Chlamydia: symptoms and treatment
- Causative agent
- Sources of infection and transmission of chlamydia
- Chlamydia Development Mechanism
- Clinical Chlamydia
- Chlamydia symptoms
- Chlamydia and pregnancy
- Diagnosis of Chlamydia
- Chlamydia treatment
- Chlamydia Prevention
Chlamydia is one of the most common infectious diseases of our time, transmitted through sexual contact. According to the World Health Organization, the incidence rate is increasing every year and today almost 30% of the world's population is infected with chlamydia. Due to the difficulties of diagnosis, the clinical course of the disease and numerous complications, urogenital chlamydia, occurring with damage to the urinary tract's cylindrical or transitional epithelium and monocytic cells, is a direct threat to female and male reproductive health. However, this disease can cause the development of arthritis, conjunctivitis, lymphogranuloma venereum, pneumonia and cardiovascular pathologies.
Chlamydia is an infectious pathology that is sexually transmitted, and occupies a leading position in the prevalence on the globe, occurring seven and a half times more often than syphilis and four times more often than gonorrhea .
According to sad statistics, the incidence rate is growing every year and today almost 30% of the world's population are carriers of chlamydial infection. The causative agent of chlamydia is diagnosed annually in 90 million people.
Among adolescent girls, sexually active, the prevalence of this disease is 10-15%, among women - 5-20%, and among representatives of the strong half of humanity - 10-20%. In this case, chlamydia most often occurs in patients 18-30 years old.
Chlamydia is an intracellular obligate parasite with a unique development cycle that is capable of binary division in the process of reproduction. It is characterized by two completely different forms of existence, which are designated as ET (elementary bodies) and RT (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 a cell of a cylindrical or transitional epithelium, and there they undergo a further development cycle with transformation into reticular bodies (after 8 weeks).
RT is a 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 most of the infected cell. After 24 hours, PT compacted, surrounded by the cell wall and turn into ET. After that, the vacuole is broken, pathogens go outside and penetrate into 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 the repeated development cycles of chdamydia stimulate the body’s immune response, thereby increasing the degree of pathological damage.
The causative agent of chlamydia is unstable in the environment and is sensitive to the effects of high temperatures, almost instantly loses its aggressive properties when dried, exposed to chemical reagents and UV rays.
Sources of infection and transmission of chlamydia
In urogenital chlamydia, the source of infection is a person, both with pronounced signs of the disease, and with asymptomatic disease.
The main routes of transmission of chlamydial infection include:
- Contact and household;
Ways to spread chlamydial infection
- Through the cervix and uterine cavity, fallopian tubes, peritoneum and pelvic organs (canalicular path);
- Through extragenital foci (hematogenous route);
- On lymphatic vessels;
- Together with the seed secret;
- Through intrauterine contraception.
Chlamydia Development Mechanism
To date, the pathogenesis of chlamydia is not fully understood, but, nevertheless, in clinical practice it is customary to distinguish five stages of the disease:
- The defeat of the mucous membranes.
- Target cell damage (primary regional infection).
- The defeat of a large number of epithelial cells and the occurrence 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 the pathogen in the body)
- Acute (uncomplicated) form of chlamydial infection that develops in the lower urogenital tract;
- Chronic form (long-term recurrent disease affecting the upper parts of the urogenital tract, including the organs of the abdominal cavity).
Clinical signs of chlamydial infection are quite diverse. In the event of infection, an asymptomatic carrier state is often noted or marked inflammatory events are observed. In diseases of the lower part of the urogenital tract, patients can be diagnosed with such pathological conditions as urethritis, endocervicitis, coleitis , bartholinitis , and during an ascending infection, endometriosis, salpingitis, pelvioperitonitis, etc.
Symptoms of chlamydia in women
When an infection enters the female body, mucous or muco-purulent discharges often appear, differing from the normal ones by a yellowish tinge and an unpleasant odor. Sometimes, in the area of the external genitalia, there is burning and itching, pain in the lower abdomen, aggravating before menstruation, intermenstrual bleeding. Some patients have complaints of general weakness, and their body temperature may rise slightly.
During pregnancy, during menopause, and during a period of increased hormonal activity (in adolescent girls), chlamydial infection can provoke the development of colpitis. In this case, maceration of the stratified squamous epithelium is observed around the cervix, it becomes edematous and easily vulnerable (hypertrophic ectopia of the cervix).
Through the cervical canal, ascending chlamydial infection can spread by hematogenous or lymphogenous route into the uterine cavity, fallopian tubes, peritoneum and nearby pelvic organs. The most frequent manifestations of ascending infection is chlamydial salpingitis and salpingo-oophoritis. They are characterized by an erased (subacute) course, not prone to weighting. As a result, impassability of the appendages develops, which is fraught with an 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 in men, urethritis develops, which can last for several months. At the same time, there is a slight inflammation of the urethra and the appearance of scanty vitreous secretions. Sometimes patients complain of itching and burning, appearing during urination.
In the urethra, scrotum, testicles and lower back often develop pains of varying intensity, and as a result of intoxication, the body temperature can rise to 37 degrees. In clinical practice, there are cases of bleeding during ejaculation and at the end of urination. At the same time, turbidity of urine may occur due to purulent filaments and cords located in it.
In the case when chlamydia form colonies and in this form they persist for a long time on the surface of the mucous membrane, we are talking about carrying an infection. This condition is due to the fact that the human immune system suppresses the reproduction of the pathogen. According to many authors, carriers are not capable of infecting their sexual partners, and therefore, from an epidemiological point of view, they are absolutely safe.
When chlamydia enters the chronic stage, patients complain of discomfort in the perineal region, pain around the anus and prostate, impaired erectile function, frequent nighttime urination, tenderness in the testicles, as well as painful ejaculation, change in sperm color and 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 is often asymptomatic. 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 case when chlamydial infection affects a woman in early pregnancy, this condition is fraught with congenital malformations and primary placental insufficiency. As a result, miscarriages often occur in sick women, as well as non-developing pregnancy are diagnosed.
In the later stages of childbirth, chlamydia is a direct threat to abortion, provokes the development of secondary placental insufficiency and impaired production of amniotic fluid.
A morphological study of the bodies of dead babies revealed chlamydial damage to their meninges, lungs and choroid plexuses. These data confirm transplacental infection.
As a result of hematogenous infection of the fetus, edematous hemorrhagic syndrome, pneumopathies, hemorrhages in the cerebral ventricles, hepatic, renal and adrenal insufficiency are observed. These factors often lead to intrauterine or early postnatal death of the child.
In some cases, the pathogen infection only affects the placenta, which is why it develops compensatory-adaptive reactions. However, with the activation of the infectious process, the protective function of the afterbirth is disturbed, which ultimately leads to the formation of placental insufficiency. Due to the reduced intake of nutrients to the fetus, chronic hypoxia and hypotrophy develop.
With the cervical form of chlamydia, premature labor or premature rupture of the membranes often occur. When ingesting infected amniotic fluid, even before the baby is born, its lungs and digestive tract are damaged. However, infection of the newborn can occur when an infected mother passes through the birth canal.
Diagnosis of Chlamydia
In the diagnosis of chlamydia in laboratory practice, several different methods are used simultaneously: culture method, PCR, immunofluorescence method, transcription amplification reaction and serological methods.
It should be noted that during the examination of the scraping (smear) you can only suspect chlamydia, and therefore this diagnostic method is used as a rapid analysis, is not 100% informative and needs to be confirmed.
This technique involves placing biological material on a sterile nutrient medium, where the pathogen multiplies in specially designed conditions for this purpose and often its colonies can be distinguished even with the naked eye. Despite the fact that it is quite a long process, it is considered one of the most informative, as it allows to establish the type and type of chlamydial infection, as well as determine the sensitivity of the microorganism to antibiotics.
Polymerase chain reaction is a technique that involves combining chlamydia DNA molecules with specially designed primers. Today it is the most accurate and reliable of all.
Immunofluorescence method is the study of scrapings 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 ELISA diagnostics, specific antibodies (immunoglobulins) that form to chlamydia are detected in the patient's blood. However, as a biomaterial can be used scraping from the urethra. However, according to foreign medical standards, this technique is not recommended for the diagnosis of chlamydia.
Transcription Amplification Reaction
A very high-precision diagnostic method based on detection of the causative agent of chlamydia in the RNA samples studied. RNA molecules, unlike DNA molecules, are not detected after its death, which allows more accurate assessment of the results of the study. In this case, scrapings from the urethra, vagina, and cervical canal or patient urine are used as the biomaterial.
This is an additional technique to detect anti-Chlamydia antibodies in the patient’s serum.
Treatment for chlamydia is carried out with the observance of three basic principles:
- Antibacterial therapy;
- Normalization of the 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 a high anti-chlamydial activity. They must have good penetrating ability, that is, to penetrate through the cell membrane into the infected cell. At the same time, the prescribed treatment should be carried out for 2-3 weeks (the time of the passage of 6-7 cycles of chlamydia development), and also, when prescribing drug therapy, the time of infection, the clinical picture of the disease and the topical diagnosis (localization of the nidus) should be taken into account.
Chlamydia is a disease caused by an intracellular infection. Therefore, its treatment is prescribed antibacterial drugs that can penetrate and accumulate in infected cells, blocking their intracellular protein synthesis. Previously, patients were prescribed teteracycline drugs in the course of treatment, however, due to the duration of antibiotic therapy and the occurrence of severe side effects, they have now been replaced by macrolides.
лечение хламидиоза у беременных производится по специально составленным схемам, эффективным с точки зрения перинатальной патологии. Note: treatment of chlamydia in pregnant women is carried out according to specially designed schemes that are effective from the point of view of perinatal pathology.
In parallel with the antibiotic therapy, patients are given immunomodulatory treatment. It is aimed at eliminating immunological changes that occur in the body affected by chlamydial infection.
It is mandatory when conducting pathogenetic therapy is the prevention of intestinal dysbiosis, involving the use of probiotics (drugs containing live lactic acid bacteria).
When conducting etiotropic treatment, local procedures are prescribed (treatment of the vagina with special disinfectants), and also, antifungal drugs may be prescribed for the prevention of candidiasis.
In order to prevent the further development and spread of the disease, timely and complete treatment of patients who have a chlamydial infection, including asymptomatic carriers, is required.
It is mandatory to identify and examine all existing sexual partners of the patient with chlamydia, after which they are prescribed prophylactic treatment.
Sanitary-educational work among the population (promotion of a healthy sexual lifestyle and information on infection pathways and clinical signs of the disease).
First of all, women who have multiple sexual partners, patients who are on gynecological registration should undergo regular examinations.
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 take all the necessary preventive and therapeutic measures provided for in the course of treatment of urogenital chlamydia.
In conclusion, I would like to note that the widespread prevalence of chlamydial infection is related to the fact that at present, during the preventive examinations, not enough attention is paid to this problem. Equally important in the spread of infection is the fact that chlamydia is most often asymptomatic. At the same time, medical specialists of various fields often give rather contradictory recommendations, and not the last place in this list is occupied by a high percentage of self-treatment, leading to the survival (persistence) of the pathogen in the host organism and the recurrence of the disease, leading to serious complications. As a result - the steady increase in the number of couples suffering from infertility.
- Chlamydia during pregnancy: treatment
- Хламидиоз у женщин: симптомы и лечение
- Уреаплазмоз: симптомы и лечение
- Chlamydia in men