotics that can be used to treat mycoplasma hominis in men.

Next to each drug is information about the sensitivity of the bacteria to it.

It can be indicated by letters:

S– high sensitivity;
I– low sensitivity;
R– resistance.

In other cases, the minimum inhibitory concentration of the antibacterial substance is determined in mg/l.

After receiving an antibiogram, the doctor can treat with a drug to which the bacteria are definitely not resistant.

Therefore, the next course of therapy is highly likely to be successful.

Treatment of a partner with mycoplasmosis in a man

One of the reasons for repeated detection of mycoplasma in a man after treatment is re-infection.

Most often, the source of infection is the same person.

This is the patient's constant partner.

To exclude similar situations, both partners should be examined and, if necessary, treated at the same time.

This guarantees the absence of relapse in case of successful therapy.

Where to go for diagnosis and treatment of mycoplasmosis?

To diagnose mycoplasmosis and treat it, you can contact our clinic.

We have dermatovenerologists who have been successfully treating this infectious disease for a long time.

Our services:

examination for mycoplasmosis
topical diagnostics: we will check which organs are involved in the inflammatory process, as this affects the choice of therapeutic tactics
examination for concomitant sexually transmitted infections
determination of mycoplasma DNA concentration in areas of inflammation
assessment of the amount of antibodies in the blood
selection of antibacterial therapy
use of other treatment methods, including non-drug ones
restoration of sexual and reproductive function after antibacterial treatment
confirmation of cure by laboratory methods

Our clinic performs effective treatment mycoplasmosis, even if it has become chronic and spread to the internal genital organs.

For the diagnosis and treatment of mycoplasmosis Please contact the author of this article, a venereologist in Moscow with many years of experience.