Sexually Transmitted Diseases - I. I. Mavrov 2005

Other bacterial infections of the urogenital organs
Staphylococcal infections

A group of diseases caused by pathogenic staphylococci. Staphylococci are widespread microorganisms. Human infections are most commonly caused by pathogenic species that are frequently resistant to Antibiotics, and they often act as the causative agents of acute and chronic genitourinary tract infections.

Etiology. Staphylococci are gram-positive, spherical Cells typically arranged in clusters; they are non-motile, do not form spores, and readily stain with all aniline Dyes. As the culture ages, many cells may become gram-negative. Smears from liquid nutrient media reveal cocci occurring singly, in pairs, tetrads, or chains. Certain staphylococci (Staphylococcus saprophyticus) form regular clusters consisting of four or eight cocci. They frequently produce yellow, red, or orange colonies. They grow well on various nutrient media under aerobic or microaerophilic conditions at a Temperature of 37 °C. They are metabolically active microorganisms, fermenting numerous CARBOHYDRATES and producing pigments that range in color from white to deep yellow. Pathogenic staphylococci typically cause erythrocyte hemolysis and plasma coagulation.

Some staphylococci are part of the normal microbial flora of human Skin and mucous membranes. Pathogenic microorganisms (Staphylococcus aureus var. pyogenes, Staphylococcus albus var. pyogenes) cause various pyogenic infections, including those of the Genitourinary system. There are "endemic" strains responsible for nosocomial (hospital-acquired) infection outbreaks. Staphylococci relatively easily develop resistance to many antimicrobial agents, posing major challenges in patient Treatment.

Routes of transmission. The primary source of staphylococcal infection includes individuals suffering from staphylococcal tonsillitis, carriers of staphylococci on their mucous membranes, and staphylococci-contaminated objects. Alongside other microorganisms (gonococci, trichomonads, chlamydia, Mycoplasmas, etc.), staphylococci can enter the urogenital tract during sexual contact or various Procedures (urethroscopy, swabbing, etc.), or be introduced by patients themselves who fail to observe hygiene rules.

Epidemiology and Pathogenesis. In addition to Purulent Skin and subcutaneous infections, tonsillitis, Pneumonia, and other conditions, staphylococci also cause acute Urinary Tract infections in women of childbearing age, indolent and recurrent genital infections (urethritis, prostatitis, etc.) in men, and neonatal infections. Today, cases of nosocomial infection are frequently observed. Nosocomial infections carry the most unfavorable prognosis in neonatal and surgical wards. Massive contamination with pathogenic staphylococci in hospitals can lead to patient infection during various procedures (sampling for Laboratory tests, urethroscopy, cystoscopy, and other instrumental examinations, etc.) and the onset of serious staphylococcal genital diseases. Conversely, from any primary lesion, staphylococci can spread throughout The Human Body via lymphatic or Blood Vessels, eventually affecting the urogenital Organs as well.

One of the causes of inflammatory genitourinary diseases is the association of staphylococci with various microbes (gonococci, trichomonads, chlamydia, mycoplasmas, etc.). Consequently, The Role of staphylococci in gonococcal, trichomonal, chlamydial, and mycoplasmal infections is often highly significant.

Staphylococcal urogenital infections occur in 8–10% of patients with non-gonococcal Inflammatory Diseases. Their development is promoted by A number of factors, notably a decline in overall bodily resistance resulting from infection or intoxication, hormonal imbalances, a local decrease in tissue resistance (diminished local Immunity) of the urogenital organs due to prior inflammatory processes, irrational local therapy, altered environmental acidity, and The Development of dysbiosis, among others.

The incubation period averages 5 to 10 days, though it can be shorter (2–3 days) or longer (1–2 months). The inflammatory process typically runs an indolent course without prominent subjective disorders, though it can also be acute. In some patients, the disease periodically exacerbates, while in others it subsides. Occasionally, the disease resolves spontaneously after a short period, leading to recovery. However, the majority of patients exhibit a prolonged, chronic course.

The clinical manifestations of staphylococcal urogenital infections are generally similar to inflammatory processes of other etiologies (gonococcal, chlamydial, mycoplasmal, etc.), differing only in a lesser intensity of the inflammatory response. Subjective symptoms of staphylococcal genitourinary infection include itching, burning pain, dysuria, and general discomfort. Asymptomatic carriage also occurs, which in many cases can serve not only as a source of infection spread but also as a cause of relapses in mixed infections—for instance, alongside trichomonal and other sexually transmitted urogenital infections.

Diagnostics. Smears of genital secretions reveal typical staphylococci. However, microscopic examination of a smear makes it virtually impossible to distinguish saprophytic microorganisms (S. epidermidis, S. saprophyticus) from pathogenic ones (S. aureus var. pyogenes). Culture Methods are employed for this purpose. When genital secretions are inoculated onto blood Agar plates and incubated for 18–20 hours at 37 °C, typical colonies form (round, smooth, elevated) that produce various pigments after a few days: S. aureus var. pyogenes yields golden-yellow, while S. epidermidis produces pearly-white, with intermediate shades also occurring. Different strains exhibit varying degrees of hemolysis. A specific staphylococcal strain is generally considered pathogenic if it produces coagulase, ferments mannitol, liquefies gelatin, or hemolyzes erythrocytes.

Treatment and Prevention. Many antibacterial drugs exert a bactericidal effect on staphylococci. However, the rapid development of resistance necessitates The Use of antibacterial drug combinations for staphylococcal genitourinary infections (such as kanamycin and furagin; erythromycin and tetracycline, etc.). For sluggish, chronic, recurrent processes complicated by pathology, physicians resort to non-specific immunotherapy (pyrogenal, levamisole, methyluracil, etc.), specific immunotherapy (staphylococcal antiphagin), desensitizing therapy (plasmol), and physiotherapy (diathermy, phonophoresis, etc.) combined with appropriate local treatment (lavage, instillation, medicinal baths, etc.).

If a staphylococcal genital infection is diagnosed in one sexual partner, all sexual contacts must be thoroughly examined, and matching treatment should be mandatory prescribed to all exposed individuals. Antibiotics are recommended following susceptibility testing of the isolated staphylococci.

It is essential to strictly adhere to aseptic and antiseptic rules during local therapy and various genital procedures (urethroscopy, cystoscopy, laboratory sampling, etc.). Given that pathogenic microorganisms can easily be transferred from one primary lesion to other body areas by the patients' own hands, careful observance of personal hygiene is imperative.