Urogenital chlamydia is today considered a rather serious medical and social problem. Chlamydia is an infectious disease that, unfortunately, has become widespread in many countries. The culprit for the development of chlamydia in adults is chlamydial infection, which, according to the preliminary assessment of the World Health Organization, is in second place among sexual diseases. The first position in this list went to Trichomonas infections.
According to statistics, there are at least four million cases of chlamydial infection in the western continents every year. In European countries (Germany, Great Britain), the number of patients with chlamydia who seek medical help is approximately 10-13% of all requests. Chlamydia in women involved in prostitution is found in 20% of cases. As a comparison, it should be noted that chlamydia in men with an active sex life is much less common - only 1.5% of cases. In Asian countries, in particular in Pakistan, chlamydial infection is found in 17% of cases in pregnant women.
It should be noted that the first information about chlamydia dates back to the Ancient World. The disease is mentioned in the records of ancient Egyptian and ancient Chinese medical collections, as well as in the Old Testament. Today, chlamydia is considered from a medical point of view only as a disease of a new generation. This is not due to the emergence of a new chlamydial infection, but rather to a new level of laboratory diagnostics, thanks to which there are now a variety of research methods, which means that it has become easier to recognize chlamydia and determine their pathological role.
A few words about the causative agent of chlamydia
Chlamydia are considered obligate intracellular microorganisms that cause various pathogenic processes. The dimensions of the chlamydial cell are quite specific, which does not allow these microorganisms to be attributed to bacteria or viruses. Chlamydia occupy, as it were, an intermediate position. Chlamydial cells are not part of the normal human microflora. For this reason, the appearance of chlamydia is associated with the onset of an active infectious process. The absence of clinical signs in most cases is considered as a temporary balance of power between pathogenic parasites and human immune defenses. In their structure, chlamydia are a bit similar to prokaryotes, and in shape they resemble small gram-negative cocci. It should be emphasized that chlamydia are not simple bacteria, but obligate pathogenic parasites with somewhat different reproduction cycles. This cycle, as a rule, includes two forms of existence that are unequal in biological and morphological properties. Thus, reticular (initial) and elementary bodies are distinguished. Since chlamydial cells are not able to independently produce energy for their life activity due to the lack of their own mitochondria, microorganisms are forced to constantly develop at the expense of the energy of the human cells they infect. Elementary bodies are carriers of characteristic species features that do not have a clear analogy in the bacterial environment. Due to the fact that the elementary bodies of chlamydia are metabolically inactive, antibiotics practically do not have a detrimental effect on them. In the cytoplasm of a sensitive (infected) cell, pathogenic microorganisms form a so-called microcolony. As a rule, leukocytes, macrophages, epithelial cells of the mucous membranes and monocytes act as cells sensitive to chlamydia. Elementary bodies, being phagocytized by an infected cell, are surrounded by a special membrane, inside which they begin an active transformation into reticular bodies. Speaking about the reticular bodies of chlamydia, it should be noted that they are several times larger than the diameter of elementary cells, and are also characterized by increased metabolic activity. Pathogenic microorganisms (chlamydia) are sensitive to the effects of ultraviolet radiation of short and long waves, and also do not tolerate high temperatures. For example, at a temperature of 37 degrees for 36 hours (sometimes throughout the day), the infectious process caused by chlamydia stops. And at a temperature of 100 degrees, a concentrated suspension of pathogenic parasites is inactivated in just one minute. At a temperature of 20 degrees, urogenital strains of chlamydia are able to remain active in plain water for up to five days.
Chlamydia transmission routes
Chlamydia infection usually occurs through unprotected sex. At risk are adult men and women aged twenty to forty. It has to do with sexual activity. Other ways of spreading chlamydial infection (for example, through contaminated infected personal belongings of the patient) do not pose an epidemiological danger, but it is not advisable to write them off. In some cases, there is a high probability of infection with pathogenic chlamydia cells in children (newborns) directly during childbirth. This is due to the passage of chlamydia through the infected birth canal. Prenatal (intrauterine) transmission is also possible.
When touching upon the spread of chlamydial infection, it should be noted that exact data are expressed only in approximate figures, since until 1996 cases of chlamydia infection were not subject to mandatory registration. However, the disease is ubiquitous. People who lead a promiscuous and frequent active sex life, as well as socially unadapted individuals who neglect the rules of personal hygiene and sex culture, are more likely to become infected.
The danger of chlamydia lies in the rather wide spread of the disease, which is already epidemiological in nature. This is facilitated by the lack of a person's genetically determined immunity against chlamydial infection. It is also obvious that the transferred disease does not serve as a basis for creating stable immunity from re-infection. In various cases of chlamydia infection, the immune response to pathogenic microorganisms does not have a clear algorithm. For example, with localized forms of chlamydia, when the inflammatory process is limited, which is facilitated by the weak immunogenic activity of chlamydia, antigenic stimulation is practically impossible. However, for example, when the genitourinary system is infected, the human body exhibits increased activity,
Consequences of chlamydiaThe consequences of chlamydia can be very different. In men, chlamydia infection primarily affects the urethra. Further, the infectious process is transferred to the epididymis, seminal vesicles and the prostate gland. In some cases, chlamydial urethritis may be accompanied by prostatitis. Its signs are observed in 46% of all cases of infection. Along with chlamydial prostatitis, vesiculitis can often develop. With untimely and insufficiently long treatment, chronic pyelonephritis may develop.
Inflammatory infectious process caused by chlamydia can also be characterized by exacerbations, for example, when a chlamydial infection penetrates from the bladder into the renal pelvis. At the same time, there is a disturbed dynamics of urination and stagnation of urine. Living in the genitourinary system, chlamydia in some cases can be the culprit of pneumonia, ophthalmic chlamydia and other diseases. Medicine has also established a clear relationship between chlamydia and impaired reproductive function in women and men. In 30% of men infected with chlamydia, there is a weakening of erection, premature ejaculation and other disorders in the genital area. Chlamydial cells are able to reliably adhere to spermatozoa, while reaching not only the fallopian tube and causing its obstruction, but also penetrate into the abdominal cavity, causing various pathologies of internal organs. The causes of chlamydia in women are quite typical. As a rule, there is a high probability of infection with chlamydia in women who do not control their sex life, allowing promiscuous casual relationships. In women with chlamydia, the cervix is primarily affected, and then there is a possibility of an ascending infection that captures the ovaries, fallopian tubes, uterus and peritoneum. Simultaneously with chlamydial infection, bacterial vaginosis is possible. In women, chlamydial infection can affect both the urethra and the cervical canal at the same time. In this case, the symptoms characteristic of chlamydia may be completely absent. A narrow vagina (in nulliparous women) and a low-lying external urethra contribute to primary infection. There is also the possibility of chlamydia entering the rectum from the cervix, causing chlamydial proctitis, which is often asymptomatic. It can only be detected through careful examination, using modern laboratory methods.
The probability of developing a disease such as ureoplasmosis against the background of chlamydial infection is quite high. Chlamydia, which are active in the female urogenital organs, can cause various pathologies of pregnancy, thereby increasing the likelihood of developing chlamydial infection in newborns, which, in turn, often leads to pneumonia and conjunctivitis. Also against the background of chlamydia in newborns, inflammation of the nasopharynx and middle ear can be observed. The consequences of intrauterine chlamydial infection (chlamydia during pregnancy) are quite serious - premature destruction of the amniotic sac can occur, which will cause the birth of a premature baby, pathological weight loss and even death of the fetus.
Ophthalmochlamydia, which is usually similar to follicular conjunctivitis, develops as a result of the transfer of chlamydial infection from the organs of the urogenital system to the eye area. This is facilitated by non-observance of elementary hygiene rules. Sometimes, although rarely, transmission of the infection from an infected person to a healthy person from eye to eye is possible. In most cases, urogenital chlamydia is characterized by an asymptomatic course, although clear manifestations of the disease are possible.
There is no consensus on what contributes to the intensity of reproduction of chlamydial infection. It is known that some hormonal drugs, in particular steroid drugs, can contribute to the active reproduction of chlamydia. Taking oral contraceptives increases the rate of shedding of chlamydial cells from the cervical canal.
Course of the disease
An important condition for the development of an infectious process is considered to be the entry and, accordingly, the reproduction of chlamydial infection in the epithelial areas of the mucous membrane of the genitourinary system. It follows that the urogenital organs serve as the entrance gate for chlamydial infection. Interacting with sensitive cells, chlamydia behave like active parasites. Using their specific activity, which is directed against lysosomes, chlamydia disarm the most important defense mechanism - phagocytosis. Thus, pathogenic microorganisms create a fertile ground for subsequent reproduction directly in the cytoplasm of human cells.
Active reproduction contributes to the development of the pathological process, which is reflected in the dynamics of general and local defense reactions. In places of the primary focus, hyperemia and edema may appear, as well as the integrity of the epithelium layer is violated, resulting in deep infiltration and inflammatory exudate. All this often leads to serious functional disorders. Long-term chlamydial infections can often cause infertility. Thus, scientific studies have shown that a third of men in married (infertile) couples have latent chlamydial infection. Left unattended, chlamydia can cause ascending inflammatory processes in women that affect the pelvic organs. And in adult men, the lack of proper treatment can lead to orchiepididymitis (inflammation of the testicles and appendages),
Chlamydia symptoms
The clinical picture of chlamydia differs, for example, from gonococcal infection by less acute inflammation, non-acceptance of therapy and a higher frequency of various complications. The incubation period of a chlamydial infection can range from one month (sometimes longer). Perhaps a typical feature of the course of the inflammatory process during infection with chlamydial infection is, as a rule, an asymptomatic course or asymptomaticity. For example, in men, a pronounced form of chlamydia, which is accompanied by hyperemia of the mucous membranes, profuse discharge, pain and dysuric disorders, is a rarity.
Signs of chlamydia in women are casuistry. Most often, a sluggish inflammatory process is observed. The main symptoms of chlamydia in men are swelling of the lips of the urethra, moderate hyperemia and poor purulent-mucous discharge. Painful sensations are possible with an ascending inflammatory process and a total lesion of the urethra. In women, the disease may be characterized by increased discharge, and pain in the lower abdomen and during urination is also possible. However, often the symptoms of chlamydia in women are minimal. With colposcopy, swelling of the mucous membrane and vacuolization of the epithelium can be detected. In the area of the external os of the uterus, a small red corolla is sometimes found.
In addition to the standard symptoms, it is often possible to detect papules, which are, as it were, an elevated mucous membrane. Such papular protrusions contain a discharge of a white-grayish color and, as a rule, are located on the anterior lip of the uterine cervix. The size of the papules can vary - from millet grain to the size of a medium bean. Also, dilated vessels in the submucosal tissue can be determined, which have a particularly clear outline around the papules. A special analysis (Schiller's test) allows you to identify an iodine-negative zone in the area of \u200b\u200bthe entrance of the cervical canal.
Diseases caused by chlamydia
For urogenital chlamydial infection, chronic, subacute and persistent form is most often characteristic. Acute inflammatory processes are much less common. In general, the clinical picture directly depends on the topography of the lesion, the time period of infection and the severity of general and local protective reactions of the body. Together, these factors determine the diversity of clinical manifestations.
The duration of acute urogenital chlamydia usually does not exceed two months. This form of the disease is characterized by purulent-mucous discharge, an acute onset of the inflammatory process and pronounced abacterial leukocytosis. However, this form of the disease is extremely rare. Chronic chlamydia is characterized by an asymptomatic form of the disease, and the duration of the inflammatory process exceeds two months. Clinical manifestations, as a rule, worsen some time after the alimentary provocation - sexual intercourse. Dysuric disorders may be intermittent, and leukocyturia is often not pronounced. Possible complications of chronic chlamydia are salpingo-oophoritis and prostatitis.
Chlamydial urethritis accounts for about 60% of all cases of non-gonococcal urethritis. Most often, chlamydial urethritis in the male population occurs in a chronic form, but sometimes an acute course of the disease is possible. Often, signs of chlamydial urethritis are increased urge to urinate, pain when urinating, and discharge from the urethra. Sometimes pain in the perineum, scrotum and anus can be disturbing. Sometimes the pain appears in the sacral areas, as well as in the lumbar region and lower extremities. The most typical symptom of chlamydial urethritis is purulent, mucous or mucopurulent discharge. Sometimes characteristic discharge appears during defecation or prolonged retention of urine. Often, signs of chlamydial urethritis are increased urge to urinate, pain when urinating, and discharge from the urethra. Sometimes pain in the perineum, scrotum and anus can be disturbing. Sometimes the pain appears in the sacral areas, as well as in the lumbar region and lower extremities. The most typical symptom of chlamydial urethritis is purulent, mucous or mucopurulent discharge. Sometimes characteristic discharge appears during defecation or prolonged retention of urine.
Often, signs of chlamydial urethritis are increased urge to urinate, pain when urinating, and discharge from the urethra. Sometimes pain in the perineum, scrotum and anus can be disturbing. Sometimes the pain appears in the sacral areas, as well as in the lumbar region and lower extremities. The most typical symptom of chlamydial urethritis is purulent, mucous or mucopurulent discharge. Sometimes characteristic discharge appears during defecation or prolonged retention of urine.
mucous or mucopurulent discharge. Sometimes characteristic discharge appears during defecation or prolonged retention of urine.
Diagnosis of chlamydia
Timely and high-quality diagnostics plays an important role in the fight against chlamydia. It should be noted that the diagnosis of chlamydia, carried out in the laboratory, is currently difficult. The most common diagnostic methods are methods of indirect and direct immunofluorescence, cytological staining and a cultural method, when the pathogen is isolated in cell culture. Of the serological methods, RSK (complement fixation test) is considered the most popular. But this test is characterized by reduced sensitivity, and its results often give false positive results. To date, DIF (direct immunofluorescence method) is widely used in conjunction with the use of monoclonal antibodies. This diagnostic method is characterized by increased sensitivity. The disadvantage of this test for chlamydia is the need for expensive equipment and the inability to determine the viability of chlamydia. For the diagnosis of chlamydial lesions, the World Health Organization recommends using a method that isolates the pathogen in the structure of cells treated with metabolites. This method is considered the most reliable. It can also be used in determining the effectiveness of prescribed therapy. But even in this case, some factors may reduce the likelihood of detecting chlamydial infection in cell culture. Such factors include, for example, taking various medications, in particular antibiotics.
For the diagnosis of chlamydial lesions, the World Health Organization recommends using a method that isolates the pathogen in the structure of cells treated with metabolites. This method is considered the most reliable. It can also be used in determining the effectiveness of prescribed therapy. But even in this case, some factors may reduce the likelihood of detecting chlamydial infection in cell culture. Such factors include, for example, taking various medications, in particular antibiotics.For the diagnosis of chlamydial lesions, the World Health Organization recommends using a method that isolates the pathogen in the structure of cells treated with metabolites. This method is considered the most reliable. It can also be used in determining the effectiveness of prescribed therapy. But even in this case, some factors may reduce the likelihood of detecting chlamydial infection in cell culture. Such factors include, for example, taking various medications, in particular antibiotics.
But even in this case, some factors may reduce the likelihood of detecting chlamydial infection in cell culture. Such factors include, for example, taking various medications, in particular antibiotics.But even in this case, some factors may reduce the likelihood of detecting chlamydial infection in cell culture. Such factors include, for example, taking various medications, in particular antibiotics.
Chlamydia treatment
Methods and scheme of treatment of urogenital chlamydia are based mainly on the use of antibiotics. However, in the treatment of chlamydia in men, it is necessary to take into account the biological characteristics of the pathogen (chlamydia). For example, these pathogenic microorganisms in some cases may have a high tropism for epithelial cells and are able to persist in membrane-limited areas of the epithelium. In this regard, microorganisms can remain unharmed when antibiotic therapy is prescribed. In turn, this can lead to unsuccessful treatment. Therefore, it is advisable to use pathogenic drugs along with etiotropic agents.
Most often, in the treatment of chlamydia, doctors prescribe fluoroquinolones, tetracyclines, and macrolides. It should be noted that antibiotic therapy, carried out without taking into account the characteristics of the microbial association or the etiological agent, often leads to the disappearance of clinical symptoms, which often causes mistakes by many doctors. It is more expedient to prescribe antibiotics together with immunotherapy, both for inpatient and outpatient treatment.
>Recently, modern medicine has been widely using new antibiotics - the so-called azalides. These drugs include azithromycin (tablets), which is characterized by increased antibacterial activity. This medicine for chlamydia is effective against gram-negative microorganisms, and also has a long release period. In some cases, various vaginal suppositories can play an important role in the destruction of chlamydial infection. In some cases, the drug erythromycin, which is often used in the treatment of chlamydia in women, especially pregnant women, has proven its effectiveness. Prevention of chlamydia consists in an orderly sexual life using barrier contraceptives, as well as timely (early) detection of infection and adequate treatment. Courtesy of simptom.orgShare:
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