Patient's question:
Positive for chlamydia detected at the hospital, mycoplasma test results not yet available, urine routine shows a lot of. The doctor prescribed azithromycin for me. Do I need to be treated with intravenous fluids in addition?Doctor's answer:
Mycoplasma is a microorganism that is primarily transmitted through contaminated sexual contact and is classified as a sexually transmitted disease (STD). If a urine or cervical secretion test shows a positive result for mycoplasma, it indicates mycoplasma infection! The eponym of mycoplasma in venereology is non-gonococcal urethritis (NGU), which includes (Chlamydia ÷ Mycoplasma).### I. What are mycoplasmas, and what are their characteristics?
Mycoplasmas are the smallest prokaryotic microorganisms capable of growing and proliferating in artificial culture media. They are intermediate in size and structural complexity between viruses and bacteria. Their size is approximately 0.3–0.4 μm, making them difficult to observe under a microscope. Due to the lack of a cell wall, mycoplasmas exhibit pleomorphism in morphology. To date, over 150 species of mycoplasmas have been identified and are widely distributed in nature. Six species of mycoplasmas commonly inhabit the human urogenital tract, including Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Mycoplasma primatum, Mycoplasma spermophilum, and Mycoplasma penetrans. Occasionally, mycoplasmas that inhabit the urogenital tract (e.g., Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, and Mycoplasma penetrans) may be isolated from the oropharynx due to oral-genital contact. Conversely, some mycoplasmas that inhabit the oropharynx (e.g., Mycoplasma fermentans, Mycoplasma salivarium, and Mycoplasma pneumoniae) may also appear in the urogenital tract. Ureaplasma urealyticum, Mycoplasma hominis, and Mycoplasma genitalium are the most clinically significant mycoplasmas. Mycoplasmas are sensitive to dryness and have poor resistance to heat; boiling or high temperatures, as well as ultraviolet light, can easily kill them. Additionally, mycoplasmas are easily inactivated by lipid solvents, detergents, and common disinfectants such as alcohol, phenol, formaldehyde, and Lysol. Mycoplasmas are insensitive to antibacterial drugs that interfere with cell wall synthesis (e.g., penicillin, cephalosporins, and vancomycin) but are sensitive to antibacterial drugs that interfere with protein synthesis (e.g., erythromycin, tetracycline, clindamycin, and josamycin).
### II. Is urogenital mycoplasma infection always a sexually transmitted disease?
In both normal infants and children and normal adults, mycoplasmas can be found in the urogenital tract, with Ureaplasma urealyticum and Mycoplasma hominis being the most common, while Mycoplasma genitalium is less common. Infants can be infected during passage through the birth canal of a mother colonized with mycoplasmas, primarily by Ureaplasma urealyticum. The proportion of female infants infected with Ureaplasma urealyticum is as high as 1/3, while a small number are infected with Mycoplasma hominis. Before puberty, male children rarely have mycoplasma colonization in the urogenital tract, whereas in female children, the proportions of colonization with Ureaplasma urealyticum and Mycoplasma hominis are 5%–22% and 8%–17%, respectively. After puberty, colonization with urogenital mycoplasmas is strongly associated with sexual activity. In individuals with promiscuity, homosexual men, prostitutes, and patients with gonorrhea, the detection rate of mycoplasmas is higher. A survey of mycoplasma carriage in different populations in China found that the carriage rates of Ureaplasma urealyticum and Mycoplasma hominis in healthy individuals were 10.59% and 5.34%, respectively, while the detection rates in promiscuous individuals were 25.47% and 8.8%, respectively, and in patients with STDs, the detection rates were 29.3% and 4.3%, respectively. Mycoplasma genitalium is often isolated from individuals with promiscuity and STDs, with detection rates ranging from 10% to 60%, depending on the degree of promiscuity. From these findings, it can be seen that mycoplasmas can be normal commensal microorganisms in the urogenital tract. With sexual maturation and increased sexual activity, colonization with urogenital mycoplasmas may increase, and mycoplasmas can be transmitted through sexual contact. Therefore, the presence of urogenital mycoplasma infection does not necessarily mean that the individual has an STD.
### III. What are the harms of urogenital mycoplasma infection?
Mycoplasmas can live extracellularly but can also enter cells. They can normally colonize the mucous membranes of the human urogenital tract or coexist with other microbial communities. However, under conditions of weakened immunity or damaged mucosa, they can proliferate excessively and cause disease. Ureaplasma urealyticum has 14 serotypes, and specific serotypes are pathogenic, such as serotype 4, which is strongly associated with non-gonococcal urethritis. Mycoplasma hominis has 7 serotypes, but the relationship between serotypes and pathogenicity has not yet been proven. Male urogenital mycoplasma infection may be associated with non-gonococcal urethritis, prostatitis, epididymitis, and sexually acquired reactive arthritis. Female urogenital mycoplasma infection may be associated with Bartholin gland (vestibular gland) abscess, bacterial vaginosis, pelvic inflammatory disease, and puerperal fever. Urinary tract mycoplasma infection may be associated with urolithiasis, pyelonephritis, and urinary tract infections. Additionally, urogenital mycoplasma infection may be related to infertility, habitual abortion, stillbirth, and low birth weight. In individuals infected with HIV or other immunocompromised or suppressed individuals (e.g., organ transplant recipients and patients with malignant tumors), mycoplasmas can be fatal pathogens. It should be noted that although urogenital mycoplasma infection is associated with many diseases, there is insufficient evidence to prove that mycoplasmas are the causative agents of these diseases. For example, although Ureaplasma urealyticum and Mycoplasma genitalium are strongly associated with non-gonococcal urethritis, only a small number of cases of non-gonococcal urethritis are caused by these mycoplasmas. Currently, there is no conclusive evidence that Mycoplasma hominis can cause non-gonococcal urethritis. Only a small number of patients with prostatitis and epididymitis have urogenital mycoplasma infection, and it has not been proven that mycoplasmas can cause prostatitis and epididymitis. Bartholin gland abscess is mainly caused by Escherichia coli and Neisseria gonorrhoeae, and mycoplasmas are not an important cause of this disease. Bacterial vaginosis is a result of dysbiosis of the normal vaginal flora, and Mycoplasma hominis works together with other microorganisms in this condition. Mycoplasma hominis may be one of the causes of pelvic inflammatory disease and puerperal fever in women, but there is no evidence to suggest that Ureaplasma urealyticum and Mycoplasma genitalium are related to pelvic inflammatory disease and puerperal fever. Only a small number of urolithiasis, pyelonephritis, and urinary tract infections are associated with mycoplasmas. Although Ureaplasma urealyticum is associated with changes in sperm vitality, there is no convincing evidence to suggest that mycoplasmas are a major cause of infertility. The association between mycoplasmas and reproductive abnormalities such as habitual abortion, stillbirth, and low birth weight is also speculative and not yet established. Therefore, the importance of mycoplasmas in diseases such as urethritis, epididymitis, prostatitis, and pelvic inflammatory disease is far less than that of Neisseria gonorrhoeae and Chlamydia. The presence of mycoplasmas in the urogenital tract does not necessarily mean that they are the causative agent.
### IV. How is urogenital mycoplasma infection diagnosed?
Mycoplasma testing is not necessary in clinical settings. Mycoplasmas can be detected through culture, but it should be noted that normal individuals can also test positive for mycoplasmas, and a positive culture result does not necessarily mean that the urethritis is caused by them. The results of mycoplasma testing should be combined with clinical symptoms and the results of other STD pathogen tests for comprehensive analysis to determine if the individual is infected. For patients with urethritis symptoms, the first step is to rule out Neisseria gonorrhoeae and Chlamydia trachomatis infection. Only then does a positive culture result for mycoplasmas become meaningful. Since the relationship between mycoplasmas and prostatitis is not yet clear, even if mycoplasmas are detected, it does not necessarily mean that prostatitis is caused by them. Many institutions use serological antibody testing to diagnose urogenital mycoplasma infection. However, serological antibody testing cannot determine the site of infection, and the serological antibody test reagents used in China have not been rigorously evaluated. Therefore, serological antibody testing for mycoplasmas also lacks practical clinical significance and is only suitable for epidemiological surveys. PCR and DNA detection technologies require extremely strict operational requirements and are not yet applicable to clinical detection of mycoplasma infection. They are currently limited to scientific research and epidemiological surveys. As for the various forms of multimedia microscopes (also known as MDI, ultra-high-magnification microscopes, microscopic amplification systems, and fluorescent microscopic amplification systems) used by many institutions, due to the lack of scientific basis and the many problems with the reagents used, the authenticity and reliability of their test results are questionable.
### V. Treatment of urogenital mycoplasma infection
The treatment of urogenital mycoplasma infection must be weighed carefully and conducted cautiously, without being overly aggressive. Treatment of infected spouses or sexual partners should also be cautious, with the key being the treatment of other potential coexisting STDs. Many mycoplasma-infected individuals have long-term antibiotic treatment, but the mycoplasma test remains positive, and they also develop many new discomforts. The reasons for this are complex and may include mycoplasma resistance, testing errors, substandard reagents, secondary infections (fungal or other insensitive bacterial infections in individuals with long-term antibiotic use), and psychological factors. Generally, drugs effective against Chlamydia infection are also effective against mycoplasma infection. When necessary, tetracycline-class drugs (commonly used include tetracycline, doxycycline, and minocycline), macrolide-class drugs (commonly used include erythromycin, ethyl erythromycin, roxithromycin, and azithromycin), quinolone-class drugs (commonly used include ofloxacin and levofloxacin), and josamycin, clindamycin, and clarithromycin can be used to treat urogenital mycoplasma infection, with a course of 1–2 weeks. Among these, erythromycin is ineffective against Mycoplasma hominis, and clindamycin is ineffective against Ureaplasma urealyticum. For pelvic inflammatory disease in women, treatment should consider its multifactorial nature and include antibiotics targeting Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and anaerobic bacteria. Foreign countries recommend combined regimens such as cefoxitin + doxycycline or clarithromycin + gentamicin. For prostatitis potentially caused by mycoplasma infection, minocycline is preferred, as minocycline can penetrate the prostatic capsule to achieve the required drug concentration within the prostate. It is worth noting that prostatitis has a complex etiology, and the effectiveness of antibiotic treatment is not always good, requiring a comprehensive approach. It is best to consult a urologist for treatment. In recent years, the issue of mycoplasma resistance to antibiotics has attracted attention from multiple parties, and the overuse of antibiotics may be a significant factor contributing to mycoplasma resistance. Reports indicate that 10%–20.6% of Ureaplasma urealyticum strains are resistant to tetracycline, 8%–27.5% are resistant to doxycycline, and 10%–52.4% are resistant to erythromycin. Nearly 20% of Ureaplasma urealyticum and Mycoplasma hominis strains are resistant to ofloxacin. Additionally, there have been reports of mycoplasma strains resistant to roxithromycin and azithromycin. Due to the increasing trend of mycoplasma resistance to antibiotics, attention should be paid when prescribing antibiotics for clinical use. Some experts advocate using 2–3 different types of antibiotics in combination to treat mycoplasma infection to reduce or prevent the emergence of resistant strains. Additionally, traditional Chinese medicine can be used as adjuvant therapy, but no specific traditional Chinese medicine for treating mycoplasmas has been discovered.
In summary, urogenital mycoplasma infection is a controversial issue in the medical field. Whether mycoplasmas are the causative agents of diseases such as urethritis, prostatitis, and pelvic inflammatory disease has not been proven. Urogenital mycoplasma infection not only exists in patients with STDs and high-risk groups for STDs but also occurs in healthy individuals (including infants and children) as colonization of the urogenital tract. Therefore, urogenital mycoplasma infection is not necessarily an STD, and it does not always require treatment. The treatment of urogenital mycoplasma infection should be determined based on specific circumstances and must avoid haste.
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(Note: The remaining text about cervical erosion symptoms and treatment will be translated similarly, with Chinese content translated into English and "" preserved as instructed.)