Chlamydia in pregnancy

The presence of a common infectious disease that occurs in a pregnant woman due to damage to the genitourinary system by gram-negative bacteria Chlamydia trachomatis is diagnosed as chlamydia during pregnancy. Chlamydia is transmitted by contact and has a code according to ICD 10 - A55-A56.8, A70-A74.9 (chlamydia of the lower genitourinary tract - A 56.0- A56.2).

This infection is a serious cause for concern, so you should know why chlamydia is dangerous during pregnancy and how it should be treated.

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Causes of Chlamydia During Pregnancy

So, as already mentioned, the causes of chlamydia during pregnancy are pathogenic bacteria that penetrate the genitourinary organs, and doctors classify urethrogenital chlamydia as an STD - a sexually transmitted disease. However, certain serotypes of this bacterium can get into the conjunctiva - the mucous membrane covering the inner part of the eyelid and the outer part of the eye, for example, in a pool or through a shared towel.

When considering the pathogenesis of chlamydial infections, it should be borne in mind that although Chlamydia trachomatis does not belong to obligate bacteria, in many it is a permanent parasite in the cells of epithelial tissues, where the conditions for its existence are most comfortable. At the same time, such "neighborhood" does not show any signs, and in such cases doctors talk about the carriage of bacteria.

By attaching to the membranes of mucous membrane cells, chlamydia penetrates the cell cytoplasm and takes a passive L-form, and “wakes up”, that is, begins to multiply and manifests itself as an infectious agent only in conditions of the body that are accompanied by a weakening of the immune system.

It is the functionally “programmed” decrease in the body’s defenses during pregnancy that provokes the activation of chlamydia, which leads to the development of inflammation of the mucous membranes of the urethra, vagina, cervical canal (cervical canal) or uterus.

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Symptoms of Chlamydia During Pregnancy

The clinical picture of chlamydial lesions is latent in almost 70% of cases. The first signs of Chlamydia trachomatis activation in pregnant women are itching of the external genitalia and burning during urination.

Also, such symptoms of chlamydia during pregnancy as pathological mucopurulent vaginal discharge are noted. In most cases, this is chlamydia in the form of inflammation of the walls of the urethra (chlamydial urethritis).

When chlamydia affects the cells of the vaginal mucosa, it also becomes inflamed, and then chlamydial vaginitis or colpitis is diagnosed.

In chlamydial cervicitis, the inflammatory process is localized in the cervical canal, and its first signs are similar. After a short period of time, eroded or hypertrophied zones with areas of necrosis or granulomatosis may appear on the mucous membrane of the cervix.

When the infection has risen even higher – into the uterine cavity, inflammation of the mucous membrane lining it – the endometrium – may develop. Chlamydial endometritis, in addition to discharge from the cervical canal, is manifested by an increase in body temperature, general weakness, pain in the lower abdomen and lower back. The same symptoms are observed with inflammation of the fallopian tubes (salpingitis) caused by chlamydia.

Consequences of chlamydia during pregnancy

Any infection during pregnancy carries a double threat to health, and chlamydia is no exception. The negative consequences of chlamydia during pregnancy affect both the mother and the fetus (child).

The consequences for the child are associated with antenatal infection of the fetus, as chlamydia enters the blood through the placenta and through the cervical canal into the amniotic fluid. This can cause placental insufficiency, fetal growth retardation and low birth weight.

In more than half of cases, the child becomes infected during childbirth, passing through the infected birth canal. Chlamydial infection of newborns in every third case leads to neonatal conjunctivitis, and also affects the mucous membranes of the respiratory system, causing respiratory chlamydia in children or neonatal pneumonia in the first three months of life.

Neonatal or chlamydial conjunctivitis of newborns manifests itself during the first two weeks after the birth of the child by swelling of the eyelids and whites, as well as purulent discharge from the eyes. The absence of timely and effective treatment is fraught with corneal ulceration and irreversible deterioration of vision. Chlamydial trachoma can also be a consequence of chlamydia infection from mothers (ICD 10 - A71).

Newborns may also have an elevated level of leukocytes in the urine (leukocyturia), which is typical for urethrogenital inflammation.

Chlamydia has consequences for the pregnant woman in the form of early termination of pregnancy or the birth of a premature baby. There may also be complications of chlamydia, which concern not only the transition of urethrogenital inflammatory processes into a chronic form and lesions of the internal genital organs of the small pelvis (leading to infertility), but infection of the mucous membranes in the respiratory tract, blood vessels and joints.

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Diagnosis of chlamydia during pregnancy

Detection of urogenital chlamydia and diagnostics of chlamydia during pregnancy

It is carried out on the basis of manifestations of the disease during a gynecological examination of patients and the determination of Chlamydia trachomatis in the laboratory.

Pregnant women must undergo the following tests:

• general blood and urine analysis,
• blood test for TORCH infections,
• on the microflora of vaginal discharge (smear from the vaginal walls),
• molecular PCR analysis of urethral mucosal scrapings (to detect chlamydia DNA),
• Enzyme-linked immunosorbent assay (ELISA) of blood for the presence of IgG and IgA antibodies to chlamydia.

Given the significant number of pathogenic agents of sexually transmitted diseases and the similarity of symptoms of most of them, differential diagnostics of chlamydia must be carried out without fail - so as not to mistake its symptoms for a manifestation of erosion or dysplasia of the cervix, as well as damage to the genital tract by trichomonas or mycoplasmosis.

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Treatment of chlamydia during pregnancy

Today, treatment of chlamydia during pregnancy – according to the European Guidelines for the Treatment of Diseases Caused by Chlamydia trachomatis – is carried out in the second and third trimesters with short-term use of antibiotics, which are prescribed only by an obstetrician-gynecologist monitoring the pregnancy and monitoring the course of treatment.

The main drugs in the treatment of chlamydia are fluoroquinolone antibiotics, as well as macrolide antibiotics, which are recognized as the safest for pregnant women. Research by the Center for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services, conducted in 2005-2006, showed that the most effective and safest tablets for chlamydia in the treatment of pregnant women are Azithromycin (synonyms - Azithromycin monohydrate, Azithromycin dihydrate, Sumamed, Azitral, Zitrolide, Sumametsin, etc.). This macrolide antibiotic should be taken once in a dose of 1 g.

In domestic gynecology, Erythromycin, penicillin antibiotic Amoxicillin (Amoxilate, Apo-Amoxi, Gonoform, Dedoxil, Izoltyl, Ospamox and other trade names) are used - one tablet (0.5 g) three times a day - for a week. And also the macrolide antibiotic Josamycin (Vilprafen).

Recommended suppositories for chlamydia - Hexicon, Viferon, Genferon - should also be prescribed by a doctor after examining the pregnant woman. Treatment of the vagina with antiseptics should be carried out only in a medical facility.

According to doctors, folk treatment of chlamydia is self-medication and is unacceptable during pregnancy by definition. Do not risk using the remedies offered by homeopathy.

Phytotherapy is a long-term procedure and rarely gives a quick effect, for this reason, herbal treatment should not be started during pregnancy. Moreover, the recipe for decoctions for internal use includes medicinal plants that are strictly contraindicated for pregnant women: parsley, oregano, St. John's wort, etc.

Doctors say that the best prevention of chlamydia is safe sexual intercourse: with a regular healthy partner, with mechanical or chemical contraception. But for a pregnant woman with already diagnosed chlamydia, this is advice for the future

Chlamydia during pregnancy definitely requires medical attention, otherwise the prognosis for the outcome of pregnancy may be disappointing in terms of the health of the child and the consequences for the health of the mother.