Негонококковый уретрит у мужчин


DOI: https://dx.doi.org/10.18565/urology.2019.4.122-128

Д.Г. Ким, М.А. Гомберг, А.Е. Гущин, А.В. Зайцев

1) ГБУЗ «Московский научно-практический центр дерматовенерологии и косметологии» ДЗМ, Москва, Россия; 2) ФБУН «Центральный НИИ эпидемиологии» Роспотребнадзора, Москва, Россия; 3) МГМСУ им. А. И. Евдокимова МЗ РФ, Москва, Россия
Обзор литературы посвящен уретриту – одному из наиболее распространенных заболеваний урогенитального тракта у мужчин. Описаны современные представления об этиологии уретрита, а также ряд проблем диагностики заболевания, основной из которых является частая невозможность установить этиологический фактор воспаления в уретре. Рассмотрена возможная связь бактерий, ассоциированных с бактериальным вагинозом у женщин, с развитием уретрита у мужчин, однако частота таких уретритов и роль конкретных микроорганизмов пока не изучены. Между тем, точное определение причин развития воспаления в уретре напрямую влияет на выбор адекватного этиотропного лечения и повышает его эффективность.

Литература


1. Farhat W., McLorie G. Urethral syndrome in children. Pediatr Rev. 2001;22(1):17–21.

2. Kisina V.I., Sidurskii S.V., Fattyakhetdinov R.Sh. et. al. Comparative efficacy of treatment of non-gonococcal urethritis in men using genetic and original azithromycin. Klinicheskaya dermatologiya I venerologiya. 2008;5:64–68. Russian (Кисина В.И., Сидурский С.В., Фаттяхетдинов Р.Ш., и др. Сравнительная эффективность лечения негонококкового уретрита у мужчин с помощью генетического и оригинального азитромицина. Клиническая дерматология и венерология. 2008;5:64–68).

3. Liedberg H. Catheter induced urethral inflammatory reaction and urinary tract infection. An experimental and clinical study. Scand J Urol Nephrol. 1989;124:1–43.

4. Okeke LI. Soap induced urethral pain in boys. West Afr J Med. 2004;23:48–49.

5. Il’in I.I. Non-gonococcalurethritis in male. M.: Medicinskajakniga. 2005;85 p. Russian (Ильин И.И. Негонококковыеуретритыумужчин. М.: Медицинскаякнига. 2005;85 с.).

6. Horner P. The Etiology of Acute Nongonococcal Urethritis-The Enigma of Idiopathic Urethritis? Sexually Transmitted Diseases. 2011;38:187–189. Doi: 10.1097/OLQ.0b013e318207c2eb.

7. Kisina V.I., Shirshova E.V., Zabirov K.I. Modern trends in diagnostics and treatment od non-gononoccal urethritis. Consilium medicum. 2005;26–30. Russian (Кисина В.И., Ширшова Е.В., Забиров К.И. Современные подходы к диагностике и лечению негонококковых уретритов. Consilium medicum. 2005;26–30).

8. Aral S.O, Holmes K.K. Social and behavioral determinants of the epidemiology of STDs: industrialized and developing countries. In: Holmes K.K.,Sparling P.F., Mardh P.-A., et al., eds. Sexually transmitted diseases. 3rded. New York. McGrow-Hill. 1999:39–76.

9. Terris M.K., Kemper M., Sajadi K.P. Urethritis. Medscape 2018

10. Gomberg M.A., Solov’ev A.M., Kovalyk V.P. Non-gonococcal urethritis: ethiology and rationale for targeting therapy. Lechvrach. 2006;7:26–31. Russian (Гомберг М.А., Соловьев А.М., Ковалык В.П. Негонококковые уретриты у мужчин: этиология и обоснование этиотропной терапии. Леч. врач. 2006;7:26–31).

11. Bradshaw C.S., Tabrizi S.N., Read T.R., et al. Etiologies of nongonococcalurethritis: bacteria, viruses, and the association with orogenital exposure. J. Infect. Dis. 2006;193:336–345.

12. Shahmanesh M., Moi H., Lassau F. et. al. European guideline on the management of male non-gonococcal urethritis.Int J STD AIDS. 2009;20(7):458–464. Doi: 10.1258/ijsa.2009.009143.

13. Bartoletti R., Wagenlehner F.M., Bjerklund Johansen T.E., et. al. Management of Urethritis: Is It Still the Time for Empirical Antibiotic Treatments? EurUrol Focus. 2019;5(1):29–35. Doi: 10.1016/j.euf.2018.10.006.

14. Ito S., Yasuda M., Seike K., et. al. Clinical and microbiological outcomes in treatment of men with non-gonococcal urethritis with a 100-mg twice-daily dose regimen of sitafloxacin. J Infect Chemother. 2012;18(3):414–418. Doi: 10.1007/s10156-012-0392-9.

15. Bachir B.G., Jarvi K. Infectious, inflammatory, and immunologic conditions resulting in male infertility. Urol Clin North Am. 2014;41(1):67–81.Doi: 10.1016/j.ucl.2013.08.008.

16. Kamwendo F., Johansson E., Moi H., et al. Gonorrhoea, genital chlamydial infection, and nonspecific urethritis in male partners of women hospitalised and treated for acute pelvic inflammatory disease. Sex Transm Dis. 1993;20:143–146.

17. Paavonen J., Eggert-Kruse W. Chlamydia trachomatis: impact on human reproduction. Hum Reprod Update.1999;5(5):433–447.

18. Simms I., Stephenson J.M. Pelvic inflammatory disease epidemiology:What do we know and what do we need to know? Sex Transm Infect. 2000; 76:80–87.

19. Gérard H.C., Wang Z., Wang G.F., et al Chromosomal DNA from a variety of bacterial species is present in synovial tissue from patients with various forms of arthritis. Arthritis Rheum. 2001;44(7):1689–1697.

20. Newbern E.C., Anschuetz G.L., Eberhart M.G., et al. Adolescent sexually transmitted infections and risk for subsequent HIV. Am J Public Health. 2013;103:1874–1881. Doi: 10.2105/AJPH.2013.301463.

21. Horner P.J., Blee K., Falk L., et al. European guideline on the management of non-gonococcal urethritis. Int J STD AIDS. 2016;27(11):928–937. Doi: 10.1177/0956462416648585.

22. Gaydos C., Maldeis N.E., Hardick A., et al. Mycoplasma genitalium comparedto chlamydia, gonorrhoea and trichomonas as an aetiological agent of urethritis in men attending STD clinics. Sexually Transmitted Infections 2009;85:438–440. Doi: 10.1136/sti.2008.035477.

23. Schwebke J.R., Rompalo A., Taylor S., et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clinical Infectious Diseases. 2011;52:163–170. Doi: 10.1093/cid/ciq074.

24. Manhart L.E., Gillespie C.W., Lowens M.S., et al. Standard Treatment Regimens forNongonococcal Urethritis Have Similar but Declining Cure Rates: A Randomized ControlledTrial. Clinical Infectious Diseases. 2013;56:934–942. Doi: 10.1093/cid/cis1022.

25. Taylor-Robinson D., Horner P.J. The role of Mycoplasma genitaliumin non-gonococcal urethritis. Sexually Transmitted Infections. 2001;77:229–231.

26. Manhas A., Sethi S., Sharma M., et al. Association of genital mycoplasmas includingMycoplasmagenitalium in HIV infected men with nongonococcal urethritis attending STD & HIV clinics. Indian Journal of Medical Research. 2009;129:305–310.

27. Horner P.J., Taylor-Robinson D. Association of Mycoplasma genitaliumwith balanoposthitis in men with non-gonococcal urethritis. Sexually Transmitted Infections. 2010;87:3.

28. Pond M.J., Nori A.V., Witney A.A., et al. High Prevalence of Antibiotic-Resistant Mycoplasma genitaliumin Nongonococcal Urethritis: The Need for Routine Testing and the Inadequacy of Current Treatment Options. Clinical Infectious Diseases. 2014;58:631–637. Doi: 10.1093/cid/cit752.

29. Gaydos C.A., Barnes M.R., Quinn N., et al. Trichomonas vaginalis infection in men who submit self-collected penile swabs after internet recruitment. Sex Transm Infect. 2013;89:504–508. Doi: 10.1136/sextrans-2012-050946.

30. Sena A.C., Bachmann L.H., Hobbs M.M. Persistent and recurrent Trichomonas vaginalis infections: epidemiology, treatment and management considerations. Expert Rev AntiInfect Ther. 2014;12:673–685. Doi: 10.1586/14787210.2014.887440.

31. Pellrud H., Golparian D., Nilsson C.S., et al. Trichomonas vaginalis infections are rare among young patients attending an STI clinic in Sweden. Acta Derm Venereol. 2015;95:343–344. Doi: 10.2340/00015555-1946.

32. WetmoreС.M., Manhart L.E., Lowens M.S., et al. Demographic, Behavioral, and Clinical Characteristics of Men With Nongonococcal Urethritis Differ by Etiology: A Case-Comparison Study. Sex Transm Dis. 2011;38(3):180–186. Doi: 10.1097/OLQ.0b013e3182040de9.

33. Frolund M., Lidbrink P., Wikstrom A., et al. Urethritis-associated Pathogens in Urine from Men with Nongonococcal Urethritis: A Case-control Study. Acta Derm Venereol. 2016;96(5):689–694.

34. Srugo I., Steinberg J., Madeb R., et al. Agents of non-gonococcal urethritisin males attending an Israeli clinic for sexually transmitted diseases. Isr Med Assoc J. 2003;5:24–27.

35. Bradshaw C.S., Tabrizi S.N., Read T.R., et al. Etiologies of nongonococcalurethritis: bacteria, viruses, and the association with orogenital exposure. J. Infect. Dis. 2006;193:336–345.

36. Martin D.H., Bowie W.R., et al. Sexually Transmitted Diseases, 3rd ed. NewYork: Mc Graw-Hill. 1999:833–844.

37. Tabrizi S.N., Ling A.E., Bradshaw C.S., et al. Human adenoviruses types associated with non-gonococcal urethritis. Sex Health. 2007;4(1):41–44.

38. Bachmann L.H., Manhart L.E., Martin D.H,. et al. Advances in the Understanding and Treatment of Male Urethritis Clin Infect Dis. 2015;61(8):763–769. Doi: 10.1093/cid/civ755.

39. Zhang N., Wang R., Li X., et al. Are Ureaplasma spp. a causе non-gonococcal urethritis? A systematic review and meta-analysis. PLoS One. 2014;9:113771. Doi: 10.1371/journal.pone.0113771.

40. Shimada Y., Ito S., Mizutani K., et al. Bacterial loads of Ureaplasmaurealyticumcontribute to development of urethritis in men. Int J STDAIDS. 2014;25:294–298. Doi: 10.1177/0956462413504556.

41. Strauss M., Colodner R., Sagas D., et al. Detection of Ureaplasmaspecies by a semi-quantitative PCR test in urine samples: Can it predict clinical significance? Isr Med Assoc J 2018;1:9–13.

42. Hall G.D., Washington J.A. Hae mophilusin fluenzae in genitourinary tract infections. Diagn Microbiol Infect Dis.1983;1:65–70.

43. Sturm A.W. Haemophilusinfluenzae and Haemophilusparainfluenzae in nongonococcal urethritis. J Infect Dis. 1986;153:165–167.

44. Wilson A.P., Wolff J., Atia W. Acute urethritis due to Neisseriameningitidis group A acquired by orogenital contact: casereport. Genitourin Med. 1989;65:122–123.

45. Hagman M., Forslin L., Moi H., et al. Neisseria meningitides in specimens from urogenital sites. Is increased awareness necessary? Sex Transm Dis. 1991;18:228–232.

46. Smith G.L. Branhamellacatarrhalis infection imitating gonorrhea in a man. N Engl J Med. 1987;316:1277.

47. Abdolrasouli A., Amin A., Baharsefat M., et al. Moraxella catarrhalis associated with acuteurethritis imitating gonorrhoea acquired by oral-genital contact. Int J STD AIDS. 2007;18:579–580.

48. Noble R.C. Colonisation of the urethra with Streptococcuspneumoniae: a case report. Genitourin Med. 1985;61:345–346.

49. Koroglu M., Yakupogullari Y., Aydogan F. A case of urethritis due to Streptococcus pneumoniae. Sex Transm Dis. 2007;34: 1040.

50. Berntsson M., Lowhagen G.B., Bergstrom T., et al. Viral and bacterial aetiologies of male urethritis: findings of a high prevalence of Epstein-Barr virus. International Journal of STD& AIDS. 2010;21:191–194. Doi: 10.1258/ijsa.2009.009262.

51. Meingassner J.G., Heyworth P.G. Intestinal and urogenital flagellates. Antibiot Chemother (1971). 1981;30:163–202.

52. Licea Ventura M.G., Sánchez Muñoz F., Zurita Alvarez J.E., Salazar Acosta C. Presence of Entamoeba histolytica in chronic urethritis. Aten Primaria. 2005;35(5):269.

53. Moi H., Haugstvedt A., Jensen J.S. Management of non-gonococcal urethritis.BMC Infect Dis. 2015;15:294. Doi: 10.1186/s12879-015-1043-4.

54. Allsworth J.E. Bacterial vaginosis–race and sexual transmission: issues of causation. Sex Transm Dis. 2010;37(3):137–139. Doi: 10.1097/OLQ.0b013e3181d36bdc.

55. Chico R.M., Mayaud P., Ariti C., et al. Prevalence of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa: a systematic review. JAMA. 2012;307(19):2079–2086. Doi: 10.1001/jama.2012.3428.

56. Bradshaw C.S., Walker J., Fairley C.K., et al. Prevalent and incident bacterial vaginosis are associated with sexual and contraceptive behaviours in young Australian women. PLoS One. 2013;8(3):e57688. Doi: 10.1371/journal.pone.0057688.

57. Hiller S.L., Nugent R.P., Eschenbach D.A., et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The vaginal infection and prematurity study Group. N. Eng. J. Med. 1995;333(26):1737–1742.

58. Oakeshott P., Hay P., Hay S., et al. Association between bacterial vaginosis or chlamydial infection and miscarriage before 16 weeks’ gestation: prospective community based cohort study. BMJ. 2002;325(7376):1334.

59. Leitich H., Kiss H. Asymptomatic bacterial vaginosis and intermediate flora as risk factors for adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. 2007;21(3):375–390. Doi:10.1016/j.bpobgyn.2006.12.005.

60. Nelson D.E., Dong Q., Pol B.V.D., et al. Bacterial communities of the Coronal Sulcus and Distal Urethra of adolescent males. PLoS One. 2012;7(5):e36298. Doi: 10.1371/journal.pone.0036298.

61. Muzny C.A., Schwebke J.R. Suspected heterosexual transmission of bacterial vaginosis without seminal fluid exposure. Sex Transm Dis. 2014;41:58–60. Doi: 10.1097/OLQ.0000000000000057.

62. Liu C.M., Hungate B.A., Toblan A.A.R., et al. Penile microbiota and female partner bacterial vaginosis in Rakai, Uganda. M Bio. 2015;6(3):e00589–15. Doi: 10.1128/mBio.00589-15.

63. Zozaya M., Ferris M.J., Siren J.D., et al. Microbiome. 2016;4:16. Doi: 10.1186/s40168-016-0161-6.

64. Bump R.C., Buesching W.J. 3rd. Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol. 1988;158(4):935–939.

65. Yen S., Shafer M.A., Moncada J., et al. Bacterial vaginosis in sexually experienced and non-sexually experienced young women entering the military. Obstet Gynecol. 2003;102(5 Pt 1):927–933.

66. Vaca M., Guadalupe I., Erazo S., et al. High prevalence of bacterial vaginosis in adolescent girls in a tropical area of Ecuador. BJOG. 2010;117(2):225–228. Doi: 10.1111/j.1471-0528.2009.02397.x.

67. Ivanov Y.B. Microbiological features of persistent nonspecific urethritis in men. Journal of Microbiology, Immunology, and Infection. 2007;40:157–161.

68. Muli F., Struthers J.K. Use of a continuous-culture biofilm system to study the antimicrobial susceptibilities of Gardnerella vaginalis and Lactobacillus acidophilus .Antimicrob Agents Chemother. 1998;42:1428–1432.

69. Patterson J.L., Girerd P.H., Karjane N.W., et al. Effect of biofilm phenotype on resistance of Gardnerella vaginalis to hydrogen peroxide and lactic acid. Am J Obstet Gynecol. 2007;197:170 e1–7.

70. Saunders S., Bocking A., Challis J,. et al. Effect of Lactobacillus challenge on Gardnerella vaginalis biofilms. Colloids Surf B Biointerfaces. 2007;55(2):138–142.

71. Swidsinski A., Doerffel Y., Loening-Baucke V., et al. Gardnerella biofilm involves females and males and is transmitted sexually. Gynecol Obstet Invest. 2010;70:256–263. Doi: 10.1159/000314015.

72. Horner P.J., Thomas B., Gilroy C.B., et al. Do all men attending departments of genitourinary medicine need to be screened for non-gonococcal urethritis? Int J STD AIDS. 2002;13(10):667–673.

73. Leung A., Eastick K., Haddon L.E., et al. Mycoplasma genitalium is associated with symptomatic urethritis. Int J STD AIDS. 2006;17(5):285–288. Doi:10.1258/095646206776790231.

74. Lautenschlager S., Eichmann A. Urethritis: an underestimated clinical variant of genital herpes in men? Jam Acad Dermatol. 2002;46(2):307–308.

75. Лопаткин Н.А. (редакц.)Урология. Национальное руководство 2009 ISBN: 978-5-9704-0983-1. Издательство: ГЭОТАР-Медиа. С. 375.

76. Swartz S.L., Kraus S.J., Herrmann K.L., et al. Diagnosis and etiology of nongonococcal urethritis. J Infect Dis. 1978;138(4):445–454.

77. Janier M., Lassau F., Casin I., et al. Male urethritis with and without discharge: a clinical and microbiological study. Sex Transm Dis. 1995;22(4):244–252.

78. Horner P.J., Taylor-Robinson D. Mycoplasma genitalium and non-gonococcal urethritis. Lancet. 1994;343(8900):790–791.

79. Ito S., Hanaoka N., Shimuta K., et. al. Male non-gonococcal urethritis: From microbiological etiologies to demographic and clinical featuresInternational Journal of Urology. 2016;23:325–331.

80. Smith R., Copas A.J., Prince M., et al. Poor sensitivity and consistency of microscopy in the diagnosis of low grade non‐gonococcal urethritis. Sex TransmInfect. 2003;79(6):487–490.

81. Желтикова Я.Д., Кондратьева Ю.С., Неймарк А.И. Возможности использования пелоидотерапии при хронических негонококковых уретритах у мужчин. Сетевое издание «Медицина и образование в Сибири». 2014;2.

82. Tully J.G., Taylor-Robinson D., Cole R.M., et al. A newly discovered mycoplasma in the human urogenital tract. Lancet. 1981;1(8233):1288–1291.

83. Lau C.Y., Qureshi A.K. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis. 2002;29(9):497–502.

84. Fredricks D.N., Fiedler T.L., Marrazzo J.M. Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med. 2005;353:1899–1911.

85. Lamont R.F., Sobel J.D., Akins R.A., et al. The vaginal microbiome: New information about genital tract flora using molecular based techniques. Br J ObstetrGynecol. 2011;118:533–549. Doi: 10.1111/j.1471-0528.2010.02840.x.

86. Schwebke J., Muzny C., Josey W. Role ofGardnerella vaginalis in the pathogenesis of bacterial vaginosis: a conceptual model. J Infect Dis. 2014;210(3):338–343. Doi: 10.1093/infdis/jiu089.


Об авторах / Для корреспонденции


А в т о р д л я с в я з и: М. А. Гомберг – д.м.н., профессор, главный научный сотрудник, ГБУЗ «Московский
научно-практический центр дерматовенерологии и косметологии» ДЗМ, Москва, Россия; e-mail: magomberg@mail.ru


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