Mykoplasmen und Ureaplasmen in der Urogynäkologie – ein systematischer Review

Zusammenfassung

Die im Urogenitaltrakt relevanten Mykoplasmen sind Mycoplasma hominis, Mycoplasma genitalium und Ureaplasma urealyticum. Ihr Vorkommen wurde bei urogynäkologischen Krankheiten bereits bei der Urethritis, Zystitis und bei oberen Harnwegsinfekten erwiesen. Ihre Beteiligung an der Entstehung der hyperaktiven Blase sowie der interstitiellen Zystitis/beim Bladder Pain Syndrome wird kontrovers diskutiert. Alle genannten Erreger können sowohl als einfache Kommensalen als auch als potenziell pathogene Keime vorkommen. In den meisten Fällen kann ihre Verantwortlichkeit für die jeweilige Pathologie nur vermutet und nicht bewiesen werden. Ziel dieses systematischen Reviews ist es, den aktuellen Wissensstand zum Einfluss von Mykoplasmen und Ureaplasmen auf urogynäkologische Pathologien bei Frauen zusammenzufassen und dem Kliniker Anhalt zu geben, wann und wie die Erregersuche indiziert ist und wie die Keime behandelt werden sollten. 377 gefundene Artikel wurden zu dieser Fragestellung analysiert. Fazit: Bei steriler symptomatischer Leukozyturie, chronischer Urethritis sowie bei Verdacht auf hyperaktive Blase oder interstitielle Zystitis/Bladder Pain Syndrome sollte ein Urethraabstrich mit PCR-Analyse auf die 3 Keime durchgeführt werden. Die Therapie sollte bei symptomatischen Frauen nur nach Antibiogramm erfolgen.

Schlüsselwörter

Mykoplasma - Ureaplasma - hyperaktive Blase - Bladder Pain Syndrome - Infektionen in der Urogynäkologie

• References/Literatur

• 1 Waites KB, Xiao L, Paralanov V. et al. Molecular methods for the detection of mycoplasma and ureaplasma infections in humans: a paper from the 2011 William Beaumont Hospital Symposium on molecular pathology. J Mol Diagn 2012; 14: 437-450
• 2 Jensen AJ, Kleveland CR, Moghaddam A. et al. Chlamydia trachomatis, Mycoplasma genitalium and Ureaplasma urealyticum among students in northern Norway. J Eur Acad Dermatol Venereol 2013; 27: e91-e96
• 3 van de Merwe JP, Nordling J, Bouchelouche P. et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol 2008; 53: 60-67
• 4 Jensen JS. Mycoplasma genitalium: the aetiological agent of urethritis and other sexually transmitted diseases. J Eur Acad Dermatol Venereol 2004; 18: 1-11
• 5 Nassar FA, Abu-Elamreen FH, Shubair ME. et al. Detection of Chlamydia trachomatis and Mycoplasma hominis, genitalium and Ureaplasma urealyticum by polymerase chain reaction in patients with sterile pyuria. Adv Med Sci 2008; 53: 80-86
• 6 Thomsen AC. The occurrence of mycoplasmas in the urinary tract of patients with chronic pyelonephritis. Acta Pathol Microbiol Scand B 1975; 83: 10-16
• 7 Thomsen AC. Occurrence of mycoplasmas in urinary tracts of patients with acute pyelonephritis. J Clin Microbiol 1978; 8: 84-88
• 8 Potts JM, Ward AM, Rackley RR. Association of chronic urinary symptoms in women and Ureaplasma urealyticum. Urology 2000; 55: 486-489
• 9 Moi H, Reinton N, Randjelovic I. et al. Urethral inflammatory response to ureaplasma is significantly lower than to Mycoplasma genitalium and Chlamydia trachomatis. Int J STD AIDS 2017; 28: 773-780 doi:10.1177/0956462416666482
• 10 Falk L, Fredlund H, Jensen JS. Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection. Sex Transm Infect 2005; 81: 73-78
• 11 Ross JDC, Jensen JS. Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment. Sex Transm Infect 2006; 82: 269-271
• 12 Bump RC, Copeland WE. Urethral isolation of the genital mycoplasmas and Chlamydia trachomatis in women with chronic urologic complaints. Am J Obstet Gynecol 1985; 152: 38-41
• 13 Stamm WE, Running K, Hale J. et al. Etiologic role of Mycoplasma hominis and Ureaplasma urealyticum in women with the acute urethral syndrome. Sex Transm Dis 1983; 10: 318-322
• 14 Kyndel A, Elmér C, Källman O. et al. Mycoplasmataceae colonizations in women with urethral pain syndrome: a case-control study. J Low Genit Tract Dis 2016; 20: 272-274
• 15 Abrams P, Cardozo L, Fall M. et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003; 61: 37-49
• 16 Eapen RS, Radomski SB. Review of the epidemiology of overactive bladder. Res Rep Urol 2016; 8: 71-76
• 17 Payne CK, Joyce GF, Wise M. et al. Interstitial cystitis and painful bladder syndrome. J Urol 2007; 177: 2042-2049
• 18 Vella M, Robinson D, Cardozo L. Painful bladder syndrome. Obstet Gynaecol Reprod Med 2012; 22: 44-49
• 19 Keay S, Schwalbe RS, Trifillis AL. et al. A prospective study of microorganisms in urine and bladder biopsies from interstitial cystitis patients and controls. Urology 1995; 45: 223-229
• 20 Duncan JL, Schaeffer AJ. Do infectious agents cause interstitial cystitis?. Urology 1997; 49: 48-51
• 21 Warren JW, Horne LM, Hebel JR. et al. Pilot study of sequential oral antibiotics for the treatment of interstitial cystitis. J Urol 2000; 163: 1685-1688
• 22 Dutkiewicz S. Treatment efficacy of chronic urethral syndrome with Doxycycline in females. Cent Eur J Urol 2010; 63: 82-83
• 23 Warren JW, Horne LM, Hebel JR. et al. Pilot study of sequential oral antibiotics for the treatment of interstitial cystitis. J Urol 2000; 163: 1685-1688
• 24 Burkhard FC, Blick N, Hochreiter WW. et al. Urinary urgency and frequency, and chronic urethral and/or pelvic pain in females. Can doxycycline help?. J Urol 2004; 172: 232-235
• 25 Potts JM, Ward AM, Rackley RR. Association of chronic urinary symptoms in women and Ureaplasma urealyticum. Urology 2000; 55: 486-489
• 26 Siddiqui H, Lagesen K, Nederbragt AJ. et al. Pathogens in urine from a female patient with overactive bladder syndrome detected by culture-independent high throughput sequencing: a case report. Open Microbiol J 2014; 8: 148-153
• 27 Lee YS, Kim JY, Kim JC. et al. Prevalence and treatment efficacy of genitourinary mycoplasmas in women with overactive bladder symptoms. Korean J Urol 2010; 51: 625-630
• 28 Garner CM, Hubbold LM, Chakraborti PR. Mycoplasma detection in cell cultures: a comparison of four methods. Br J Biomed Sci 2000; 57: 295-301
• 29 Moi H, Reinton N, Moghaddam A. Mycoplasma genitalium in women with lower genital tract inflammation. Sex Transm Infect 2009; 85: 10-14
• 30 Humburg J, Frei R, Wight E. et al. Accuracy of urethral swab and urine analysis for the detection of Mycoplasma hominis and Ureaplasma urealyticum in women with lower urinary tract symptoms. Arch Gynecol Obstet 2012; 285: 1049-1053
• 31 Casin I, Vexiau-Robert D, De La Salmonière P. et al. High prevalence of Mycoplasma genitalium in the lower genitourinary tract of women attending a sexually transmitted disease clinic in Paris, France. Sex Transm Dis 2002; 29: 353-359
• 32 Carlsen KH, Jensen JS. Mycoplasma genitalium PCR: does freezing of specimens affect sensitivity?. J Clin Microbiol 2010; 48: 3624-3627
• 33 Bébéar CM, de Barbeyrac B, Pereyre S. et al. Activity of moxifloxacin against the urogenital mycoplasmas Ureaplasma spp., Mycoplasma hominis and Mycoplasma genitalium and Chlamydia trachomatis. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 2008; 14: 801-805
• 34 Bissessor M, Tabrizi SN, Twin J. et al. Macrolide resistance and azithromycin failure in a Mycoplasma genitalium-infected cohort and response of azithromycin failures to alternative antibiotic regimens. Clin Infect Dis Off Publ Infect Dis Soc Am 2015; 60: 1228-1236
• 35 Hilt EE, McKinley K, Pearce MM. et al. Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. J Clin Microbiol 2014; 52: 871-876
• 36 Wolfe AJ, Toh E, Shibata N. et al. Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol 2012; 50: 1376-1383