Urogenital chlamydia

Urogenital chlamydia is one of the most common diseases among sexually transmitted infections.

In Europe, chlamydia is a common disease. Currently, at least 50% of sexually active young women are infected with chlamydia. The mechanism of transmission of infection, as a rule, is sexual.

Epidemiology

Annually around the world, about 105.7 million new cases of chlamydial infection of the genital tract are recorded.

[1], [2], [3], [4], [5], [6], [7], [8]

Causes of the urogenital chlamydiosis

Chlamydia belong to a separate group of microorganisms of eubacterial nature. They can infect a wide range of hosts and cause a variety of diseases. Microorganisms are united in a single genus Chlamydia, belonging to the single family Chlamydiaceae, which is in the order of Chlamydiales. There are 3 types of chlamydia - C. Pneumoniae, S. Psittaci, C. Trachomatis.

[9], [10], [11], [12], [13], [14],

Risk factors

• Prostitution.
• Numerous and occasional sexual relations.
• Previously transferred STI.
• Contact with a patient with chlamydial infection or with urethritis / cervicitis syndrome.

[15], [16], [17], [18], [19]

Symptoms of the urogenital chlamydiosis

Women:

• often asymptomatic;
• discharge from the genital tract;
• dysuria (with the exclusion of another urinary tract infection);
• pain in the lower abdomen;
• irregular bleeding from the genital tract;
• dyspareunia.

Men:

• discharge from the urethra;
• dysuria;
• itching with urination;
• pain in the epididymis.

Children:

• conjunctivitis in newborns;
• pneumonia in children the first 6 months. Life.

Chlamydia cervicitis is the most common primary manifestation of chlamydial urogenital infection in women. The disease is more often asymptomatic. Sometimes patients complain of minor discharge from the genitals, and can also experience itching of the vagina, dysuria, bleeding in the intermenstrual period. Chlamydia cervicitis is characterized by yellow, muco-purulent discharge from the cervical canal. Chlamydia can affect the appendages of the uterus and pelvic peritoneum, as a result of which inflammatory diseases of the pelvic organs develop.

In pregnant women, the course of the disease often changes. When chlamydia affects the tubes and endometrium, the process of implantation of a fertilized egg and formation of the placenta is disrupted, which contributes to the development of secondary placental insufficiency. Chlamydia can affect the placenta and membranes, cause the formation of pathogenic immune complexes, which significantly disrupts the function of the asphyxia as an organ that provides the fetus with adequate nutrition when breathing. In such cases, signs of depletion of compensatory-adaptive reactions, involutive-dystrophic processes, dissociation of the development of stroma and villi elements, excessive deposition of fibrinoid and lymphocytic infiltration are found in the post-discharge. Morphofunctional changes in the placenta lead to placental insufficiency, which in turn leads to a delay in the development and fetal hypotrophy. The risk of injury after infection with a woman during pregnancy is greatest. In those cases when pregnancy occurs against a background of chronic Chlamydia infection, the presence of a woman antichlamydial antibodies prevents the spread of the infectious process.

Forms

Women:

• cervicitis;
• PID;
• urethritis;
• perihepatitis.

Men:

• urethritis;
• epididymitis.

Men and women:

• proctitis;
• conjunctivitis;
• Reiter's syndrome;
• venereal lymphogranuloma.

Children:

• urethritis;
• vulvovaginitis;
• proctitis;
• conjunctivitis;
• venereal lymphogranuloma.

Newborns and babies:

• conjunctivitis in newborns;
• pneumonia in children the first 6 months of life.

[20], [21], [22], [23],

Complications and consequences

Women:

• PID;
• chronic pelvic pain syndrome;
• perihepatitis;
• infertility;
• ectopic pregnancy;
• conjunctivitis;
• Reiter's syndrome.

Men:

• orcoepididymitis;
• prostatitis;
• Reiter's syndrome;
• conjunctivitis;
• infertility (rarely).

[24], [25], [26], [27], [28], [29], [30], [31]

Diagnostics of the urogenital chlamydiosis

Methods of laboratory diagnostics:

• Direct immunofluorescence (PIF) - the method is relatively simple and is available in virtually any laboratory. The sensitivity and specificity of the method depends on the quality of the luminescent antibodies used. Because of the possibility of obtaining false-positive results, the UIF method can not be used in forensic medical examination. In addition, this method is not recommended for the study of materials obtained from the nasopharynx and rectum.
• The culture method - seeding on cell cultures, is considered a priority for laboratory diagnosis of chlamydial infection, especially for forensic medical examination, it is more specific than UIF, it is indispensable in determining the cure for chlamydia, as other methods can produce distorted results. However, the sensitivity of the method remains low (within 40-60%).
• Immunoenzyme analysis (ELISA) for the detection of antigens due to low sensitivity is rarely used for diagnosis.
• Nucleic acid amplification methods (IASCs) are classified as highly specific and sensitive, and can be used for screening, especially for the study of non-invasive clinical materials (urine, ejaculate). The specificity of the methods is 100%, the sensitivity is 98%. These methods do not require the survival of the pathogen, however, strict requirements for the transport of clinical material must be observed, which can significantly affect the result of the analysis. These methods include PCR and PCR in real time. A new and prospective NASBA (Nucleic Acid Based-Amplification) method in real time allows us to determine a viable pathogen and replace the culture method.
• Serological methods (microimmunofluorescent, immuno-enzyme) have limited diagnostic value and can not be used to diagnose urogenital chlamydial infection and, especially, to control cure. Detection of IgM AT can be used to diagnose pneumonia in newborns and children of the first 3 months of life. When examining women with PID, infertility is diagnostically significant, the detection of an increase in the titer of IgG AT is 4 times in the study of paired blood sera. An increase in the level of IgG AT to chlamydiae (to the serotype of venereal lymphogranuloma) is considered the basis for the examination of the patient in order to exclude the venereal lymphogranuloma.

Conducting a test to determine the sensitivity of chlamydia to antibiotics is not appropriate. The collection of clinical samples is carried out:

• in women, samples are taken from the cervical canal (diagnostic methods: culture, PIF, PCR, ELISA) and / or urethra (culture method, PIF, PCR, ELISA) and / or vaginas (PCR);
• In men, samples are taken from the urethra (culture method, PIF, PCR, ELISA) or examine the first portion of urine (PCR, LCR). The patient should refrain from urinating for 2 hours before taking the sample;
• in infected newborns, samples are taken from the conjunctiva of the lower eyelid and from the nasopharynx; study also the detachable vulva in girls.

The technique of taking material depends on the methods used.

Currently, the following terminology is used in the diagnosis: fresh (uncomplicated clamidiosis of the lower sections of the genito-urinary tract) and chronic (long-term, persistent, recurrent chlamydia of the upper tract of the genitourinary tract, including pelvic organs). Next, a topical diagnosis, including extragenital localization, should be indicated. Chlamydia infection occurs after the incubation period, which lasts from 5 to 40 days (an average of 21 days).

When complications develop, consultation of related specialists is required.

The procedure of the doctor with the established diagnosis of chlamydial infection

1. Tell the patient about the diagnosis.
2. Presentation of information on behavior during treatment.
3. Gathering of a sexual anamnesis.
4. Detection and examination of sexual contacts are carried out depending on the clinical manifestations of the disease and the estimated duration of infection - from 15 days to 6 months.
5. In the case of detection of chlamydia in a woman giving birth, a baby or a pregnant woman who has not received timely treatment, a newborn is inspected with taking material from conjunctival bags of both eyes. When a chlamydial infection is detected in a newborn, his parents are examined.
6. In the presence of chlamydial infection of the genitals, rectum and pharynx in children in the postnatal period, it is necessary to suspect sexual violence. It should be borne in mind that perinatally obtained C. Trachomatis can persist in a child under 3 years of age. Native brothers and sisters of an infected child should also be examined. The fact of sexual violence must be reported to law enforcement agencies.
7. Conduction of epidemiological measures among the contact persons (sanation of the epidemiological focus) is carried out jointly with the regional epidemiologist:
   • inspection and examination of contact persons;
   • ascertaining laboratory data;
   • the decision on the need for treatment, its scope and timing of follow-up.
8. In case of residence of contact persons in other territories, an order-coupon is sent to the territorial HLC.
9. In the absence of results from treatment, it is recommended to consider the following possible causes:
   • false positive result of the study;
   • non-compliance with treatment regimen, inadequate therapy;
   • repeated contact with an untreated partner;
   • infection from a new partner;
   • infection with other microorganisms.

[32], [33], [34], [35], [36], [37]

Patient education

Training of patients should be aimed at preventing the spread of infection.

Treatment of the urogenital chlamydiosis

Urogenital chlamydiosis can be effectively cured with antibiotic therapy. Venereologists recommend such drugs: azithromycin, doxycycline, erythromycin or ofloxacin. Pregnant women are recommended to take erythromycin or amoxicillin.

Forecast

With inadequate therapy, complications may develop.

• Women with mucopurulent discharge from the cervical canal, symptoms of adnexitis, infertility.
• Persons who have had sexual contact with a sick chlamydial infection.
• Persons undergoing examination for other STIs.
• Newborns from mothers who have had a chlamydial infection during pregnancy.

[38], [39], [40], [41], [42], [43], [44]