Chlamydia: Symptoms and Treatment
- Pathogen of the disease
- Sources of infection and ways of transmission of chlamydia
- The mechanism of development of chlamydia
- Clinical forms of chlamydia
- Symptoms of Chlamydia
- Chlamydia and pregnancy
- Diagnosis of chlamydia
- Treatment of Chlamydia
- Prophylaxis of chlamydia
Chlamydia is one of the most common infectious diseases of our time, transmitted through sexual contacts. According to the World Health Organization, the incidence rate is increasing year by year and to date almost 30% of the world's population is infected with chlamydia. Due to the difficulties in diagnosis, the clinical course of the disease and numerous complications, urogenital chlamydia, which occurs with the defeat of the cylindrical or transitional epithelium of the genito-urinary tract and monocytic cells, is a direct threat to female and male reproductive health. However, this ailment can cause the development of arthritis, conjunctivitis, venereal lymphogranuloma, pneumonia and cardiovascular pathologies.
Chlamydia is an infectious sexually transmitted pathology that occupies a leading position in the prevalence on the globe, occurring seven and a half times more often than syphilis and four times more likely than gonorrhea .
According to the sad statistics, the incidence rate is increasing every year and to date almost 30% of the world's population are carriers of Chlamydia infection. The causative agent of chlamydia is diagnosed annually in 90 million people.
Among adolescent girls who are sexually active, the prevalence of this disease is 10-15%, among women - 5-20%, and among the representatives of the strong half of humanity - 10-20%. Most often, clamidiosis occurs in patients aged 18-30 years.
Pathogen of the disease
Chlamydia is an intracellular obligate parasite with a unique cycle of development, which in the process of reproduction is capable of binary division. He has two completely different forms of existence, which are designated as ET (elementary bodies) and PT (reticular bodies).
Elementary chlamydial bodies, endowed with infectious properties, are capable of extracellular existence. They are transmitted from person to person, by endocytosis they penetrate into the cell of the cylindrical or transitional epithelium, and there is their further development cycle with transformation into reticular bodies (in 8 weeks).
PT is the form of the pathogen parasitizing and multiplying by division, being in the middle of the cell. Chlamydial microcolonies are located inside the vacuole, which occupies the most part of the infected cell. After 24 hours RT is condensed, surrounded by a cell wall and transformed into ET. After this, the vacuole ruptures, the pathogens come out and penetrate into the nearby cellular structures.
In the case when the host cell dies before the formation of infectious ET, the disease does not develop.
It should be emphasized that the infection of new cells and recurring cycles of development of hdamidia stimulate the immune response of the body, thereby increasing the degree of pathological lesions.
The causative agent of chlamydia is unstable in the external environment and has a sensitivity to high temperatures, almost instantly loses its aggressive properties during drying, exposure to chemical reagents and UV rays.
Sources of infection and ways of transmission of chlamydia
In urogenital chlamydia, the source of infection is a person, both with marked signs of the disease, and with an asymptomatic course of the disease.
The main ways of transmission of chlamydial infection include:
Routes of ascending chlamydial infection
- Through the cervix and uterine cavity, fallopian tubes, peritoneum and pelvic organs (canal path);
- Through extragenital foci (hematogenous pathway);
- By the lymphatic vessels;
- Together with the seed secret;
- Through means of intrauterine contraception.
The mechanism of development of chlamydia
To date, the pathogenesis of chlamydia is not yet fully understood, but nevertheless, in clinical practice, it is common to distinguish five stages of the disease:
- Lesion of mucous membranes.
- Defeat of target cells (primary regional infection).
- The defeat of a large number of epithelial cells and the emergence of clinical signs of the disease.
- Formation of the immune response (immunopathological reactions).
- Residual phase, accompanied by morphological and functional changes in various organs and tissues (in the absence of an agent in the body)
Clinical forms of chlamydia
- Acute (uncomplicated) form of chlamydial infection, developing in the lower parts of the genito-urinary tract;
- Chronic form (a long-term recurrent disease affecting the upper sections of the urogenital tract, including the abdominal cavity organs).
Clinical signs of chlamydial infection are quite diverse. In the case of infection, asymptomatic carriage is often observed or pronounced inflammatory phenomena are observed. In diseases of the lower part of the genito-urinary tract, pathological conditions such as urethritis, endocervicitis, colpitis , bartholinitis can be diagnosed in patients, and endometriosis, salpingitis, pelvioperitonitis, etc., in ascending infection.
Symptoms of Chlamydia
Symptoms of chlamydia in women
When the infection penetrates into the female body, mucous or muco-purulent discharge often differs from the normal ones with a yellowish tinge and an unpleasant odor. Sometimes in the external genital area there is burning and itching, pains in the lower abdomen, intensifying before menstruation, intermenstrual bleeding. Some patients have complaints of general weakness, and they can slightly increase body temperature.
During pregnancy, with menopause, and in the period of increased hormonal activity (in adolescent girls), chlamydial infection can provoke the development of colpitis. In this case maceration of the multilayered flat epithelium is observed around the cervix of the uterus, it becomes swollen and easily vulnerable (hypertrophic ectopia of the cervix).
Through the cervical canal, an ascending chlamydial infection can spread by hematogenous or lymphogenous pathways into the uterine cavity, fallopian tubes, peritoneum and nearby pelvic organs. The most frequent manifestations of an ascending infection are chlamydial salpingitis and salpingo-oophoritis. They are characterized by an erased (subacute) current, not prone to weighting. As a consequence, the obstruction of the appendages develops, which is fraught with ectopic pregnancy, and this condition leads to tubal infertility, miscarriage and the development of adhesive processes in the pelvis.
Symptoms of chlamydia in men
In the early stages of the disease, men develop urethritis, which can last for several months. At the same time there is a slight inflammation of the urethra and the appearance of meager vitreous discharge. Sometimes patients complain of the itching and burning that appear in the process of urinating.
In the urethra, scrotum, testicles and in the back often develop pain of varying intensity, and also due to intoxication, body temperature can rise to 37 degrees. In clinical practice, there are cases of bloody discharge during ejaculation and at the end of urination. At the same time, there may be a clouding of urine due to the purulent filaments and strands in it.
In the case when chlamydia form colonies and in this form persist for a long time on the surface of the mucosa, it is a matter of carrying the infection. This condition is explained by the fact that the human immune system suppresses the propagation of the pathogen. According to many authors, carriers are not able to infect their sexual partners, and therefore from the epidemiological point of view they are absolutely safe.
With the transition of chlamydia to the chronic stage, patients complain of discomfort in the perineal region, pain around the anus and in the prostate, erectile dysfunction, frequent nocturnal urination, soreness in the testicles, as well as painful ejaculations, sperm color change and a decrease in its volume.
при развитии хламидиоза в аноректальной области патологический процесс зачастую протекает бессимптомно. Note: with the development of chlamydia in the anorectal region, the pathological process often proceeds asymptomatically. However, sometimes patients complain of itching and pain in the rectum, as well as the presence of discharge from the anus.
Chlamydia and pregnancy
In the event that chlamydial infection affects a woman in the early stages of pregnancy, this condition is fraught with the emergence of congenital malformations and primary placental insufficiency. As a consequence, often in sick women, miscarriages occur, and an undeveloped pregnancy is diagnosed.
At later terms of bearing the child, chlamydia is a direct threat of termination of pregnancy, provokes the development of secondary placental insufficiency and impaired production of amniotic fluid.
Morphological examination of the bodies of deceased babies revealed chlamydial damage to their meninges, lungs and vascular plexuses. These data confirm transplacental infection.
Due to hematogenous infection of the fetus, there is edematous hemorrhagic syndrome, pneumopathy, cerebral hemorrhage, hepatic, renal and adrenal insufficiency. These factors often lead to intrauterine or early postnatal death of the child.
In some cases, the infectious agent affects only the placenta, because of which compensatory-adaptive reactions develop in it. However, with the activation of the infectious process, the protective function of the ulcer is disrupted, which ultimately leads to the formation of placental insufficiency. Due to reduced intake of nutrients, chronic hypoxia and hypotrophy develop to the fetus.
With the cervical form of chlamydia, premature birth or premature rupture of membranes often occurs. When swallowed infected amniotic fluid, even before the birth of a child, his lungs and digestive tract are affected. However, infection of the newborn can occur when passing through the birth canal of an infected mother.
Diagnosis of chlamydia
In the diagnosis of chlamydia in laboratory practice, several different methods are simultaneously used: culture method, PCR, immunofluorescence method, transcriptional amplification reaction and serological techniques.
It should be noted that when examining the scraping (smear) you can only suspect Chlamydia, and therefore this method of diagnosis is used as an express analysis, is not 100% informative and requires confirmation.
The culture method
This technique involves placing biological material on a sterile nutrient medium, where the pathogen in the specially created conditions for this rapidly multiplies and often its colonies can be discerned even with the naked eye. Despite the fact that this is a rather long process, it is considered one of the most informative, since it allows to establish the type and type of chlamydial infection, and also to determine the sensitivity of the microorganism to antibiotics.
Polymerase chain reaction is a technique that involves the connection of DNA molecules of chlamydia with specially created primers. To date, it is the most accurate and reliable of all existing.
Immunofluorescent method is the study of scraping from the urethra stained with special dyes using a fluorescent microscope. In this case the detectability of the pathogen is 70 out of 100.
When carrying out the ELISA diagnostics in the patient's blood, specific antibodies (immunoglobulins) are formed that form to the chlamydia. At the same time, scraping from the urethra can be used as a biomaterial. However, according to foreign medical standards, this technique is not recommended for the diagnosis of chlamydia.
Transcriptional amplification reaction
A very high-precision diagnostic method based on the detection of the causative agent of chlamydia in test RNA samples. RNA molecules, unlike DNA molecules, are not determined after its death, which allows more accurate evaluation of the results of the study. In this case, a biomaterial is used for scraping from the urethra, vagina and cervical canal or urine of the patient.
This is an additional technique that allows detecting antichlamydial antibodies in the patient's blood serum.
Treatment of Chlamydia
Treatment of chlamydia is carried out under the following three basic principles:
- Antibacterial therapy;
- Normalization of protective functions of the immune system (immunomodulation);
- Restoration of normal vaginal microflora.
Pathogenetic therapy of chlamydial infection is considered effective only when the patient is prescribed drugs that have high antichlamydia activity. They must have a good penetrating ability, that is, through the cell membrane to penetrate inside the infected cell. At the same time, the prescribed treatment should be performed for 2-3 weeks (the time of passage of 6-7 cycles of development of chlamydia), and also, when prescribing drug therapy, the timing of infection, the clinical picture of the disease and the topical diagnosis (localization of the pathological focus) should be taken into account.
Chlamydia is a disease caused by intracellular infection. Therefore, in its treatment, antibacterial drugs are prescribed that can penetrate and accumulate in infected cells, blocking their intracellular protein synthesis. Previously, in the process of treatment, patients were prescribed tetracycline-based drugs, but due to the duration of antibiotic therapy and the occurrence of severe side effects, they have now been replaced with macrolides.
лечение хламидиоза у беременных производится по специально составленным схемам, эффективным с точки зрения перинатальной патологии. Note: treatment of chlamydia in pregnant women is performed according to specially designed schemes, effective in terms of perinatal pathology.
In parallel with antibacterial therapy, patients are given immunomodulatory treatment. It is aimed at eliminating the immunological changes that occur in the body affected by chlamydia infection.
Without fail, pathogenetic therapy is used to prevent intestinal dysbiosis, which involves the use of probiotics (preparations containing live lactobacilli bacteria).
When conducting etiotropic treatment, local procedures are prescribed (treatment of the vagina with special disinfectants), and antifungal agents may be prescribed for the prevention of candidiasis.
Prophylaxis of chlamydia
In order to prevent the further development and spread of the disease, the timely and complete cure of patients who have a chlamydial infection, including asymptomatic carriers, is required.
All sex partners of the patient with chlamydia should be identified and examined without fail, after which they are given preventive treatment.
Sanitary and educational work among the population (propaganda of a healthy sexual way of life and information about the ways of infection and clinical signs of the disease).
First of all, regular examinations should be carried out by women who have multiple sexual partners, patients who are on gynecological records.
Many authors argue that even if it is impossible to accurately diagnose the pathological process, that is, to make the final diagnosis, the patient should conduct all the necessary preventive and therapeutic measures provided for by the course of treatment of urogenital chlamydia.
In conclusion, I would like to note that the wide prevalence of Chlamydia infection is due to the fact that currently, during the preventive examinations, this issue is not given enough attention. Important in the spread of infection is the fact that chlamydia is most often asymptomatic. At the same time, medical specialists of different directions often give quite conflicting recommendations, as well as a high percentage of self-treatment that leads to the survival (persistence) of the pathogen in the host's organism and relapses of the disease leading to serious complications. As a consequence - a steady increase in the number of couples suffering from infertility.
- Chlamydia in pregnancy: treatment
- Chlamydia in women: symptoms and treatment
- Ureaplasmosis: symptoms and treatment
- Chlamydia in men