Ureaplasma. Can an analysis for ureaplasma be erroneous? Will a general urine test show ureaplasma

Two subspecies of Ureaplasma urealyticum have previously been identified: (1) parvum and (2) T-960. To date, these subspecies are regarded as two separate species: Ureaplasma parvum and Ureaplasma urealyticum, respectively.

Ureaplasmosis- caused by microorganisms that are close in size to large viruses and have neither DNA nor a cell membrane. They are occasionally considered as a kind of transitional step from viruses to single-celled ones. Transmission of the infection occurs, as a rule, sexually, but there may also be intrauterine infection from a sick mother, and in addition, microbes can enter the child's genital tract during childbirth and remain there all their lives, for the time being in a dormant state.

Ureaplasmas can provoke inflammation of any parts of the genitourinary tract - the bladder, urethra, prostate, testicles and their appendages, and in women - the vagina, uterus and appendages. In addition, in some studies it was possible to find out that ureaplasmas can be fixed on spermatozoa and disrupt their motor activity, and in some cases simply destroy sperm. After all, microbes can cause joint inflammation, especially in rheumatoid arthritis. Authors who classify ureaplasmas as obligate pathogens believe that they cause urethritis, prostatitis, postpartum endometritis, cervicitis, pyelonephritis, infertility, various pathologies of pregnancy (chorioamnionitis) and fetus (pulmonary pathology). Other scientists believe that ureaplasmas are part of the opportunistic flora of the urogenital tract and can cause infectious and inflammatory diseases of the genitourinary organs only under specific conditions (in particular, with insufficient immunity) or with appropriate microbial associations.

Ureaplasmosis can develop in both acute and chronic forms. As with many other infections, the disease does not have symptoms typical of this pathogen. Clinical manifestations of ureaplasmosis depend on the infected organ. At the same time, the pathogen is often determined by modern methods in perfectly healthy women who do not present any complaints, and often in combination with other infections.

To date, there are a number of objective difficulties in solving the problem of ureaplasmosis:
1. Ureaplasmosis, indeed, is a disease that is prone to chronic course.
2. In the diagnosis of ureaplasmosis, false positive responses are often found, which leads to overdiagnosis and false responses when monitoring treatment.
3. Chronic ureaplasmosis requires complex treatment.
4. Ureaplasma is a conditionally pathogenic microorganism (for some women it is the normal flora of the vagina). “To treat or not to treat ureaplasma” can only be decided by a qualified doctor.

Treatment of ureaplasma

Treatment of ureaplasma includes complex procedures depending on the location of the inflammatory process. In general, antibacterial agents are used that are aimed at destroying the infection; immunomodulators that activate the body's defenses; drugs that reduce the risk of side effects when taking antibiotics. A specific treatment regimen for ureaplasma can only be determined by a specialist who has all the information about the patient (examination, history, tests). As well as the problem of pathogenicity of ureaplasmas, the question of the need to eliminate these pathogens from the urogenital tract also remains open. As a rule, doctors suggest taking measures to eliminate these microorganisms if a person has an infectious-inflammatory process at the place of their existence (urethritis, prostatitis, cervicitis, vaginitis), as well as infertility, miscarriage, inflammatory diseases of the pelvic organs, chorioamnionitis, postpartum febrile conditions with the existence of ureaplasmas in the genitourinary tract.

Etiotropic treatment of ureaplasma infection is based on the appointment of antibacterial drugs of various groups. The activity of drugs against any infection is determined by the minimum inhibitory concentration in in vitro studies. Minimum inhibitory concentration values ​​generally correlate with clinical outcomes. It would seem that antibiotics with the lowest minimum inhibitory concentration should be the optimal drugs, but the seriousness of such parameters as bioavailability, the ability to create large interstitial and intracellular concentrations, tolerability and compliance of treatment cannot be disregarded.

Ureaplasmas are resistant to beta-lactam antibiotics (penicillins and cephalosporins), due to the fact that they lack a cell wall, and sulfonamides, since these microorganisms do not produce acid. In the treatment of ureaplasma infection, those antibacterial agents that affect protein synthesis from DNA, that is, those that have a bacteriostatic effect, can be effective. These are tetracycline drugs, macrolides, fluoroquinolones, aminoglycosides, in the general smear it can be slightly increased or not exceed the norm at all. To determine the pathogen, more accurate methods of examination are used - PCR and bacterial culture.

Quite often (up to 75-80% of cases) there is a simultaneous detection of ureaplasmas, mycoplasmas and anaerobic microflora (gardnerella, mobilunkus). The optimal pH value for the reproduction of mycoplasmas is 6.5 - 8. In the vagina, the normal pH is 3.8 - 4.4. The acidic reaction is supported by lactic acid, which is formed by lactobacilli from glycogen in the cells of the mucous membrane of the genital tract. Normally, 90 - 95% of microorganisms are lactobacilli, while others account for 5 - l0%, respectively (diphtheroids, streptococci, E. coli, staphylococci, gardnerella). As a result of various adverse effects: the use of hormone therapy antibiotics, radiation exposure, deterioration of living conditions and the formation of immunodeficiency, as well as mental stress, a state of dysbiosis occurs and the number of opportunistic microflora increases.

It is extremely important to inform your sexual partners about the disease, even if nothing bothers them, and to convince them to definitely undergo examination and treatment. Since the asymptomatic development of the disease does not reduce the risk of complications.

Methods for diagnosing urepalasma

Cultural study on selective media. Such an examination allows within 3 days to determine the culture of the pathogen and separate ureaplasmas from other mycoplasmas. Materials for the study are scrapings from the urogenital tract and urine of the patient. The method allows to determine the sensitivity of isolated pathogens to various antibiotics, which is extremely important given the fairly common today antibiotic resistance. The specificity of the method is 100%. This method is used to simultaneously detect Mycoplasma hominis and Ureaplasma urealyticum.
Detection of DNA pathogens by PCR. Examination allows to detect the pathogen within a day in a scraping from the urogenital tract and determine its species.
Serological tests. They can detect the presence of antigens and specific antibodies to them in the blood. They can be useful in the recurrent course of the disease, in the formation of complications and infertility.

Transmission routes

Infection with ureaplasmas can be from the mother during childbirth. They are detected on the genitals and in the nasopharynx of newborns.

Adults become infected through sexual contact. Household infection is unlikely.

Ureaplasmas are found on the genitals in approximately every third newborn girl. In boys, this figure is much less.

Often in children infected) during childbirth, self-healing from ureaplasmas occurs over time. It usually happens in boys.

Therefore, in schoolgirls who do not live sexually, ureaplasmas are detected only in 5-22% of cases.

In people who are sexually active, the prevalence of ureaplasmas increases, which is associated with infection during sexual contact.

Carriers of ureaplasmas are usually women. They are rare in men. Men can heal themselves.

Ureaplasma is sometimes transmitted by household contact, and sexually, with the latter being the most common. A vertical transmission route is also likely, which can occur as a result of an ascending infection from the vagina and cervical canal. Intrauterine route of infection - in the presence of ureaplasma in the amniotic fluid, the fetus becomes infected through the digestive tract, skin, eyes, urogenital tract. For men, ureaplasmosis is an exclusively sexual infection.

The incubation period is on average 2-3 weeks.

Data on infection of the urogenital tract with ureaplasmas among the sexually active population varies from 10 to 80%. Ureaplasmas are usually found in people who are sexually active, and quite often these microorganisms are detected in people who have three or more sexual partners.

In humans, only two species of this genus are capable of causing the development of a pathological process: ureaplasma urealiticum and. The habitat of these microbes is the urogenital area. In more rare cases, the microorganism is found in the tissue of the lungs and kidneys.

Ureaplasma urealyticum and ureaplasma parvum cause. This disease is more commonly diagnosed in women, as men usually do not have acute symptoms. Ureaplasmosis refers to sexually transmitted diseases. In women, one pathogen is more often found, and in rare cases, two at once, which makes it possible to draw a conclusion about the presence of ureaplasma spp. Ureaplasma parvum has more pronounced pathogenic properties than ureaplasma urealyticum. Treatment of an infection caused by ureaplasma parvum is more complex and lengthy, the risk of complications is very high.

Ureaplasma infection is now widespread. Experts note a high degree of colonization of the urogenital organs by ureaplasma urealiticum: in men - 25%, in women - up to 60%.

Ureaplasma urealyticum

Ureaplasma urealyticum got its name from its ability to break down urea. This is its main difference from those in the same genus. The ability to ureal is a trigger for the development of urate nephrolithiasis and urolithiasis.

U.urealyticum is the causative agent of sexual infection. The disease is characterized by signs of prolonged inflammation with complications and sexual transmission of the pathogen. Ureaplasma urealyticum can cause asymptomatic carriage and realize its pathogenic properties only under certain conditions.

Factors provoking inflammation of the urogenital tract:

• Diseases of the genital organs,
• Decreased immune defense
• sexual infections,
• Inflammation of the prostate
• Immunodeficiencies and violation of local defense factors,
• Dysbiosis of the vagina in women.

Ureaplasma urealyticum refers to T-mycoplasmas capable of forming small colonies. Microbes grow at a temperature of 37 ° C and an optimal pH of 6.5-7.0. Ureaplasmas are catalase-negative, inert to sugars, cause beta-hemolysis of rabbit and guinea pig erythrocytes. A feature of ureaplasmas is the need for urea and cholesterol. They break down uric acid to ammonia, grow well on dense enriched media and practically do not grow on liquid media.

According to generally accepted medical standards in women, ureaplasma urealyticum is a conditionally pathogenic microorganism that manifests its pathogenic properties only under the influence of adverse factors. In association with other pathogenic or opportunistic microbes, ureaplasma can lead to the development of a number of pathologies that require urgent treatment. In most cases, this microorganism is highly resistant to modern antibiotics and is difficult to treat.

Ways of transmission of infection

The spread of ureaplasma infection occurs as follows:

1. Ureaplasma urealyticum is the causative agent of a sexually transmitted infection. Infection occurs during unprotected intercourse with an infected person. The microorganism feels great on the surface of spermatozoa and on the epithelium of the vagina.
2. Ascending microbes penetrate into the genitourinary system and uterus. The vertical route of transmission of infection occurs when ureaplasma penetrates from the vagina and cervical canal into the ureter and kidneys.
3. Transmission of infection from mother to fetus occurs through the placenta. Intrauterine infection is possible through the gastrointestinal tract, skin, eyes and organs of the urinary system of the fetus.
4. During childbirth, during passage through the birth canal, mechanical infection of the newborn occurs.
5. Organ transplant patients can become infected. This is a transplant route of infection.
6. In more rare cases, anal and oral contact.
7. The contact-household method accounts for less than 1%.

What causes ureaplasma urealyticum?

Among women

The microbe can cause development in women, pelvic diseases, bacterial, cervical erosion, cervical insufficiency, infertility.

Ureaplasma infection in women often occurs latently. The clinic of pathology is determined by the location of the pathological process. Women have moderate mucous discharge, pain and burning sensation when urinating, aching and cramping pains in the abdomen, itching of the genitals. Symptoms are usually mild and disappear quickly. The infection is activated with nervous strain, physical fatigue, weakening of the body's defenses.

An infected woman does not feel any effects of the microbe on the body. Usually she has an active sex life, is not protected, plans the birth of a child. Complications in women are extremely rare. In weakened individuals with reduced overall resistance, the diseases described above occur, requiring antibiotic therapy.

In men

In men, ureaplasma urealiticum provokes the development of cystitis, sexual dysfunction. The first symptoms appear a month after infection. Ureaplasma infection in men disrupts spermatogenesis and promotes kidney stone formation. With urethritis, the head of the penis turns red, itching and burning in the urethra, pain that worsens with urination, and clear discharge. In advanced cases, the infection can spread to the prostate and kidneys.

Chronic ureaplasmosis in men occurs without subjective symptoms. In the morning, or after a long retention of urine, there is a scanty, cloudy discharge. The external opening of the urethra often sticks together, the urine becomes cloudy, there is a "urinary" smell. In men, carriage is practically not observed.

Diagnostic methods

To determine the etiological significance of ureaplasma urealyticum in the development of the disease, it is necessary to establish the number of microbial cells in the discharge of the urinary organs.

• Usually, people who are preparing to become parents and are under the supervision of specialists in a family planning center are sent for analysis.
• Pregnant women are screened for this infection.
• Persons with chronic pathology of the genital organs should be examined to determine the etiology of the pathological process.
• All persons with suspected sexually transmitted diseases should be examined.

The main diagnostic methods of ureaplasma infection are:

Treatment

If there are appropriate symptoms and if the pathogen is isolated in an amount of more than 10 4 CFU / ml, the disease must be treated. Patients are treated with antibiotics.

During treatment, patients must refrain from sexual activity, do not drink alcohol, do not sunbathe in the sun and in a solarium, do not drink milk, carbonated and mineral water. The duration of treatment is 10-14 days. Both sexual partners should be treated.

In the absence of timely and adequate treatment, ureaplasmosis can lead to the development of formidable complications: prostatitis, salpingo-oophoritis, pyelonephritis. The cause of infertility in men is a violation of the process of sperm formation. Ureaplasma urealyticum causes impaired sperm motility and quantity, the appearance of pathologically altered forms. In women, infertility is caused by infection of the endometrium with ureaplasmas or infection of the ovum.

Prevention of ureaplasmosis

Preventive measures to prevent the development of ureaplasmosis and other sexually transmitted diseases:

1. Use of condoms.
2. Application after sexual intercourse of antiseptic solutions - Miramistin, Chlorhexidine, candles - Polizhenaks, Hexicon.
3. Strengthening immunity.
4. Hygiene of the genitals.
5. Periodic screening for STIs.

Ureaplasma urealyticum is the causative agent of a typical sexually transmitted disease that requires treatment in order to avoid complications and the spread of sexual infection in society.

Video: ureaplasma specialist

Video: obstetrician-gynecologist about ureaplasma

It is taken to confirm the diagnosis of "ureaplasmosis". To prescribe the correct treatment, it is important to determine the type of microorganism, its quantity and localization in various parts of the genitourinary system.

Types of pathogen and clinical manifestations

The causative agents of ureaplasmosis are a genus of bacteria of the mycoplasma family. Normally, they inhabit the mucous membranes of the genitourinary system in 60% of healthy men and women. Mycoplasmas are an intermediate between bacteria and viruses and exhibit tropism for the epithelial cells of the urinary tract.

Therefore, one of the methods for making a diagnosis is the study of scrapings from the surface of the mucous membrane of the vagina and urethra to detect the pathogen in epithelial cells and leukocytes - markers of inflammation.

Ureaplasmas differ from other mycoplasmas in their ability to break down urea to ammonia with the help of the urease enzyme, which is synthesized by the cytoplasm of the microorganism.

In 2015, 7 species were assigned to the genus. Clinically important for the laboratory are:

• ureaplasma urealyticum (10 serotypes);
• ureaplasma parvum (4 serotypes).

Until 1954, both of these species belonged to one - ureaplasma urealyticum, in 2002 a separate species was isolated - ureaplasma parvum.

More recently, ureaplasmosis was not considered a disease and was not included in the International Classification of Diseases. Currently, this disease is considered one of the sexually transmitted diseases. In addition, the role of the pathogen in miscarriage and premature delivery is being studied.

For a long time, ureaplasmas can persist on the surface of the mucous membranes, a decrease in local and general immunity contributes to the pathological reproduction of the pathogen. Pathological reproduction of ureaplasma parvum and ureaplasma urealyticum can provoke the development of myometritis, endometritis, urethritis, pyelonephritis, salpingitis, oophoritis or accompany these diseases caused by other pathogens.

In men, these microorganisms can cause urethritis, epididymitis and other diseases of the genitourinary organs. Most often, ureaplasmosis accompanies gonorrhea and chlamydia.

• infertility;
• pyelonephritis;
• arthritis;
• pregnancy disorders;
• infection of the fetus in the womb and during the passage of the birth canal.

The clinical symptoms of ureaplasmosis are very similar to the clinical manifestations of all STDs: the patient develops itching, burning, pain during urination and in the genital area. The disease may be accompanied by vaginal discharge. In the presence of a clinical picture, the doctor prescribes tests for ureaplasmosis to the patient. Smear microscopy, ELISA and culture are used to determine the degree of infection and the main pathogen: ureaplasma urealiticum or parvum.

Stages of smear examination

A flora smear is a study under a microscope of cells taken by scraping from the walls of the vagina in women or prostate secretion in men. This express method is used for severe clinical manifestations of the inflammatory process, with spontaneous miscarriage or ectopic pregnancy. When planning a pregnancy or treating infertility, a smear is taken from both men and women.

Ureaplasma parvum is often found in a smear with reactive arthritis. A control study is carried out 3-4 weeks after the end of the course of antibiotic therapy.

In order for the results of the analyzes to be as accurate as possible, it is necessary to prepare in advance for the selection of the material. This is especially important for women:

In men, prostate secretion is taken for microscopy for ureaplasmosis. To do this, the probe is inserted into the urethra to a depth of 3 cm. The procedure is accompanied by pain and discomfort, which disappear within a short time.

In women, for a smear for ureaplasmosis, a scraping is taken from the walls of the vagina, urethra, and cervix. To do this, use a disposable spatula, the selection of material is carried out in a gynecological chair. The procedure is usually painless. Discomfort, pain usually indicate an inflammatory process.

The resulting material is applied to glass, stained and examined under a microscope. Preparation of a smear for reading the results is carried out within 1 working day. The decoding of the analysis in this case consists in counting the number of leukocytes, erythrocytes and studying the composition of the flora, including lactobacilli, ureaplasmas, mycoplasmas, trichomonas, gonococci, chlamydia, candida.

If ureaplasma is found in a smear, this is not yet a basis for making a diagnosis. The number of microbial bodies matters. The norm of ureaplasma in the test material is 103 CFU. A positive result for ureaplasmosis is recorded if the number of microbial bodies exceeds 105 CFU. It is worth considering that without clinical manifestations and changes in the level of leukocytes in the test sample, the diagnosis is not considered confirmed.

What should be the normal

The norm for leukocytes varies depending on the place of sampling:

1. For the urethra, the norm is from 0 to 5 cells per field of view.
2. For the vagina, the normal number is 0 to 10, and in pregnancy, 0 to 20 cells.
3. For the cervix - from 0 to 30 leukocytes in the field of view.

The excess of these indicators and the presence of erythrocytes in the smear indicate an inflammatory process.

It is impossible to determine whether ureaplasma parvum or ureaplasma urealyticum is the causative agent of the disease using simple smear microscopy. To differentiate species, more accurate studies are needed: ELISA or PCR, for which a smear or scraping from the vaginal mucosa is also used. For the patient, there is not much difference which ureaplasma - parvum or urealiticum - caused the disease. In any case, the doctor prescribes antibiotic therapy for all types of ureaplasmas, and sometimes for pathogens of concomitant diseases.

When an analysis is made for ureaplasma in women, deciphering the results often reveals concomitant diseases: gonorrhea, trichomoniasis, candidiasis, as well as the amount of normal microflora.

Although most experts consider PCR diagnostics to be the most reliable in detecting ureaplasmosis, it is not carried out in all laboratories, so sometimes patients have to take an ELISA or RIF. The results of these analyzes sometimes raise doubts about the presence of the causative agent of ureaplasmosis in the body, especially in the early stages of the disease or during the recovery period, when the course of treatment has been completed. In such cases, a false positive result of ureaplasma can be obtained. With such a conclusion, a comprehensive examination is required in order to confirm or reject this conclusion and state a complete recovery.

A false positive result in ELISA can be obtained after treatment. There are still antibodies in the blood, which will definitely reveal themselves for a long time during the research of the material, showing a positive reaction. At the same time, PCR and bakposev of the viruses themselves do not detect and give a negative answer. Doctors call this phenomenon a "residual trace" after a course of therapy. To make sure that the virus is really absent, you can repeat the ELISA after a few months and compare the titers. With a false positive result, ureaplasma is absent, so the titers will decrease over time.

It may be a false positive result of ureaplasma due to the fact that when carrying out the ELISA and PCR methods, completely different material is taken for research. If the ELISA shows class A antibodies, then there is an infection in the body and it is already being fought, as evidenced by the presence of immunoglobulins in the blood. However, PCR analysis can state a negative result on the same day. This is solely because the material was not taken from the place where the viruses live. Since antibodies are found in the blood, they can be found anywhere. With the causative agent of the disease, everything happens in a completely different way. Ureaplasma in the body can be located locally, that is, in a certain area. If it is present in the uterine cavity, then in the study of urethral discharge, the analysis will be negative. This happened only because the area for material sampling was incorrectly determined.

Ureaplasma is present in the body, which has shown itself during PCR, but antibodies are completely absent in the blood with weakened immunity. This situation is also a reason to conclude a false positive result, because the PCR and ELISA readings do not match. In this case, you can start