Ureaplasma is a bacterium that provokes inflammatory diseases in the organs of the genitourinary system. Urgent treatment of ureaplasmosis is necessary if a person is a carrier, a mucosal lesion is detected.
In diagnostic studies, together with ureaplasma, chlamydia, mycoplasmas and other harmful microorganisms are often found.
As a result, it takes complex treatment ureaplasma in women according to the scheme effective drugs: antibiotics, suppositories, etc.
Causes
An increase in the rate of reproduction of pathogens is provoked by the occurrence of the following factors:
- rapid decrease in immunity;
- pregnancy, medical abortion;
- infections that develop in the body over time;
- hormonal disorders that occur during menstruation.
Symptoms of ureaplasmosis
Main features pointing to:
- discharge of a yellowish tint with an unpleasant odor;
- pain, discomfort in the vagina;
- sharp pain, spreading to a significant part of the abdomen. They appear if the infection has been in the body for a long time, affecting the appendages, the uterus;
- when infected with ureaplasma by oral contact, symptoms characteristic of purulent tonsillitis may manifest;
- burning, discomfort when urinating.
If ureaplasma is detected, the disease needs treatment. It is necessary to consult a doctor to get the recommendations necessary to eliminate the likelihood of complications, the spread of infection.
If chronic manifestations of ureaplasma are found in a woman, you need to assign a scheme, which will take a long time to complete.
Ureaplasma in women - consider the symptoms of infection, the main causes of the appearance and schemes for effective treatment of ureaplasmosis. Healthy Life Program:
Necessary conditions for successful treatment
When promptly seeking medical attention The treatment regimen consists of several points.:
- After diagnostic measures prescribing antimicrobials from ureaplasma for women. Additionally, drugs are prescribed that restore the immune system.
- A course of treatment should be completely abstain from sexual activity.
- Additionally, local treatment (candles) is prescribed.
- An individual diet, for the duration of treatment, it is necessary to completely abandon alcoholic beverages, exclude food hazardous to health.
If violations in the work of the intestine are detected, it is necessary to take drugs to update the beneficial microflora. It is necessary to restore the microflora of the vagina, which can be completely destroyed by ureaplasma.
An individual complex is selected or standard medicines are used for the intake of bifidus and lactobacilli.
Medicines for effective therapy
Rules for effective treatment:
- Medicines are used if an acute inflammatory process is detected.
- To completely get rid of the disease it is necessary to apply a course of treatment. More often, doctors prescribe antibiotic therapy. In order not to harm your health, you need to pay attention to the work of the digestive tract.
- The circuit is usually built according to a standard pattern, including antibiotics and immunosuppressants.
If the results of the tests showed that the person is the carrier of the infection, it is necessary to prescribe medications. This measure is especially important during pregnancy.
Preventive methods should be used if the sexual partner has diseases associated with the development of ureaplasma.
Sometimes the initially prescribed treatment regimen may be minimally effective.
In order to notice this unpleasant factor in time, laboratory tests should be done regularly. Usually they are carried out about once every 30 days.
How to treat ureaplasma in women, what drugs? Let's consider in more detail.
antibiotics for infection
To eliminate the symptoms of ureaplasmosis in women, treatment is prescribed. Choose drugs from the following groups:
- Macrolides (Sumamed). Accumulate inside the cells, the optimal concentration is maintained for 3 days. Sumamed is used once, the course is about a week.
- Fluoroquinolones. Usually doctors recommend using Avelox. A gradual increase in its concentration inside the body is impossible, which is why the course lasts a long time. To fully cope with the disease, it is often necessary to use the drug for 3 weeks.
- Tetracyclines. Used when other means are not effective. Prescribe Doxycycline or Unidox. The listed drugs are rarely used, usually as part of complex therapy, since ureaplasma resistance to them has been identified.
If a person asked for medical help on time, the inflammation developed slightly, it is enough to use one of the listed antibiotics according to the scheme approved by the specialist.
If complications are possible, the inflammatory reaction is aggravated, the patient is prescribed a complex scheme of drugs from different groups.
You can't mix them, so he goes through several courses of treatment at once.
Auxiliary medicines
People with good immunity rarely suffer from ureaplasmosis. The disease affects patients in whom it is reduced. To get rid of relapses, it is necessary to use comprehensive measures until complete recovery.
It is necessary to strengthen the immune system, make sure that fewer antibiotics affect the gastrointestinal tract.
- Immunomodulators. Among these medicines doctors prescribe Ureaplasma Immun, which must be administered intramuscularly several times a day.
- Antifungal medicines. They are necessary if the patient takes record doses of antibiotics. Important microflora in the intestine is removed almost completely. To prevent the reproduction of fungi, microorganisms, special drugs are used, for example, Nystatin.
- Products containing beneficial bacteria for rapid restoration of intestinal microflora.
- Vitamins to strengthen immunity, body defenses.
Candles
Among the medicines in the treatment of ureaplasmosis, suppositories help:
with antimicrobial ingredients. These funds are Chlorhexidine or its analogues.
With regular use of such candles, the number of dangerous bacteria and viruses is reduced.
Usually 1 suppository per day is enough and a small course that lasts 1-2 weeks;
suppositories containing immunomodulators. They restore immunity, show high activity against viruses, eliminating the possibility of their reproduction.
These drugs are taken at least twice a day, and the course is less than 10 days.
Candles can be used in combination with regular antibiotics., but not as independent drugs for ureaplasmosis.
disease in pregnant women
Ureaplasma therapy is sometimes delayed by women if the bacterium was discovered during pregnancy. Many decide to start treatment only after childbirth.
Many doctors advise treat ureaplasma in women during pregnancy immediately after diagnosis to avoid dangerous consequences:
- miscarriage, premature birth. Possible with early opening of the cervical canal of the uterus;
- causing damage as a result of violation of organic mechanisms;
- the spread of infection in the uterine cavity, which can cause significant harm to the fetus even before birth.
If the disease is detected during pregnancy, it must be treated not only with obvious signs, but even if the expectant mother is a carrier.
This does not rule out the possibility of passing the disease to the child..
So you can reduce the likelihood of congenital infection, protect the child from the appearance of pathologies, complications after childbirth.
Diagnosis to exclude ureaplasmosis is mandatory during pregnancy, since scientifically proven that the disease is capable of increase the likelihood of miscarriage, provoke premature birth.
Many drugs of conventional therapy are contraindicated in pregnancy. Other drugs are prescribed, the treatment regimen involves the use of other drugs:
- Vilprafen- allowed during pregnancy. Apply carefully, it is advisable to consult a doctor in advance. Usually the drug is prescribed after the 20th week of pregnancy. Otherwise, there is a possibility of damage to the fetus, which is just being formed;
- drugs used to increase bifido- and lactobacilli;
- often only suppositories are prescribed for local exposure, because of which they cannot cause significant harm to the fetus;
- vitamins, mineral complexes to strengthen the body, restore immunity.
To cure ureaplasmosis, it is necessary to use diagnostic tests regularly. They can quickly determine whether a person is completely cured.
During therapy, control tests are taken 3 times to completely exclude the possibility of re-infection in the body.
People who have already received test results several times, taken medications prescribed by a specialist, and after some time these microorganisms were found in the biomaterial again are interested in ways to permanently cure ureaplasma.
Ureaplasma in women is part of the vaginal microflora, so doctors call it conditionally pathogenic. When immunity decreases, a person takes antibiotics or antibacterial drugs for a long time, becomes infected with an STI, and an inflammatory process develops.
That is why it is not the ureaplasma itself that is dangerous, but the disease that this opportunistic microbe causes, and then treatment is necessary. If microorganisms “doze” in the body, which is not manifested by unpleasant symptoms, then it is not always necessary to take medication.
Ways of transmission of infection
When a woman who trusts her sexual partner takes tests, she is extremely surprised if she sees that ureaplasma is present in the body. It begins to seem to her that the man is cheating, that it was he who infected her. Pregnant women begin to panic especially, in whom a “clean” smear gave similar results. But you need to listen carefully and be treated according to the scheme prescribed by the doctor.
Sometimes ureaplasmosis is really the result of infection in one way or another:
- sexual;
- household;
- from mother to child during the birth process.
The risk of infection increases in those who have predisposing factors:
At the same time, it is important to understand that it will not be possible to completely cure for the simple reason that the microorganism is already present in the body, it is part of the microflora. The disease can worsen if a person has had a cold, a viral disease, that is, immunity has decreased.
Therefore, one of the secrets of how to get rid of ureaplasma is to try not to get sick, to observe the regime of work and rest, and not to worry about various reasons.
Such an answer to the question of whether ureaplasmosis can be cured does not mean at all that it is impossible to get rid of ureaplasma once and for all, then even with poor analyzes, you should not get rid of the inflammatory process. Thinking that "it will pass by itself" is wrong. Because if the disease is started, it will entail complications.
Complications in women and men
Those who are not treated, after a certain time of disease progression, may find complications in reproductive system. This applies not only to girls, women, but also men. Because the question of how to cure ureaplasma is usually asked by the fair sex, while some guys naively believe that these are all women's problems and will not affect them in any way, their health will not worsen. However, all this is not so.
If you do not recover from ureaplasmosis, then the woman will have complications:
- inflammation in the cervix - cervicitis;
- inflammatory process in the mucous cells of the vagina - vaginitis;
- diseases in the pelvic organs;
- inflammatory process in the uterus - endometritis;
- inflammation in the appendages, ovaries of the uterine organ - adnexitis;
- problems with reproductive function - the inability to become pregnant.
Men with advanced ureaplasmosis in the future may suffer from:
- inflammation of the prostate gland, or;
- problems with urination;
- urethritis - a pathological process in the urethra;
- epididymitis - inflammation in the epididymis.
Wrong treatment regimens
Sometimes patients cannot be completely cured, because the doctor diagnoses a full range of pathologies, but instead of starting with the treatment of ureaplasmosis, he prescribes drugs for other diseases, which leads to an advanced form of inflammation.
The whole point, perhaps, is that the symptoms are similar to other inflammatory processes. These are fatigue, abdominal pain, urinary incontinence.
The insidiousness of the disease is sometimes that the course is asymptomatic. But with an exacerbation in men there are:
- pain when urinating;
- scanty discharge from the urethra, in the morning;
- slight pain in the groin.
Exacerbation in women is manifested:
- constant urge to urinate;
- pain when emptying the bladder;
- mucous secretions;
- pain in the lower abdomen.
Accurate diagnosis and complex therapy
Material for it is necessary to take from women from the urethra, from the fornix of the vagina and from the cervical canal. And in men - scraping from the urethra.
In order to understand that patients got rid of the disease, the analysis must also be passed after, but at least 2 weeks after the end of therapy.
Pathology is cured if you build a competent complex scheme with the necessary drugs for oral administration in a particular case, vitamin therapy, and other ways to strengthen immunity. Sometimes doctors prescribe vaginal suppositories and suppositories designed to restore the vaginal microflora.
The disease is curable if all instructions are followed. Complete the entire prescribed course from beginning to end, without missing anything, without independently replacing one drug with another. At the same time, do not drink alcohol, sexual life even with barrier contraceptives.
Ureaplasmosis is defined as an infectious and inflammatory disease of the genitourinary system, which is transmitted mainly through sexual contact and is caused by a microorganism Ureaplasma urealyticum, or Ureaplasma parvum.
In humans, these bacteria primarily affect the urethra in men and the vagina in women. Ureaplasmosis as a separate disease is rare, more often found in association with and. Therefore, with symptoms characteristic of urogenital infections (, mucous or purulent or), simultaneously with tests for ureaplasmosis, diagnostics for mycoplasmosis and chlamydia are always carried out.
Ureaplasmosis is isolated as a separate disease only if an inflammation pattern develops and the tests are positive only for ureaplasma (u.urealyticum or u.parvum).
Until now, there has not been a consensus in medicine regarding ureaplasmas. Some consider them pathogenic (pathogenic), others are confident in their complete harmlessness and classify them as normal microflora of the human body. The ways of transmission of ureaplasmosis also raise questions: almost 30% of girls who do not live sexually have ureaplasmas, and the household route of transmission has not been reliably proven. Carriage is also doubtful - in men, ureaplasmas may not be detected at all, however, in women, after sexual contact with absolutely healthy men, for some reason, these bacteria were found.
As a result, modern medicine nevertheless formulated its attitude towards ureaplasmas. The “middle way” of selecting criteria has prevailed, according to which the diagnosis and treatment of various cases of ureaplasmosis is carried out.
- Ureaplasmas are opportunistic pathogens present in the normal microflora of the vagina in women (more than 60%) and the urethra in men (about 50%). In the majority, they do not manifest themselves in any way, do not give symptoms of inflammation, and therefore, even in the case of a positive diagnosis, such people do not need any treatment.
- Detection of ureaplasma during pregnancy does not give rise to panic: the very fact of their presence does not threaten complications or miscarriage and does not harm the health of the baby. All complications are possible only with the development of inflammation associated with the reproduction of ureaplasmas and other pathogenic bacteria. A decrease in immune defense is the main factor that provokes the onset of the disease, and maximum attention should be paid to the general health of expectant mothers.
- Almost always, ureaplasmas are found together with mycoplasmas and chlamydia. Therefore, the treatment is carried out with drugs to which all these microorganisms are sensitive. Usually a combination of various antibiotics is required, the scheme is always supplemented with immunomodulators and probiotics, vitamins and diet.
Ways of transmission and causes of development of ureaplasmosis
It has been proven that infection with ureaplasma occurs mainly through sexual contact, and a child can get an infection from the mother during pregnancy or during childbirth. Household (through objects, underwear) transmission routes are unlikely and practically not proven. Gateway of infection usually become the vagina and urethra, less often infection occurs orally or anally. Further distribution of ureaplasmas is possible only with their active reproduction in a weakened organism. Incubation period lasts 1-3 weeks after sexual contact.
The causes of the manifestation of ureaplasmosis are considered a number of factors in which a decrease in the immune status of a given person is possible. The combination of several of them increases the likelihood of the transition of ureaplasmas from opportunistic to the category of pathogenic microorganisms.
Age period 14-29 years is considered the most active, including in relation to sexual life. Hormonal levels and social freedom, confidence in one's health or no thought at all about its vulnerability predispose to the spread of sexually transmitted infections.
During pregnancy occurring under conditions of physiological or moral stress, it is possible to exacerbate dormant infections that have never manifested themselves before. Poor nutrition, work to wear, high study loads, uncertainty about the future - all affect pregnancy and its outcome.
Concomitant sexually transmitted diseases caused by gonococci, chlamydia and mycoplasmas; simple viruses, papilloma or human immunodeficiency (and HIV) always contribute to the emergence and development of ureaplasmosis.
The immune system, weakened by prolonged stress or any chronic diseases, is not able to resist the reproduction of ureaplasmas. The result is the spread of infection and inflammation of the organs that make up the urogenital tract.
Weakening of the body after operations, hypothermia, a course of radioactive exposure in the treatment of cancerous tumors or due to deteriorating living conditions, it also contributes to the development of symptoms of ureaplasmosis.
The growth of opportunistic microorganisms is favored by uncontrolled treatment with antibiotics and hormonal agents, leading to dysbacteriosis- violation of the balance of microflora inside the human body.
Symptoms of ureaplasmosis in women
Primary signs of the disease associated with damage to the vagina and cervical canal, then the infection is introduced into the urethra. Symptoms develop and small mucous discharges appear from the cervix and vagina. At urethritis a woman complains of a burning sensation in the urethra during urination, and the urge to urinate also becomes more frequent. After a few days, if the immune system is in order and there is no dysbacteriosis, the symptoms may disappear altogether and never appear again. When the body is weakened, the spread of ureaplasmas will follow the principle of ascending infection, capturing the internal genital organs, bladder and kidneys.
Chronic ureaplasmosis can lead to cervical erosion, and subsequently to epithelial cancer, which quickly metastasizes. At first, a woman is concerned about small mucous secretions, then bleeding during menstruation joins - a sign of the infection moving to the endometrium. On examination, a bright red mucosal defect with jagged edges is visible. On ultrasound, a thickening of the endometrium is determined.
- Screening: pregnant; women under 25; having multiple sexual partners with unprotected intercourse.
- Diseases: inflammatory processes in the pelvic organs in men and women; urethritis, cystitis and pyelonephritis; asymmetrical arthritis; conjunctivitis; inflammation of the testicles and appendages; infertility.
- Infection control before medical procedures: before abortion, artificial insemination, the introduction of intrauterine contraceptives; before examining the patency of the fallopian tubes.
- To identify infected people and people from the circle of sexual contacts.
Material for analysis is taken from men - from the urethra, from women - from the cervix, vagina and urethra.
Remains preferable, despite the duration of its execution. First, the material from the patient is sown on an artificial nutrient medium, then isolated from the grown colonies of the pathogen and determined using tests. The identification of ureaplasmas is based on their specific enzymatic activity: ureaplasma is able to break down urea. Re-seeding is carried out to determine the sensitivity to antibiotics. The results are obtained in a week or 10 days, the final diagnosis is made and adequate treatment is prescribed.
(polymerase chain reaction) helps to identify bacterial DNA specific to a given type of microorganism. The method is 100% accurate if it is performed correctly and does not require other confirmation of the diagnosis.
Ureaplasma can persist throughout life, so their definition for diagnosis does not make sense: it is impossible to distinguish between “fresh” and “old” traces of infection.
Treatment
Treatment of ureaplasmosis necessarily at the risk of complications during pregnancy, which are confirmed by objective examinations; with male and female infertility, if other causes, except for ureaplasmosis, have not been established. Ureaplasmosis is also treated if there are symptoms of inflammation of the urinary organs and tests confirm this fact. Before planned medical interventions (surgeries, invasive diagnostic methods) to prevent the spread of ureaplzm outside the infected area, short courses of antibiotics are used.
Fundamentally, the treatment of ureaplasmosis does not differ from the treatment of other STDs.
Tetracycline antibiotics ( doxycycline, unidox) are absolutely contraindicated during pregnancy. The modern treatment regimen puts them in the category of reserve ones also due to the appearance of ureaplasma resistance to these drugs in about 10% of cases.
Group fluoroquinolones(all drug names end in "-oxacin") in action is close to antibiotics, but has no natural analogues. Drugs used to treat co-infections ofloxacin, ciprofloxacin. The peculiarity of drugs in this group is contraindicated in children under 15 years of age and pregnant women; increase sensitivity to ultraviolet radiation and can cause skin burns, so it is not recommended to sunbathe and be treated with fluoroquinolones at the same time.
General treatment combined with local, for men, these are instillations of medicines into the urethra (solutions of protargol or collargol) and baths with antiseptics. Women are prescribed vaginal or rectal suppositories. Candles "Genferon" have an antibacterial and antiviral effect, anesthetize and restore tissues, activate the immune system. Use twice a day, a course of 10 days. Suppositories "Hexicon" x 1/day will help cure uncomplicated ureaplasmosis in a 7-day course. It is allowed to use them during pregnancy and lactation.
In chronic disease, immunomodulators are used - methyluracil, cycloferon, thymalin and t-activin in order to activate the immune system and get first a controlled exacerbation, and then a stable improvement. Rehabilitation therapy: drugs with lacto- and bifidobacteria after a course of antibiotics; antifungals ( fluconazole); vitamin and mineral complexes. Complete nutrition with the exception of hot spices, alcohol and fried foods, with salt restriction. Sexual contacts are excluded for the entire period of treatment.
Folk remedies
The main tasks are to strengthen the body, reduce the effects of inflammation. For these purposes, locally used herbal antiseptics (sage, chamomile, calendula) in the form of douches or baths. Prepare infusions at the rate of 1 tbsp. a spoon (without a slide) of dry grass or flowers per 200 ml of boiling water, exposure 1 hour; then the infusion is filtered through 3-5 layers of gauze. You can add a decoction of oak bark, prepared in the same proportion. Infusions are not prepared for the future, each time you need to take care of a fresh portion. The course will require 7-10 procedures.
Drinks from herbs or berries will help reduce inflammation, avoid complications of ureaplasmosis on the kidneys and joints. Tea from lingonberry leaf and St. John's wort, a decoction of lingonberry berries and raspberry leaves work perfectly. However, it is worth remembering that diuretic the effect which these remedies exert may do a disservice during antibiotic treatment. Medicines will be more quickly excreted from the body, and their concentration will decrease below the therapeutic level. That's why all folk remedies such actions are acceptable only after the end of the main course of treatment.
Video: expert opinion on ureaplasmosis
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 illness. 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 association 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 involvement in the process fallopian tubes, ovaries and their ligaments. 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 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 detect ureaplasmas are clinical and / or laboratory signs of an inflammatory process: urethritis, PID. Should not be carried out routine research 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:
- creamy discharge on the walls of the vagina with an unpleasant odor;
- positive amine test (increased "fishy" smell when 10% KOH is added to the vaginal secretion);
- an increase in the pH of the vaginal contents above 4.5;
- 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
- 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
- Waites K. et al, Mycoplasmas and ureaplasmas as neonatal pathogens. Clinical microbiol review, Oct 2005, 757-789
- 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
- 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
However, not all ureaplasmas cause disease - several types are pathogenic for our body: Ureaplasma urealyticum(ureaplasma urealiticum) and Ureaplasma parvum(ureaplasma parvum).
How does ureaplasma infection occur?
sexual route of infectionUndoubtedly, the most common way of infection is through sexual contact. However, in fairness, it is worth noting that about 20-40% of those infected do not feel any symptoms of the disease itself - therefore they are only carriers. Under unfavorable conditions for the body, these symptoms may appear, but as long as the immune system keeps the ureaplasma population under control, the patient may not even be aware of the disease. It should be noted that infection with ureaplasmosis is possible with such types of contact as: kissing, oral or genital sexual contact without barrier means of protection.
Vertical route of infection (mother to fetus at birth)
This type transmission of infection is possible precisely due to the fact that the favorite habitat of ureaplasma is the mucous membrane of the genital tract - through which the child passes during natural childbirth.
Contact-household way of transmission
At present, there is no convincing evidence of the possibility of infection by this method. Therefore, it is not worth seriously considering the possibility of infection in the pool, through the common toilet lid or household items.
Symptoms of ureaplasmosis
| First of all, the symptoms of inflammation of the urethra (urethritis) are noticed. In this case, there is discomfort and burning in the urethra, which increases with urination up to pronounced pains. Also, during sexual intercourse, there are painful sensations that are aggravated by ejaculation. | |
| Discharge from the urethra | Usually they are not plentiful, more mucous in nature, liquid in consistency. |
| Inflammation of the epididymis | In severe cases, testicular lesions may occur - while the patient feels heaviness and bursting pain in the testicles, which are aggravated by palpation. |
| Symptoms of prostatitis | Occur, as a rule, some time after the onset of symptoms of urethritis. This indicates the progression of the infection. With prostatitis, the symptoms are soreness in the perineal region, the pain may increase when sitting, when feeling the perineal region. Also, prostatitis can be manifested by a decrease in libido and a reduction in the duration of an erection. Sexual contact can be painful. |
| male infertility | Long-term prostatitis and orchitis (inflammation of the testicles) can lead to persistent male infertility. |
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| Urethritis (inflammation of the urethra) | Pain and burning in the urethra. Pain is also characterized by a sharp increase in urination. The mucous membrane of the external pharynx of the urethra is inflamed. |
| Discharge from the vagina and urethra | Allocations are not plentiful, as a rule, have a mucous character. |
| Pain during genital intercourse | Occurs as a result of additional mechanical irritation of the inflamed mucosa. |
| Bloody issues from the vagina after sexual genital contact | The cause of this symptom can be inflammation of the vaginal mucosa, its increased sensitivity to mechanical stress. |
| Pain in the lower abdomen | This symptom may indicate the progress of the infection through the genital tract with damage to the uterine mucosa, fallopian tubes. What can cause complications such as endometritis, adnexitis. |
| female infertility | With inflammation of the genital tract, damage to the endometrium of the uterus, normal conception and intrauterine development of the child is impossible. Therefore, female infertility or frequent miscarriages in the early stages of pregnancy can be observed. |
Complications of ureaplasmosis
Unfortunately, recently there has been an increase in the number of complications caused by the long course of ureaplasmosis. As mentioned above, ureaplasmosis can be the cause of male or female infertility, along with damage to the organs of the genitourinary system, the development of autoimmune diseases, the so-called rheumatic diseases, is possible. - Male infertility - can develop as a result of damage to the prostate by ureaplasma, and with damage to the testicles. With inflammation of the prostate, the secretion of the portion of sperm secreted by it decreases, while the qualitative composition of the sperm changes, which makes the process of sperm moving through the woman's genital tract impossible.
- Impotence - with the development of prostatitis, a painful erection or its absence can be the cause of a persistent organic pathology that requires adequate treatment under the supervision of a specialist doctor.
- Female infertility - damage to the uterine mucosa leads to the fact that the process of implantation of a fertilized egg becomes impossible. At the same time, even if the conception took place, the inflammatory process in the endometrium can be the cause of an early miscarriage.
- Premature birth - in some cases, if there is a course of pregnancy against the background of ureaplasmosis, it is worth fearing the earlier development of labor activity. There is also a high chance of having a baby with low birth weight.
- Rheumatic diseases - long-term chronic form ureaplasmosis can be one of the triggering factors for the development of an autoimmune process. Because ureaplasmosis can be risk factors in the development of rheumatic diseases.
Diagnosis of ureaplasmosis
It is impossible to make a diagnosis of ureaplasmosis on the basis of external symptoms - only laboratory data are a reliable basis for making a diagnosis. However, gynecological examination to laboratory examinations in without fail must be present.How to prepare for a visit to a gynecologist if there are suspicions of sexually transmitted infections?
You should know for sure that a gynecological examination (examination in the mirrors) will be carried out without fail to diagnose such diseases. This study is performed in order to visually assess the presence or absence of secretions, their properties, the condition of the mucous membrane of the vagina and cervix, the condition of the external pharynx of the cervical canal, the condition of the mucous membranes of the external genitalia.
The presence of mucopurulent secretions, a sharp ammonia smell and inflammation of the mucous membranes of the vagina and urethra will testify in favor of ureaplasmosis and other sexually transmitted diseases.
A visit to the doctor should be preceded by preparation:
- 2 days before the appointment with the doctor, you must refrain from any kind of sexual contact
- Within 2 days before the examination, it is necessary to stop using any vaginal suppositories, gels and other drugs administered vaginally.
- It is necessary to stop douching, the use of vaginal tampons.
- On the eve of visiting the doctor in the evening, it is worth washing yourself with warm water, preferably without using soap.
- Washing is contraindicated on the day of treatment.
Laboratory tests to detect ureaplasmosis are performed with various types biomaterial is the patient's blood and a swab from the mucous membranes of the genital organs.
Bacteriological analysis, PCR research, seeding - these types of diagnostics use the material obtained as a result of taking a smear. Serological studies in which antibodies against a specific infectious agent are detected are performed using the patient's blood.
Currently, only PCR diagnostics is recognized as effective in the diagnosis of ureaplasmosis. All other diagnostic methods are either uninformative or are produced for scientific purposes. Consider the advantages and disadvantages of each of their applied methods.
Bacteriological examination of a smear for ureaplasma- not produced, since mycoplasmas are simply not visible when examining a smear with a microscope - they are so small. However, this examination is carried out because in 80% of cases of diagnosis of sexually transmitted diseases, ureaplasmosis is combined with several other types of infections, and this method can also reveal concomitant bacterial or fungal vaginosis, which must be cured before prescribing the main treatment against ureaplasma. Therefore, you should not refuse this examination - it is necessary for the appointment of complex treatment.
Culture from a swab or secretions from the genital tract- in relation to ureaplasma is not effective. However, as already mentioned above, this method is also of some value in identifying concomitant sexual infections.
PCR diagnostics- allows you to multiply and identify the genetic material of the pathogen. This method has the highest reliability and sensitivity. Therefore, it is the diagnosis of choice.
Serological studies (ELISA, PIF)- these studies allow to detect antibodies to the infectious agent. They are difficult to interpret due to the fact that there is no stable immunity to ureoplasmic infection in the body, and the number of carriers of this infection is much greater than those who have developed symptoms of the infectious process.
Conducted clinical and laboratory studies make it possible to identify ureaplasmosis and concomitant infectious diseases of the genitourinary system with a high degree of probability. It is high-quality diagnosis and identification of all infectious lesions that allows us to prescribe adequate treatment and hope for a full recovery. It should be noted that your sexual partner should also be examined in full - after all, the effectiveness of the treatment of only one of the infected sexual partners in this case will be minimal.
Treatment of ureaplasmosis
It is worth pointing out one important point- treatment of ureaplasmosis should be carried out according to the following rules: - Treatment is prescribed to both partners at the same time, and the appointment of treatment should be preceded by a full diagnosis.
- In case of detection of concomitant infectious diseases, treatment is prescribed according to an individual scheme, depending on the identified spectrum of infections.
- During the period of treatment, any sexual intercourse is prohibited - including with the use of barrier methods of protection.
- The treatment carried out requires a control examination to diagnose cure within the time frame set by the doctor.
- Treatment should be carried out with the drugs prescribed by the attending physician with strict adherence to the prescribed treatment regimen. Premature termination of treatment is possible only after a second consultation with the attending physician.
Before informing you about the standard schemes for the treatment of an infectious process, we draw your attention to the fact that: the treatment of infectious and inflammatory diseases with the use of antibacterial drugs is possible only under the supervision of a specialist in charge.
| Name of the antibiotic | Daily dosage and frequency of use | The duration of the course of treatment |
| Doxycycline | 100 mg twice a day | 10 days |
| Clarithromycin | 250 mg twice a day | 7-14 days |
| Erythromycin | 500 mg 4 times a day | 7-14 days |
| Levofloxacin | 250 mg once a day | 3 days |
| Azithromycin | 500 mg once on the first day, 250 mg once a day | 4 days |
| Roxithromycin | 150 mg twice a day | 10 days |
Stimulation of immunity
In order to effectively fight ureaplasma infection, antibiotics alone are not enough. After all, antibacterial agents only help the immune system cope with bacteria that harm the body. Therefore, whether a complete cure occurs depends largely on the state of the immune system.
To stimulate the immune system, it is necessary to adhere to a rational regime of work and rest, nutrition should be balanced and contain easily digestible protein, vegetable fats and vitamins A, B, C and E.
Also, to stimulate the immune system, they often resort to medications - such as immunal or St. John's wort tincture.
Adequate treatment of infectious and inflammatory diseases is possible only under the supervision of a specialist!
How can you tell if there has been a cure?
After the end of the course of drug treatment, a month later, a diagnosis of cure can be made. For this, the same methods of laboratory research are used as for the detection of a disease - PCR diagnostics and bacteriological examination of a smear from the vaginal mucosa. A negative test result indicates a complete cure. In the presence of positive result the attending physician may suggest repeating the course of treatment with another antibiotic.
Prevention of ureaplasmosis
There is currently a lot of debate about whether to use drug treatment among persons who are carriers of ureaplasma, but they have no symptoms of ureaplasmosis. This circumstance indicates that ureaplasma can be attributed to opportunistic infections that appear only under certain unfavorable conditions.What should be done in order not to become infected with ureaplasmosis, and if infection has occurred, what should be done to avoid complications?
- Reducing or eliminating casual sex.
- In case of accidental sexual contact (regardless of the type of contact), it is necessary to use individual barrier protective equipment.
- Treatment should be complex and culminate in a negative result of the control test.
- Maintaining immunity for high level will allow the body to cope with this infection on its own.
How is ureaplasmosis manifested in pregnant women? What is the treatment? Why is it dangerous?
Previously, doctors often recommended to pregnant women who have been diagnosed with ureaplasmosis, artificial termination of pregnancy. The tactics have now changed. Most often, a woman can carry a pregnancy and give birth to a child. However, the disease negatively affects both pregnancy and the condition of the fetus. Therefore, it is better to take tests and be treated in advance. Features of ureaplasmosis during pregnancy:
1.
Pregnant women have reduced immunity. Even if ureaplasmas are present in the body in small quantities, they can cause infection.
2.
Do not take antibiotics in early pregnancy. Antibacterial drugs have side effects and may adversely affect the fetus.
3.
Against the background of reduced immunity, ureaplasmosis opens the gate for sexually transmitted infections. If a woman becomes infected with an STD, this will even more negatively affect the course of pregnancy.
Possible complications of ureaplasmosis during pregnancy:
- Miscarriage. In the early stages, the disease can lead to miscarriage.
- premature birth. The child is born premature, weakened. This is due to the fact that ureaplasmosis loosens the cervix. You can take it in, but it can also negatively affect the condition of the child.
- Violation of the uteroplacental blood flow.
- hypoxia(oxygen starvation) of the fetus.
- Intrauterine growth retardation.
- If pregnancy against the background of infection proceeds without complications, there is no threat of miscarriage, then treatment is prescribed from the 22nd week. Higher risk earlier negative impact antibiotics on fetal development.
- Usually used antibacterial drugs from the group macrolides (erythromycin) in conjunction with immunotherapy (thymalin, T-activin) and probiotics (lactusan, colibacterin, bifidumbacterin).
- Treatment is selected individually. Your doctor may also prescribe other drugs.
Is it possible to treat ureaplasmosis with folk remedies?
Ureaplasmosis - infection which can lead to a number of complications. Its effective treatment is possible only with the use of antibacterial drugs prescribed by a doctor. Folk remedies can be neither the main method of treatment, nor an alternative to medications. But, as an addition to the main therapy, they are able to improve the condition, reduce symptoms, and speed up recovery.
Before using these or other folk remedies, be sure to consult your doctor.
.Below are some recipes for informational purposes only.
Some folk recipes for ureaplasmosis
Recipe #1Ingredients:
- succession grass - 3 parts;
- raspberry leaves - 3 parts;
- rose hips - 3 parts;
- dill fruits - 1 part;
- nettle leaves - 1 part;
- primrose root - 1 part;
- birch leaves - 1 part;
- lungwort (grass) - 1 part;
- violet (grass) - 1 part;
- plantain - 2 parts;
- meadowsweet flowers - 2 parts.
Finely chop and mix all ingredients. Take 1 tablespoon of the resulting mixture and pour one glass of boiling water. Insist 9 hours.
Mode of application:
Take 1/3 cup 3 times a day before meals.
Recipe #2
Ingredients:
- licorice root - 1 part;
- leuzea root - 1 part;
- kopeck root - 1 part;
- pharmaceutical chamomile flowers - 1 part;
- alder cones - 1 part;
- succession grass - 1 part.
Cooking method:
Mix all ingredients thoroughly and mix. Take one tablespoon of the resulting mixture and pour boiling water over it. Insist 9 hours.
Mode of application:
Take one third of a glass 3 times a day, before meals.
Recipe #3
Ingredients:
- thyme - 1 part;
- series - 1 part;
- yarrow herb - 1 part;
- leuzea root - 1 part;
- burnet root - 1 part;
- wild rosemary - 1 part;
- birch buds - 1 part.
Finely chop and mix all ingredients. Take one tablespoon of the resulting mixture and pour a glass of boiling water. Insist 9 hours.
Mode of application:
Take ½-1 cup daily, just before meals.
Recipe #4
Ingredients:
- upland uterus - 1 part;
- wintergreen - 1 part;
- winter love - 1 part.
Finely chop and mix all ingredients. Take one tablespoon of the resulting mixture and pour 500 ml of water. Let it brew for 12 hours.
Mode of application:
Take ½ cup 4 times a day.
What is ureaplasmosis 10 in 4 degrees?
One of the methods for diagnosing ureaplasmosis is the sowing of the pathogen on a special medium. This study helps not only to detect microorganisms, but also to determine their number (titer). People who have ureaplasmas do not always have symptoms of the disease. So, according to statistics, ureaplasma positive are 15-70% of sexually active women and up to 20% of men.
Thus, doctors need a clear criterion that would help to identify a high risk of disease. The titer of the pathogen became such a criterion. If it is 10 to the 4th power or less, this is considered the norm. At a higher rate, they speak of a high degree of risk or a confirmed diagnosis of ureaplasmosis.
But, even if the titer is low and the person has no symptoms, ureaplasma positivity may have some negative consequences:
- A carrier can infect a sexual partner, who will develop the disease.
- A ureaplasma-positive woman can infect a child during childbirth (the probability of infection is 50%).
- With a decrease in immunity in a ureaplasma-positive person, an infection may develop.
How is ureaplasmosis manifested in newborns? Why is this disease dangerous?
Despite the fact that a woman with ureaplasmosis can endure pregnancy and give birth to a child, the pathogen negatively affects the condition of the fetus, infection of the newborn is possible. Ways of transmission of the pathogen from mother to fetus:
- through the placenta transplacental);
- in contact with the birth canal during childbirth.
At a later date, it develops placental insufficiency, fetal hypoxia. A child is born ahead of schedule, weak, weakened. If the fetus experiences severe oxygen starvation, then later the child may have mental disorders.
There is evidence that ureaplasmas can interfere with the development nervous system. Because of this, in the past, physicians often recommended abortion to infected women. Today the tactics have changed.
Diseases of newborns that can be caused by ureaplasma:
- pneumonia(pneumonia);
- bronchopulmonary dysplasia- a chronic disease that develops in newborns after artificial lung ventilation;
- sepsis(blood poisoning);
- meningitis- inflammation of the dura mater.
Cases of ureaplasma damage to the respiratory system and testicles in schoolchildren are described.
Can ureaplasmosis occur in the mouth? How is it manifested?
Ureaplasmosis can be contracted during kissing and oral sex. But through kisses, the pathogen is not always transmitted. If it's an ordinary friendly kiss on the cheek or touching the lips, then infection is unlikely. This also applies to children and parents. If you kiss a child, then most likely you will not infect him. The risk of infection is even lower if a sick person carefully observes oral hygiene.
plan pregnancy.
During pregnancy, there is a risk of miscarriage and prematurity, infection of the fetus. The only effective preventive measure is timely preliminary treatment.
Can ureaplasmosis occur in a virgin? Where does it come from?
The detection of ureaplasma in a virgin can have different reasons:- In fact, the girl is not a virgin and hides it. Infection occurred during sexual contact.
- Infection occurred during a kiss, oral-genital contact.
- The household route of infection (through common objects, including personal hygiene items, through the rim of the toilet bowl, bath, etc.) has not been proven. But it is not excluded either.
- Often, ureaplasmosis is found in girls whose mothers suffered from this disease during pregnancy. In this case, the girl received the infection from her mother.
Thus, even in the absence of sexual intercourse and protected sex, there is a possibility that a girl or young man ureaplasma will be detected.
Are mycoplasmosis and ureaplasmosis the same thing?
Both diseases are caused by microorganisms belonging to the Mycoplasmataceae family. It is divided into two genera: Mycoplasma and Ureaplasma. Thus, mycoplasmas and ureaplasmas are “relatives”. They cause the same inflammatory processes in the genitourinary system, infections manifest the same symptoms. Treatment methods are also practically the same.After treatment of ureaplasmosis, itching appeared. What to do?
If, after a course of treatment for ureaplasmosis, itching, vaginal discharge, peeling of the skin in the genital area, it is necessary to visit the doctor again and undergo an examination. There is a possibility that the disease was not fully treated (especially if control tests for ureaplasma were not performed), or there was a re-infection from an untreated partner. In addition, due to a decrease in immunity, ureaplasmas can open the gate for other infections. Often the problem is the development of vaginal dysbacteriosis after a course of antibiotics. This is not uncommon among women who have received antibiotic therapy for urinary tract infections. Treatment of vaginal dysbacteriosis is carried out with the help of eubiotics, probiotics, immunomodulators.
What is ureaplasma parvum and urealiticum?
These are two types of ureaplasmas that can cause ureaplasmosis. These two microorganisms Ureaplasma parvum and Ureaplasma urealyticum, - they try to detect in the laboratory when diagnosing the disease. The causative agent Ureaplasma urealyticum was first discovered in 1954 by researcher M. Shepard in a patient who suffered from urethritis of non-gonococcal origin. Since then, several more species of these bacteria have been discovered: Ureaplasma cati, Ureaplasma canigenitalium, Ureaplasma felinum, Ureaplasma diversum, Ureaplasma parvum, Ureaplasma gallorale.
Ureaplasmas are unique microorganisms that, in their structure, occupy an intermediate position between viruses and bacteria. They are referred to transient microflora: these microorganisms are not characteristic of healthy person, but long time can be present in the body without causing harm, and when the defenses are weakened, they can cause infection.