The problems existing in the propaganda, diagnosis and treatment of mycoplasma infection in reproductive tract are the concentrated manifestations of the above phenomenon. Because of these factors, the cost of seeing a doctor for mycoplasma infection in reproductive tract is amazing, often thousands of dollars. It also makes many people who are infected with mycoplasma in reproductive tract or who are put on the hat of mycoplasma infection put on heavy psychological shackles and immerse themselves in pain all day long. However, what kind of pathogen is mycoplasma? Is genital mycoplasma infection necessarily a sexually transmitted disease? What harm does genital mycoplasma infection have? Must mycoplasma infection be treated? Is genital mycoplasma infection really difficult to treat?
1. What is mycoplasma and what are its characteristics?
Mycoplasma is the smallest prokaryotic microorganism, which is between virus and bacteria in size and structural complexity, and can grow and proliferate in artificial culture medium. The size is about 0.3 ~ 0.4 micron, which is difficult to see clearly under the microscope. Mycoplasma is polymorphic in morphology because it has no cell wall. Up to now, there are more than 150 known mycoplasma species, which are widely distributed in nature. There are 16 kinds of mycoplasma living in human body, among which there are 6 kinds of common mycoplasma living in human urogenital tract, including Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Mycoplasma primates, Mycoplasma spermatozoon and Mycoplasma penetrans. Due to the contact between oral cavity and genitals, sometimes mycoplasma living in urogenital tract (such as Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium and Mycoplasma perforatum) can be isolated in oropharynx occasionally. On the contrary, some mycoplasma living in the oropharynx (such as Mycoplasma fermentans, Mycoplasma saliva and Mycoplasma pneumonia) can also appear in the urogenital tract. Ureaplasma urealyticum, mycoplasma hominis and mycoplasma genitalium are the most important mycoplasma in the medical field at present.
Mycoplasma is not dry and has poor heat resistance. Boiling, high temperature and ultraviolet rays are easy to kill. At the same time, mycoplasma is easily inactivated by fatty solvents, detergents and commonly used disinfectants, such as alcohol, phenol, formaldehyde and lysol. Mycoplasma is not sensitive to antibacterial drugs (such as penicillin, cephalosporin, vancomycin, etc. ) interfere with cell wall synthesis; However, it is sensitive to antibacterial drugs that interfere with the synthesis of protein, such as erythromycin, tetracycline, clindamycin and spectinomycin.
Second, genital mycoplasma infection must be a sexually transmitted disease?
Mycoplasma can live in the urogenital tract of normal infants and adults, among which Ureaplasma urealyticum and Mycoplasma hominis are the most common, while Mycoplasma genitalium is rare. When the mother's birth canal is infected by mycoplasma, the baby can be infected, mainly with Ureaplasma urealyticum, and the proportion of girls infected with Ureaplasma urealyticum is as high as 1/3, and a few infected with mycoplasma hominis. Before puberty, there were fewer mycoplasma in male children's genitourinary tract, while the proportions of ureaplasma urealyticum and mycoplasma hominis in female children's genital tract were 5%~22% and 8% ~ 17% respectively. After puberty, the stay of mycoplasma in reproductive tract has a strong correlation with sexual activity, and the detection rate of mycoplasma in sexually promiscuous people, homosexuals, prostitutes, gonorrhea and other sexually transmitted diseases is high. Some people have investigated the carrying situation of mycoplasma in reproductive tract of different populations in China, and found that the carrying rates of ureaplasma urealyticum and mycoplasma hominis in healthy population are 10.59% and 5.34% respectively, while the detection rates of the two mycoplasma in promiscuous population are 25.47% and 8.8% respectively, and in sexually transmitted diseases are 29.3% and 4.3% respectively. Mycoplasma genitalium is mostly isolated from promiscuous people and patients with sexually transmitted diseases, and the detection rate is 10% ~ 60%, which is related to the degree of sexual dysfunction.
It can be seen from the above findings that mycoplasma can be a resident microorganism with normal urogenital tract. With the increase of sexual maturity and sexual activity, the colonization of mycoplasma in urogenital tract can increase, and mycoplasma can be transmitted through sexual contact. Therefore, urogenital mycoplasma infection cannot be regarded as a sexually transmitted disease.
Third, the harm of mycoplasma infection in reproductive tract?
Mycoplasma is parasitic outside the cell, but it can also enter the cell. Mycoplasma can normally live on the mucosa of human urogenital tract, and can also live with other flora. However, in the case of low immunity or mucosal damage, it will multiply and cause disease. Ureaplasma urealyticum has serotype 14, and its specific serotype has pathogenic effect, such as type 4, which has a strong correlation with nongonococcal urethritis. There are seven serotypes of mycoplasma hominis, but the relationship between serotypes and pathogenicity has not been confirmed.
Male urogenital mycoplasma infection may be related to nongonococcal urethritis, prostatitis, epididymitis and acquired reactive arthritis. Mycoplasma infection in female genital tract may be related to Pasteurella (vestibular gland) abscess, bacterial vaginosis, pelvic inflammatory disease and puerperal fever. Ureaplasma urealyticum infection may be related to urolithiasis, pyelonephritis and urinary tract infection. In addition, mycoplasma infection in urogenital tract may be related to fertility abnormalities such as infertility, habitual abortion, stillbirth and low birth weight. Mycoplasma can be a lethal pathogenic microorganism in HIV-infected people and other immunocompromised or suppressed people (such as organ transplant recipients and malignant tumor patients).
It should be noted that although mycoplasma infection in reproductive tract is related to many diseases, there is not enough evidence to show that mycoplasma is the pathogen of these diseases. For example, although ureaplasma urealyticum and mycoplasma genitalium are strongly related to nongonococcal urethritis, only a few nongonococcal urethritis are caused by these two mycoplasma. At present, there is no definite evidence that mycoplasma hominis can cause nongonococcal urethritis. Only a few patients with prostatitis and epididymitis have urogenital mycoplasma infection, and it has not been proved that mycoplasma can cause prostatitis and epididymitis. Pasteurella abscess is mainly caused by Escherichia coli and Neisseria gonorrhoeae, and mycoplasma is not an important cause of disease. Bacterial vaginosis is the result of normal vaginal flora imbalance, in which mycoplasma hominis and other microorganisms work together. Mycoplasma hominis may be one of the causes of pelvic inflammatory disease and puerperal fever in women, but there is no evidence that Ureaplasma urealyticum and Mycoplasma genitalium are related to pelvic inflammatory disease and puerperal fever. Only a few urolithiasis, pyelonephritis and urinary tract infections are related to mycoplasma. Although ureaplasma urealyticum is related to the change of sperm motility, there is no convincing evidence that mycoplasma is an important cause of infertility. The correlation between mycoplasma and habitual abortion, stillbirth and low birth weight is also speculative and inconclusive.
Therefore, the importance of mycoplasma in urethritis, epididymitis, prostatitis and pelvic inflammatory disease is far less than that of gonococcus and chlamydia. Just because mycoplasma is detected in the urogenital tract does not mean that it is the cause.
Fourth, how to diagnose mycoplasma infection in reproductive tract?
There is no need to detect mycoplasma clinically. Mycoplasma can be detected by culture, but it should be noted that normal people can also detect mycoplasma. Positive mycoplasma culture does not necessarily mean that urethritis is caused by it. The test results of mycoplasma need to be combined with clinical symptoms and other sexually transmitted diseases pathogens to determine whether it is sick or not. For patients with urethritis, the infection of Neisseria gonorrhoeae and Chlamydia trachomatis should be excluded first, and the positive result of mycoplasma culture is meaningful. Because the relationship between mycoplasma and prostatitis is still uncertain, even if mycoplasma is detected, it cannot be said that prostatitis is caused by mycoplasma.
Many units use the method of detecting serum antibody to diagnose mycoplasma infection in reproductive tract. In fact, the detection of serum antibody can not determine which part of the infection is, and most of the mycoplasma serum antibody detection reagents used in China have not been strictly evaluated. Therefore, the detection of mycoplasma serum antibody has no practical significance in labor and is only suitable for epidemiological investigation. However, PCR and DNA detection technology can not be applied to the clinical detection of mycoplasma infection due to extremely strict operational requirements, and are currently limited to scientific research and epidemiological investigation.
As for the inspection of various forms of multimedia microscope (also known as MDI, ultra-high magnification microscope, micro-amplification system, fluorescence micro-amplification system, etc. ) At present, it is used by many companies. Due to the lack of scientific basis, there are also many problems in the reagents used, and the authenticity and reliability of the test results are questionable.
Five, the treatment of genital mycoplasma infection
For the treatment of mycoplasma infection in reproductive tract, we must weigh the advantages and disadvantages, proceed cautiously and not be too active. The treatment of infected spouses or sexual partners should also be cautious, and the key is to target other sexually transmitted diseases that may coexist. Many mycoplasma infected people have been treated with antibiotics for a long time, but the mycoplasma test is still positive, and many new discomforts have appeared. The reasons are extremely complicated, such as mycoplasma resistance, detection errors or unqualified reagents, double infection (long-term use of antibiotics is prone to fungal and other insensitive bacterial infections), psychological factors and so on.
Generally speaking, drugs that are effective for chlamydia infection are also effective for mycoplasma infection. When necessary, tetracycline drugs (commonly used tetracycline, doxycycline and minocycline), macrolides (commonly used erythromycin, erythromycin succinate, roxithromycin and azithromycin), quinolones (commonly used ofloxacin and levofloxacin), spectinomycin, clindamycin and clarithromycin can be used to treat mycoplasma infection of reproductive tract, and the course of treatment is 1 ~ 2 weeks. Erythromycin is ineffective against mycoplasma hominis and clindamycin is ineffective against ureaplasma urealyticum. For female pelvic inflammatory disease, many factors should be considered, and the treatment should include antibiotics against Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis and anaerobic bacteria. The combination therapy of cefoxitin+doxycycline or clarithromycin+gentamicin is recommended abroad. Minocycline should be used to treat prostatitis which may be caused by mycoplasma infection, because minocycline can pass through the prostate capsule and reach the drug concentration needed to kill mycoplasma in the prostate. It is worth mentioning that the etiology of prostatitis is complex, and the effect of antibiotic treatment is not necessarily good. Comprehensive treatment is needed, and it is best to follow the advice of a urologist.
In recent years, the problem of mycoplasma resistance to antibiotics has attracted much attention, and abuse of antibiotics may be an important factor leading to mycoplasma resistance. It is reported that the resistance rate of Ureaplasma urealyticum to tetracycline is 10% ~ 20.6%, to doxycycline is 8% ~ 27.5%, and to erythromycin is 10% ~ 52.4%. Ureaplasma urealyticum and mycoplasma hominis are resistant to ofloxacin, accounting for nearly 20%. In addition, mycoplasma resistant to roxithromycin and azithromycin has also been reported. Because the resistance of mycoplasma to antibiotics is on the rise, clinical medication should be paid attention to. Some experts believe that in the treatment of mycoplasma infection, in order to reduce or prevent the emergence of drug-resistant strains, it is appropriate to use 2 ~ 3 different types of antibiotics for combined treatment. At the same time, traditional Chinese medicine can also be given adjuvant treatment, but no specific traditional Chinese medicine for treating mycoplasma has been found yet.
In a word, genital mycoplasma infection is a controversial issue in the medical field at present. Whether mycoplasma is the cause of urethritis, prostatitis and pelvic inflammatory disease has not been confirmed. Genital mycoplasma infection exists not only in STD patients and high-risk groups, but also in healthy people (including infants). Therefore, mycoplasma genitalium is not necessarily a sexually transmitted disease, nor does it have to be treated. The treatment of mycoplasma infection in reproductive tract depends on the specific situation and should not be rushed.