Mycoplasma genitalium and other sexually transmitted infections causing urethritis – their prevalence, impact on male fertility parameters and prostate health
Date
2023-07-17
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Abstract
Ureetra ehk kusetoru ülesandeks on osaleda seemnevedeliku ja uriini transpordis, samas võib ta muutuda sissepääsuks uretriiti tekitavate seksuaalsel teel levivate infektsioonide (STLI) tekitajate jaoks. Uretriidi tagajärjel võib kahjustuda reproduktiivfunktsioon, kuid tõenduspõhine info selle kohta on ebaühtlane. Valideerimata on uus uretriidi diagnostikameetod, uriini voolutsütomeetria. Ka puudus Eestis seni selge ülevaade meeste uretriidi etioloogia kohta.
Uurimistöö eesmärgiks oli hinnata uretriidi esinemissagedust erinevates populatsioonides Eestis ja selle mõju meeste urogenitaalsüsteemile, selgitada erinevate tekitajate (Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis) seost kaebuste, sümptomite ja põletikunäitajatega, ning hinnata uriini voolutsütomeetria rakendatavust uretriidiga patsientidel. Uurimistöösse kaasati 3571 Tartu Ülikooli Kliinikumi Meestekliiniku patsienti.
Klamüüdia oli kõrgeima esinemissagedusega patogeen seksuaalse riskikäitumisega Eesti meeste seas (14.8%), kuid M. genitalium oli olulisel teisel kohal (4.2%). Nendele järgnesid N. gonorrhoeae (2.5%) ja T. vaginalis (0.7%). Kombineeritud STLI esinemissagedus oli madal (1.5%). STLI tekitajate esinemissagedus rasedate naiste meeste (C. trachomatis 1.6%) ja viljatute paaride meeste seas (C. trachomatis 1.2%, M. genitalium 1.1%) oli madal. Ükski uretriidi makroskoopiline tunnus ei olnud patognoomiline ühegi konkreetse tekitaja suhtes, seetõttu on nii patsientide seksuaalkäitumise kui ka sümptomite hindamine olulised STLI testimise otsuse langetamisel.
Esmasjoauriini voolutsütomeetriline analüüs osutus kiireks ja objektiivseks meetodiks meeste uretriidi skriinimisel. N. gonorrhoeae põhjustas uriinis tugevaima põletikreaktsiooni, C. trachomatis’e ja M. genitalium’i puhul oli põletik mõõdukas ja T. vaginalis’e korral nõrk. M. genitalium kutsus esile põletikreaktsiooni ka seemnevedelikus, mis oli enamasti madalam WHO poolt pakutud lävendist. See lävend vajab langetamist, et leida üles rohkem patsiente, kes vajavad ravi.
M. genitalium ja C. trachomatis avaldasid negatiivset mõju seemnevedeliku parameetritele, sh spermatosoidide üldarvule ja liikuvate spermatosoidide arvule. Seega on nende patogeenide potentsiaalset mõju meeste viljakusele vaja edaspidi täiendavalt uurida.
Function of urethra is the transportation of seminal fluid and urine. At the same time, urethra can be an entrance point for urethritis-associated sexually transmitted pathogens. Urethritis can result in impairment of reproductive function but the evidence about this topic is uneven. Novel diagnostic technique of urethritis, flow-cytometric analysis, is not validated. Until now, there was no clear etiological picture of male urethritis in Estonia. Aim of the study was to reveal the prevalence of urethritis among different populations in Estonia, its impact on male urogenital system, association between different STI agents (Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis) and patients’ complaints, symptoms & inflammatory parameters, and the applicability of flow-cytometric analysis for urethritis patients. The study included 3571 male patients from Centre of Andrology, Tartu University Hospital. Chlamydia had the highest prevalence among Estonian men with high-risk sexual behaviour (14.8%) but M. genitalium held an important second place (4.2%). N. gonorrhoeae (2.5%), T. vaginalis (0.7%) and combined STIs (1.5%) were detected less frequently. Prevalence of STIs among male partners of pregnant women (C. trachomatis 1.6%) and male partners of infertile couples (C. trachomatis 1.2%, M. genitalium 1.1%) was low. Neither of the macroscopic signs of urethritis was pathognomonic for any particular disease or STI agent, therefore, patient’s sexual behaviour patterns should also be accounted for when making decision about STI testing. Flow cytometry of first-voided urine appeared to be a rapid and objective screening method in case of suspected male urethritis. N. gonorrhoeae did provoke the strongest inflammatory reaction in first-voided urine, M. genitalium and C. trachomatis did induce moderate inflammation, while in case of T. vaginalis the inflammatory reaction was weak. M. genitalium provoked inflammatory reaction in semen, too, but in most cases far below the WHOs proposed limit. This limit should be lowered in order to find out more patients who need treatment. M. genitalium and C. trachomatis possessed negative impact on semen parameters, including total count of spermatozoa and count of spermatozoa with progressive motility. Thus, the potential impact of these pathogens on male fertility requires further investigations.
Function of urethra is the transportation of seminal fluid and urine. At the same time, urethra can be an entrance point for urethritis-associated sexually transmitted pathogens. Urethritis can result in impairment of reproductive function but the evidence about this topic is uneven. Novel diagnostic technique of urethritis, flow-cytometric analysis, is not validated. Until now, there was no clear etiological picture of male urethritis in Estonia. Aim of the study was to reveal the prevalence of urethritis among different populations in Estonia, its impact on male urogenital system, association between different STI agents (Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis) and patients’ complaints, symptoms & inflammatory parameters, and the applicability of flow-cytometric analysis for urethritis patients. The study included 3571 male patients from Centre of Andrology, Tartu University Hospital. Chlamydia had the highest prevalence among Estonian men with high-risk sexual behaviour (14.8%) but M. genitalium held an important second place (4.2%). N. gonorrhoeae (2.5%), T. vaginalis (0.7%) and combined STIs (1.5%) were detected less frequently. Prevalence of STIs among male partners of pregnant women (C. trachomatis 1.6%) and male partners of infertile couples (C. trachomatis 1.2%, M. genitalium 1.1%) was low. Neither of the macroscopic signs of urethritis was pathognomonic for any particular disease or STI agent, therefore, patient’s sexual behaviour patterns should also be accounted for when making decision about STI testing. Flow cytometry of first-voided urine appeared to be a rapid and objective screening method in case of suspected male urethritis. N. gonorrhoeae did provoke the strongest inflammatory reaction in first-voided urine, M. genitalium and C. trachomatis did induce moderate inflammation, while in case of T. vaginalis the inflammatory reaction was weak. M. genitalium provoked inflammatory reaction in semen, too, but in most cases far below the WHOs proposed limit. This limit should be lowered in order to find out more patients who need treatment. M. genitalium and C. trachomatis possessed negative impact on semen parameters, including total count of spermatozoa and count of spermatozoa with progressive motility. Thus, the potential impact of these pathogens on male fertility requires further investigations.
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Väitekirja elektrooniline versioon ei sisalda publikatsioone
Keywords
urethritis, diseases of urogenital tract, sexually transmitted diseases, prevalence (statistics), sexual behavior, risk behavior, men, reproductive health