Ureaplasma is one of the factors that make Russian medicine unique. In Russia, the discovery of this microbe in the human body is much more often made a drama than in the West. Let's see what kind of bacteria it is and why approaches to it differ in our country and in the West.
Ureaplasmas are one of the smallest microorganisms that can live independently, outside the host cells. They are close relatives of mycoplasmas, belong to the same family, therefore, in scientific articles, they are often considered together. Scientists distinguish two types of ureaplasma (U.urealyticum and W. Parvum), in studies and articles they are generalized (Ureaplasma spp.). These microorganisms do not have a normal cell wall. This complicates the treatment of the infections they cause: many antibiotics do not take them...
Ureaplasmas are considered conditionally pathogenic microorganisms, they are very often found in healthy people. Sexual transmission of these bacteria exists, but it is not necessary for their spread: they are found in people without sexual experience. In the vast majority of cases, these bacteria do not cause any problems, but sometimes they can cause illness.
What kind of diseases can ureaplasma cause, is it necessary to look for it in every person with unpleasant sensations below the belt, is it necessary to treat all the "infected"? Different countries can still give different answers to this question.
What disease does ureaplasma cause?
Russian recommendations indicate that ureaplasmas, if their pathogenic properties are realized, are the cause of urethritis, cervicitis (inflammation of the cervix), complications of pregnancy, postpartum and post-abortion complications.
Many Western sources indicate that ureaplasmas can cause approximately the same set of pathologies. However, the team of authors of the European Recommendations for the Treatment of Sexually Transmitted Diseases (STDs) states that the qualitative evidence only shows that ureaplasmas sometimes cause urethritis in men and bacterial vaginosis in women. The role of ureaplasmas in the development of other diseases, according to European experts, cannot currently be considered proven.
Who needs a ureaplasma test and treatment
In the Russian clinical guidelines, tests for ureaplasma are proposed to be done in the presence of signs of inflammatory diseases of the urogenital tract and reproductive system, as well as in the presence of symptoms of dysbiotic disorders of the vaginal microbiota in the absence of pathogenic pathogens. According to the Russian "canon", the ureaplasma should be destroyed in case of inflammation in which no other pathogens have been found (gonococcus, chlamydia).
Tests are also provided for some people who do not have symptoms and signs of inflammation: sperm donors, patients with infertility, with miscarriage in the past. If ureaplasma is detected, treatment is recommended in these cases.
These recommendations are in conflict with similar Western documents.
The team of authors of the European guidelines for the treatment of STDs has strongly criticized overdiagnosis and over-treatment. In an official statement released in 2018, they spoke out against routine screening for ureaplasma. Scientists believe that the diagnosis of infections caused by ureaplasma is unnecessary in asymptomatic cases and in most patients with signs of disease.
European scientists believe that now there are only two exceptions to this rule: non-gonorrheal urethritis in men and bacterial vaginosis in women. With the symptoms of these diseases, it makes sense to conduct tests for ureaplasma, followed by treatment if detected.
They call the main negative consequences of the mass detection of ureaplasmas and the subsequent treatment of this:
- the development of resistance to antibiotics - like ureaplasma, like other bacteria;
- lack of attention to the real causative agents of urogenital infections;
- significant economic burden both on patients and, in certain cases, on the state.
Scientists emphasize that one of the reasons for the love for the diagnosis of ureaplasmosis is the possibility of its commercialization. Experts point out that the frequent detection of ureaplasmas (and mycoplasmas) and the subsequent fight against them are widely conducted in Eastern and Southern Europe, South America. That is, what we call in this article the “Russian version” is typical for many countries.
Apparently, science knows not everything about the pathogenic properties of ureaplasma, it cannot be ruled out that we will still see changes in the guidelines. At the same time, today we can say that Russian documents deviate to a certain extent from the standards of evidence-based medicine.