MYCOPLASMA AND UREAPLASMA INFECTIONS IN PATIENTS OF AN AMBULATORY UROLOGY WARD Introduction Mycoplasma genus contains microorganisms that, unlike

other bacteria, have no cell wall. Because they are present in the healthy mucosal flora, their pathogenic role is controversial. There have been detected numerous species of Mycoplasma, all together forming the class Mollicutes from the family Mycoplasmataceae. The latter contains 69 species of Mycoplasma, out of which 2 are pathogenic-M. pneumoniae, which is a common bacteria isolated in cases of atypical respiratory disorders, and M. hominis, which takes part in the development of pelvic inflammatory diseases. The family also contains 2 species of Ureaplasma, one being pathogenic: Ureaplasma urealyticum. The majority have a pseudococcoidal shape. A quite unique characteristic is that they require sterols for their cytoplasm membrane. Having a small genome- 0.58-1.38 mega base- biosynthesis is minimal, so the sterol need is ensured by cholesterol coming from the host cells. Pathogenesis 1. Mycoplasma hominis (M. hominis) Adhesion is assured by a polar extension, this tip structure containing adhesive proteins (P1). Arginin activity releases a high amount of ammonia, which has a cytotoxic effect. 2. Ureaplasma urealyticum (U. urealyticum) By inhibiting the movement of sperm cells, bacteria participate in the etiology of sterility. Urea metabolism induces the presence of urinary calculi. Protease activity contributes to the degradation of secretory IgA.

Diseases produced by U. urealyticum and M. hominis are pyelonephritis, Reiter- syndrome, peritonitis, septic arthritis.

urethritis, prostatitis,

In pregnancy U. urealyticum can be transmitted to the fetus causing chorioamnionitis, and it is believed that U. urealyticum has a role in spontaneous abortion, premature delivery, and in some neonatal infections e.g. septicemia. Material and methods Urethral secretions have been collected from 375 male patients with urogenital disorders. Only 231 indicated possible M. hominis or U. urealyticum infections. Soon after sampling, the swabs have been processed using Mycoplasma DUO and Mycoplasma IST2 testing methods. Mycoplasma DUO contains substrates that are altered enzymatically by the presence of genital mycoplasmas. Mycoplasma IST2 enables culture, identification, quantitive enumeration and antibiotic susceptibility testing for 9 antibiotics: doxycycline, josamycine, ofloxacine, erythromycine, tetracycline, ciprofloxacin, azithromycin, clarythromycin, and pristinamycin.These are present in different quantities in the upper or lower strip.The dosage is doubled or tripled for ex. Doxycycline 4 mg/l 8 mg/l , making it possible to choose the most effective treatment, in order to not weaken the liver with surplus antibiotics. Results M. hominis and U. urealytium infections were detected in 6/231 and 40/231 men respectively. Single U. urealyticum infections were present in 35 patients, and only one had exclusively M. hominis infection. M. hominis was found only in patients suffering from prostatitis. Patients diagnosed with Benign Prostatic Hyperplasia (BPH), presented neither M. hominis nor U. urealytium infections. Totally there were 193 cases of prostatitis, 11 cases of epidydimitis and 32 of fertility impairment. Out of these 39, 3 respectively 5 were U. urealyticum positive patients.

Regarding the symptoms, M. hominis manifested itself exclusively in dysuria, no other symptoms were observed by these patients. Only U.urealyticum positive patients had more broad- spectrum symptoms, including dysuria 27 ( 90% ) , hypogastric pain 11 ( 34,37%) and in some cases testicular pain 2 ( 6,25% ). Each case which presented coexistence of U. urealyticum and M. hominis ( 5 ) , occurred in prostatitis, the only symptom being dysuria. The occurrence of U. urealyticum in patients who complained of erectile dysfunction was considerable 6/35 (17,41% ) , this underlining an issue debated by many physicians, does U. urealyticum infection affect sexual potential? U. urealyticum infection could be observed mostly in patients from rural areas (28/40), and a significantly smaller number (12/40) were urban residents. It has been known that M. hominis and U. urealyticum occurs in co-infections, explaining its controversial diagnosis and treatment. That is why we looked for other bacteria in the secretions of positive patients, and this hypothesis proved to be right. Out of the 35 single U. urealyticum positive samples a few ( 7 ) presented other microorganisms such as S. haemolyticus (2/7), Streptococcus agalactiae (2/7), Enterococcus Staphylococcus saprophyticus(1/7). Because of the lack of cell wall, M. hominis and U. urealyticum are resistant to antibiotics targeting these structures for ex. penicillin. But they are susceptible to other broad-spectrum antibiotics which inhibit their division. It has been shown that the rate of resistance to fluoroquinolones (ciprofloxacin, ofloxacin) is dramatically increasing. All of the cases in this study were sensitive to and treated with tetracycline, however some proved to be Ciprofloxacin resistant. Ofloxacin in small dosage( 1 mg/l ) appears to be inefficient in order to treat the infection, but at 4 mg/l its inhibitory effect can be seen. After treatment none of the patients presented Mycoplasma pathogens in their urethral secretion , none of them were tetracycline-resistent. faecalis (2/7), and

Conclusion Mycoplasma hominis and Ureoplasma urealyticum usually coexist in the human body, having a role in the development of prostatitis and epidydimitis, and they are completely absent in the cases of BPH. Presence of U. urealyticum can be linked to erectile dysfunction, and rarely to testicular pain. M. hominis causes only dysuria. They occur more often in patients who reside in rural areas. In some cases they can be found as part of a co-infection, increasing the virulence of other microorganisms.