Urogenital chlamydiais the most common sexually transmitted disease. Frequency. Registered in 30-60% of women and 15% of men suffering from non-gonococcal inflammatory diseases of the genitourinary organs, as well as in 5-20% of persons seeking medical help. The predominant age is 16-40 years. Etiology and pathogenesis. The causative agent is Chlamydia trachomatis (DK serovars) – small (300 im) gram-negative cocci. The main forms are elementary and reticular bodies. The elementary body is a highly virulent form of the pathogen adapted to extracellular existence. The reticular body is a form of intracellular existence of the parasite, metabolically active, providing reproduction of the microorganism. The duration of the incubation period is 5-30 days. Not only the urogenital organs, lined with cylindrical and transitional epithelium, are affected, but also the rectum, posterior pharyngeal wall, conjunctiva, as well as epithelial and epithelioid cells of other organs. Often chlamydia is combined with other sexually transmitted diseases. Risk factors
- promiscuous sex life
- Low socioeconomic status.
- The disease proceeds in the form of subacute or torpid urethritis. With an infection mixed with gonococci, the clinical picture of acute urethritis is more often observed. Without treatment, chlamydia persist in the urethra indefinitely and cause all sorts of complications. Chronic prostatitis is one of the most common complications: chlamydia is found in the secret and prostate tissue. Epididymitis is an inflammation of the epididymis, often subacute, with a bilateral process, partial or complete obstructive aspermia begins. Damage to the seminal vesicles (vesiculitis), bulbourethral glands (couperitis), urethral glands and lacunae (littreitis, morganitis) and other local complications are mild and do not have specific features
- Ophthalmic chlamydia occurs in the form of simple or follicular conjunctivitis (paratrachoma) and develops, as a rule, as a result of the introduction of chlamydia from the urogenital focus of infection by contaminated hands.
- Rashper’s syndrome – damage to the urogenital organs, eyes, joints (more often occurs in carriers of HLA-B27 Ag).
- Endocervicitis is a common and typical manifestation of urogenital chlamydia. More often it is asymptomatic, sometimes pain in the lower abdomen, vaginal discharge are noted. Cervix – erosion, mucopurulent discharge. Not often in the area of the pharynx, peculiar lymphoid follicles are found that are not detected in other urogenital infections. Endometritis sometimes occurs in the postpartum or postabortion period
- Salpingitis and salpingoophoritis are the most common manifestations of ascending chlamydial infection. Often occur subclinically, and they are detected during examination in connection with infertility. More severe complications are pelvioperitonitis and perihepatitis. Ophthalmic chlamydia, pharyngitis, proctitis, urethritis proceed similarly to similar manifestations in men
- Urogenital chlamydia in women can lead to ectopic pregnancy, spontaneous abortion, fetal malnutrition, premature discharge within the fetal fluid, chorioamnionitis.
- More often, chlamydia infection occurs during the passage of the genital tract of a sick mother, less often – in utero. Conjunctivitis is noted (20% of newborns with chlamydia), pharyngitis, eustachitis, bronchitis, pneumonia, concomitant lesions of the pharynx and gastrointestinal tract.
- Material sampling: it is necessary to take a scraping of cells (obtained using a Volkmann spoon), and not an inflammatory discharge, because the pathogen is located intracellularly
- Isolation of the pathogen in cell culture is an expensive method, susceptibility is 60-80%. Direct immunofluorescence with monoclonal AT is the main method for diagnosing chlamydia, currently used, susceptibility is 55-75%. Special studies: PCR, ligase chain reaction test.
- Inflammatory diseases of the pelvic organs.
Tactics of conducting
- Syphilis testing t HIV testing
- Examination and treatment of sexual partners. Drug therapy
- Tetracycline 500 mg 4 times a day for 7-14 days.
- Metacycline 300 mg 3 times a day for 7-10 days.
- Doxycycline 0.1 g 2 r / day for 7-14 days (in case of infection with gonococci or anaerobic bacteria, ceftriaxone 250 mg IM 1 r / day, cefoxitin, other 3rd generation cephalosporins or quinolones are also prescribed).
- Erythromycin 500 mg 4 times a day for 7-14 days.
- Azithromycin 1 g once (with fresh acute chlamydia), 250 mg / day for 10 days (in other cases).
- Ofloxacin 300 mg twice a day for 7 days.
- Pefloxacin 400 mg twice a day for 10-14 days.
- In chronic and complicated forms of chlamydia, the duration of treatment is at least 14 days. Contraindications. Tetracycline – during pregnancy and children under 8 years of age.
precautionary measures. Tetracycline : cause photosensitivity, therefore it is recommended to avoid sun exposure. Drug Interactions
- Dairy products, antacids, iron products disrupt the absorption of tetracyclines
- When combined with erythromycin and terfenadine, a cardiotoxic effect is likely.
- Men: transient oligospermia, urethral strictures (uncommon)
- Women: tubal infertility. Current and forecast. The prognosis for early treatment is favorable. However, due to the asymptomatic course of the early stages of the disease, chronic inflammatory diseases of the pelvic organs may develop.
Pregnancy. Perinatal infection can lead to neonatal pneumonia and/or conjunctivitis. Tetracycline and ofloxacin are contraindicated in pregnancy. Erythromycin is recommended. ICD. A56 Other sexually transmitted chlamydial infections