Chlamydia in women is a urogenital venereal disease caused by chlamydia. More than half of the cases are asymptomatic. With a manifest course or relapse, patients may complain of itching in the vagina, pain during urination, mucous or purulent-mucous whiteness, pain in the lower abdomen, lower back, groin area. With prolonged persistence of the disease, the only sign of chlamydia may be infertility. Gynecological examination and laboratory research methods are used for diagnosis. The treatment regimen includes etiotropic antibiotics, antimycotic, eubiotic and immunomodulatory drugs.
A74.9 Chlamydia infection, unspecified
Chlamydia is the most common sexually transmitted disease. More than 105 million new cases of urogenital chlamydia infection are registered annually in the world. The disease is detected in 30-50% of patients with inflammatory lesions of the genitals and in 10-40% of registered pregnant women. Women aged 16-25 are usually infected. In recent years, pathology is increasingly being diagnosed in teenage girls who have started their sexual life early. The importance of timely detection and treatment of chlamydia infection is directly related to its widespread prevalence, frequent asymptomatic or latent course, and the significant impact of chlamydia on a woman’s reproductive function.
The causative agent of the disease is a highly contagious gram-negative bacterium Chlamydia trachomatis, tropic to cylindrical and transitional epithelium. Chlamydia is an obligate intracellular parasite and exists in two cellular forms (corpuscles) — highly infectious extracellular elementary and reproductive intracellular reticular. The full cycle of development of the microorganism takes from 1 to 3 days and ends with the complete destruction of the affected epithelial cell. There are two main ways of infection with chlamydia:
- Contact-sexual. The source of infection is a sexual partner with clinical manifestations or an asymptomatic course of the disease. Infection occurs during vaginal, anal or oral sexual intercourse.
- Vertical intranatal. Chlamydia can be transmitted from the mother to the newborn child when passing through the infected birth canal. Cases of antenatal (intrauterine) spread of the disease have not been recorded.
The probability of infection with chlamydia by contact household method is unlikely, but not excluded. The bacterium is characterized by extremely low resistance to the action of destructive environmental factors: drying, ultraviolet radiation, high temperature, alcohol and antiseptic solutions. At the same time, on natural fabrics at temperatures up to +18 ° C, the microorganism can maintain its viability for up to two days. Therefore, in families with a low level of hygiene, in the presence of a person actively secreting chlamydia, transmission of infection through bedding or toiletries is theoretically possible.
The risk of infection is increased in women with low socio-economic status. Predisposing factors for infection with chlamydia are:
- early sexual debut;
- frequent change of sexual partners;
- sex without the use of barrier contraceptives;
- substance abuse.
There are several stages of the development of chlamydia in women. First, the pathogen in the form of elementary bodies enters the body, penetrates into the cells of the cylindrical epithelium and passes into the intracellular reticular form. The primary focus of chlamydial infection is usually localized in the mucosa of the cervical or urethral canal. Intensive intracellular reproduction of the bacterium leads to the destruction of the epithelial cell and further spread of infection. As the pathogen accumulates, clinical signs of the disease may manifest and intensify. In most cases, chlamydia is asymptomatic, the patient becomes a source of infection for partners.
With a decrease in immunity and the presence of predisposing factors (isthmic-cervical insufficiency, abortions and other invasive interventions, the installation of an IUD), chlamydia spreads in an ascending way. The uterus, uterine appendages, and peritoneum are involved in the inflammatory process. A lymphogenic or hematogenic method of spreading infection is not excluded, which is confirmed by the detection of foci of chlamydia in other organs and tissues (joints, conjunctiva of the eyes, etc.). Chlamydia is often associated with other pathogens of STIs (trichomonas, gonococci, pale treponema, genital herpes virus, etc.). P.), which aggravates the course of the disease.
When identifying individual clinical forms, the prescription of infection, the severity of manifestations and the involvement of various organs in the process are taken into account. Depending on the severity of the course and the duration of infection, specialists in the field of gynecology distinguish the following variants of chlamydia in women:
- Fresh. Infection occurred no later than two months ago, mainly the lower parts of the urogenital tract (cervical canal, vagina, urethra) are affected.
- Chronic. The disease lasts for two or more months, is characterized by an asymptomatic or recurrent course with the spread of inflammation to the pelvic organs.
Taking into account the topography of the spread of the infectious process, there are:
- Local lesions of the urogenital organs: endocervicitis, urethritis, colpitis, bartholinitis.
- Ascending spread of infection: endometritis, salpingitis, adnexitis, perigepatitis, pelvioperitonitis, peritonitis.
- Extragenital lesions: pharyngitis, conjunctivitis, inflammation of the anorectal area, arthritis, etc.
Symptoms of chlamydia in women
The duration of the incubation period, in which there are no symptoms of infection, is from 5 to 35 days (on average — 3 weeks). More than 60% of patients have an asymptomatic course. With fresh chlamydia, a woman may notice discomfort and burning in the vulva and vagina, pain during urination and turbidity of urine (when the urethral canal mucosa is involved in the process), an increased amount of mucous or yellowish mucopurulent whites. Sometimes an increase in temperature to subfebrile figures is detected.
During the period of exacerbation with recurrent chlamydia, signs of an upward spread of the disease appear with the involvement of the uterus and appendages in the process. A woman complains of aching or pulling pains in the lower abdomen, groin area, lower back. Painful sensations increase before menstruation, during sexual intercourse, sudden movements and physical exertion.
Menstrual function is usually not impaired. With a significant prescription of the infectious process and the development of chronic adnexitis, the endocrine function of the ovaries and the ovarian-menstrual cycle may be disrupted. Menstruation becomes irregular, painful, rare, abundant or, conversely, scarce. Infertility is often the only sign of a long-term asymptomatic course of urogenital chlamydia.
Chlamydia infection in women is most often complicated by tubal-peritoneal infertility due to obliteration by adhesions of the fallopian tubes and the adhesive process in the pelvic cavity. Spontaneous abortions, ectopic pregnancy, chorioamnionitis, fetal hypotrophy, premature discharge of amniotic fluid are more often observed in patients with chlamydia. A serious complication is the spread of inflammation to the peritoneum with the occurrence of periappendicitis or acute fibrous perigepatitis (Fitz-Hugh-Curtis syndrome). Women with a hereditary predisposition may develop Reiter’s syndrome, in which damage to the urogenital sphere is combined with specific conjunctivitis and asymmetric arthritis.
Since the clinical symptoms of chlamydia in women are meager and nonspecific, the leading place in the diagnosis is played by the results of studies. To confirm the diagnosis, the gynecologist prescribes the patient:
- Examination on a chair in mirrors. With a fresh infection, the exocervix is hyperemic, erosions can be detected on its surface, and specific lymphoid follicles can be found in the area of the external uterine pharynx. In patients with chronic chlamydia with bimanual palpation, heavy, compacted, painful appendages are felt.
- Detection of chlamydia in a smear. The priority method of diagnosis is considered to be smear culture on flora, the sensitivity of chlamydia to antibiotics in the course of the study is usually not determined. Molecular genetic diagnostics (PCR) is aimed at identifying fragments of the pathogen’s DNA in the urogenital scraping.
- Serological methods. Antibodies to chlamydia are detected in the blood serum even after the disease. The presence of antichlamydial IgA and IgG seroconversion are evaluated with the help of RSC (with ascending infection, the titer of antibodies in paired sera increases by 4 or more times). The RIF and ELISA methods are highly specific. The diagnosis of urogenital chlamydia can be considered reliably confirmed with positive results of at least two different methods, one of which is PCR.
- Checking the patency of the fallopian tubes. It should be borne in mind that ascending chlamydia infection is complicated by the development of adhesions in the pelvis and fallopian tubes. If there are indications for the assessment of tubal patency, the patient undergoes ultrasound hysterosalpingoscopy, hysterosalpingography, salpingo- and falloposcopy, laparoscopic chromosalpingoscopy.
Differential diagnosis is performed with other STIs (gonorrhea, trichomoniasis, ureaplasmosis, etc.). In the presence of extragenital lesions, consultation of an ophthalmologist, rheumatologist, orthopedist, surgeon, urologist, dermatovenerologist may be required.
Treatment of chlamydia in women
Since only reticular forms of the microorganism are sensitive to antibiotics, the main method of therapy is the use of fluoroquinolones, tetracyclines and macrolides that can accumulate intracellularly. In uncomplicated forms of chlamydia, the course of etiotropic treatment is 7-10 days, in the presence of complications — 2-3 weeks. In parallel with antibiotics, drugs for the prevention of complications and normalization of immunity are shown. Usually for this purpose are assigned:
- Antimycotic agents. The use of nystatin, fluconazole and other drugs of this group can prevent the development of candidiasis.
- Eubiotics (probiotics). Taking probiotic drugs against the background of a course of antibacterial treatment and for 10 days after its completion is aimed at preventing dysbiosis.
- Immunomodulators. Normalization of the immune status improves the elimination of bacteria by inhibiting their reproduction inside cells.
After completing the course of antibiotic therapy, the patient is shown remedies that restore the natural biocenosis of the vagina. To confirm the cure, a control laboratory study is carried out 3-4 weeks after the end of taking antibiotics and after 3 subsequent menstruations. Until the patient recovers, it is recommended to refrain from unprotected sex.
Prognosis and prevention
With timely detection and adequate treatment, the prognosis is favorable. Usually, in the absence of complications, chlamydia in women is completely cured in 1-2 weeks. Late diagnosis and chronic persistent course of the process are associated with a high risk of adhesions and the development of tubal-peritoneal infertility. To prevent chlamydia infection, it is recommended to refrain from sexual contact with unfamiliar partners, use barrier contraception. To prevent possible complications in chronic infection, it is important to undergo regular examinations with a gynecologist and take prescribed medications in good faith.