Different microorganisms - different approach
Under the general word mycoplasma, several different pathogens are combined, and the approach to them is different. Ureaplasma urealyticum, Ureaplasma parvum and Mycoplasma hominis are opportunistic: they occur in a significant proportion of healthy women, are often part of the normal microflora and cause problems only under certain conditions, usually in combination with an imbalance in the vaginal environment. Mycoplasma genitalium is a separate, complete pathogen of a sexually transmitted infection that must be treated in a woman and her partner, regardless of symptoms.
- Ureaplasma urealyticum and parvum are opportunistic
- Mycoplasma hominis - opportunistic
- Mycoplasma genitalium - the causative agent of STIs
- Treatment for M. genitalium is mandatory
- Carriage of ureaplasma without symptoms is usually not treated
- Context is important: symptoms and state of microflora
When is treatment needed?
Treatment is discussed if there are complaints and objective signs of inflammation: copious discharge with an odor, itching, burning, pain when urinating, inflammatory changes in the smear. Separately, situations with complicated pregnancy are considered: threat of premature birth, premature rupture of membranes, signs of intrauterine infection, repeated pregnancy losses in the past. In these cases, the doctor evaluates the totality of data and can prescribe therapy. When Mycoplasma genitalium is detected, treatment is always prescribed, and the partner must be examined.
- Symptoms of inflammation and changes in smear
- Detection of Mycoplasma genitalium
- Threat of premature birth
- Premature rupture of membranes
- Complicated obstetric history
- Preparation for invasive interventions according to the doctor’s decision
When there is no need to treat
If ureaplasma or mycoplasma hominis is discovered by chance, there are no complaints, a smear does not show inflammation and pregnancy proceeds normally, treatment is usually not required. Prescribing antibiotics in such a situation does not improve the outcome of pregnancy, but disrupts the microflora of the vagina and intestines, which in itself can provoke candidiasis and bacterial vaginosis. Quantitative indicators, which often frighten women, are not a reliable criterion for treatment decisions. It is neither possible nor necessary to completely get rid of opportunistic flora.
- No symptoms or inflammatory changes
- Pregnancy proceeds without complications
- Do not focus only on quantitative results
- Antibiotics without indications disrupt microflora
- The goal of treatment is not sterility, but health
- The decision is made by the doctor, not the laboratory
What tests make sense?
The most informative methods are those that determine the DNA of the pathogen in the secretions of the genital tract. For Mycoplasma genitalium, PCR is the only reliable method of detection. To assess the state of microflora, comprehensive studies are used that show the balance between lactobacilli and opportunistic microorganisms. Be sure to perform a regular smear on the flora, which shows the presence of inflammation. A blood test for antibodies to ureaplasma and mycoplasma is not very informative and is not used to decide on treatment. If an STI is detected, the partner is also examined.
- PCR for Mycoplasma genitalium
- Comprehensive assessment of vaginal microflora
- Flora smear to detect inflammation
- Screening for other STIs
- A blood test for antibodies is not very informative.
- Sexual partner examination
What to fear and how to support pregnancy
The main task during pregnancy is not to identify as many microorganisms as possible, but to notice inflammation and complications in time. You should be alert to changes in the nature of discharge, leakage of water, pain in the lower abdomen, and increased temperature. If treatment is prescribed, it is important to take the drug in full dose and the full course and not replace it yourself: not all antibiotics are approved during pregnancy. Simple things are useful - avoiding douching, which destroys microflora, using a condom with a new partner, and regular monitoring by an obstetrician-gynecologist.
- Observing the nature of discharge
- Immediate treatment in case of water leakage
- Taking the prescribed drug in full course
- Refusal to change antibiotics on your own
- Avoiding douching
- Barrier contraception with a new partner
- Regular visits to the obstetrician-gynecologist
