Chlamydia is a group of infections caused by various types of chlamydia. They affect the respiratory, cardiovascular, musculoskeletal, genitourinary systems, organs of vision. Urogenital chlamydia has manifestations of inflammatory diseases: urethritis, prostatitis, cystitis, vulvovaginitis, cervicitis, erosion, endometritis and is detected only by specific diagnostic methods. A characteristic symptom is vitreous discharge from the genitourinary tract. Disease are dangerous with multiple complications, including ascending infections of the genitourinary tract, infertility, neurochlamydia, joint lesions, heart and vascular diseases, impotence – in men
A74.9 Chlamydia infection, unspecified
Urogenital (genitourinary) chlamydia is a sexually transmitted infection caused by chlamydia (Chlamydia trachomatis). The problem of urogenital infection is very acute today. In recent years, there has been an increase in chlamydia both among the sexually active adult population (men and women from 20 to 40 years old) and in the adolescent environment. Early sexual relations, unprotected sex with casual partners, insufficient awareness of the possible consequences of such relationships put chlamydia on one of the first places in the list of sexual infections.
Almost 90 million people are infected with chlamydia every year. Persons with reduced immunity are especially susceptible. In 40% of cases, chlamydia infection causes various gynecological diseases, in 50% – tubal infertility. Disease is often combined with other sexual infections: ureaplasmosis, trichomoniasis, gonorrhea, syphilis, mycoplasmosis. The combination of several infections aggravate each other’s course and lengthen treatment. Women have a greater susceptibility.
Causes of chlamydia
The causative agent of urogenital chlamydia – Chlamidia trachomatis – is a small bacterium that parasitizes inside human cells. Disease can exist for a long time in the human body and not manifest itself. When suppressing the protective forces, weakening the body, they begin to multiply actively and cause clinical manifestations of chlamydia. There are 15 different types that cause damage to the eyes, lymph nodes, genitourinary organs, etc.
The most common way of transmission is sexual. Infection of a newborn is possible during childbirth, it is accompanied by the development of congenital chlamydia in the child. Much less often there is a household way of transmission in the family through bedding and toiletries, linen, etc. Usually 1-2 weeks pass from the moment of infection to the appearance of the first symptoms (less often up to 1 month).
Symptoms of chlamydia
Asymptomatic course occurs in 67% of women and 46% of men, which often complicates its diagnosis and treatment, increases the risk of complications. Even with the latent course, a sick person is potentially dangerous and able to infect his sexual partner. Usually, the first clinical manifestations are noted 7-14 days after sexual infection.
Chlamydia in men
Men have mucopurulent or watery discharge from the urethra, itching and burning during the act of urination. There is swelling and redness of the external opening of the urethra. Gradually, the symptoms subside, the discharge is observed only in the morning. The acute phase of chlamydia is replaced by a chronic one with a lesion of the urethra.
Chlamydia in women
In women, chlamydia is manifested by pathological secretions from the vagina of a mucous or mucopurulent nature, yellowish tint, with an odor. Sometimes discharge is accompanied by itching, burning, low temperature, abdominal pain.
Chlamydia in children
Chlamydia in children often occurs with damage to the respiratory organs, eyes, ears. If symptoms appear, you should immediately consult a doctor. A particular danger is chlamydia of newborns, which occurs as a result of infection of a child from a sick mother during childbirth. The main forms of congenital chlamydia are:
- chlamydial conjunctivitis (ophthalmochlamydia) is an inflammation of the mucous membrane of the eyes
- generalized form – damage to the heart, lungs, liver, digestive tract
- encephalopathy, accompanied by seizures and respiratory arrest
- chlamydial pneumonia is an extremely severe form of pneumonia with a high mortality rate.
Urogenital complications in men are chlamydial prostatitis, urethritis, epididymitis. Urogenital complications are fraught for men with a violation of spermatogenesis and infertility.
- prostatitis develops when the prostate gland is involved in the infectious process. Chlamydial prostatitis is accompanied by unpleasant sensations and pain in the lower back, rectum, perineum, minor mucous or watery discharge from the urethra, difficulty urinating, violation of potency;
- urethritis occurs with a lesion of the urethra and is characterized by itching in the urethra, frequent painful urge to urinate, mucopurulent discharge. Chronic urethritis caused by chlamydia leads to urethral stricture;
- epididymitis develops with inflammation of the appendage of the testicle, which is accompanied by high fever, swelling and redness of the scrotum, an increase in the appendage of the testicle.
Disease is no less dangerous for women, causing various lesions of the female reproductive system. The ascent infection through the genital tract can cause inflammatory changes from the side:
- cervix – endocervicitis. Infection increases the risk of developing tumor processes in the cervix;
- the mucous membrane of the uterine cavity – endometritis;
- fallopia tubes – salpingitis;
- appendages of the uterus – salpingoophoritis.
Inflammatory processes of the uterus and uterine appendages, followed by the formation of adhesions and scars in the fallopian tubes, cause tubal infertility, ectopic pregnancy, spontaneous termination of pregnancy.
Other consequences in men and women can be inflammatory processes of the pharynx, rectum, kidneys, joints, lungs, bronchi, etc. One of the serious complications is Reiter’s disease, characterized by a triad of clinical manifestations: conjunctivitis, urethritis, arthritis. Repeated infection with chlamydia significantly increases the risk of complications.
Diagnosis of chlamydia in men is often carried out by urologists. A visit to a venereologist is necessary to exclude other STIs that the patient could have contracted along with chlamydia. Women need to consult a gynecologist.
- A general smear. Microscopy of the separated urethra, vagina and cervix does not give an objective picture of the presence. The number of white blood cells in this case may be slightly increased or be within the normal range.
- PCR. With the advent of PCR diagnostics (polymerase chain reaction method), venereology has received the most accurate way to detect chlamydia, which makes it possible to detect even a small amount of the pathogen in the studied material. The accuracy of the result with PCR reaches 95%.
- ELISA. The methods of ELISA (immunoassay), revealing the presence of antibodies to the pathogen and DIF (direct immunofluorescence) – microscopy of smears stained in a certain way, are informative with an accuracy of up to 70%.
- Cultural research. For the diagnosis of chlamydia, back-seeding of the taken material and determination of sensitivity to antibiotics are also used.
As a material for the diagnosis of chlamydia, urine, blood, semen in men, secretions from the genitals, scraping of cells of the affected organ are used.
Treatment of chlamydia
Treatment of chlamydia infection is a complex medical problem, and it needs to be solved taking into account the individuality of each patient. In the treatment, the use of ready-made algorithms cannot be recommended. In elderly people with concomitant diseases, the state of immunity, intestinal microflora and genitourinary tract should be taken into account. During the course of treatment (on average 3 weeks), it is recommended to exclude sexual contact, alcohol, spices, spicy food, excessive physical activity.
- Antibacterial drugs. Since the causative agent of chlamydia Chlamydia trachomatis is a parasitic intracellular microorganism, the choice of antibiotics is limited to those drugs that penetrate into the cells. Such drugs include antibiotics macrolides, tetracyclines and fluoroquinolones. When selecting antibiotics, the presence of a mixed infection (mycoplasma, gardnerella, ureaplasma) is taken into account for their simultaneous treatment.
- Additional pharmacotherapy. In addition to the antibiotic, the treatment regimen for chlamydia includes immunomodulators (interferon, meglumine acridon acetate), antifungal drugs (nystatin, fluconazole), multivitamins, enzymes (pancreatin), bacteriophages (staphylococcal, proteinaceous, etc.), probiotics.
- Local therapy. For the local treatment of chlamydia, vaginal and rectal candles, baths, tampons, enemas are used.
- Physiotherapy procedures. Physiotherapy procedures are used: ultrasound therapy, magnetotherapy, ionophoresis and electrophoresis with medicinal substances.
Disease is an infection that is easier to avoid than to get rid of. The main rules for the prevention of chlamydia, as well as other sexual infections, are:
- the presence of a permanent sexual partner;
- abstaining from casual sexual contact or using condoms;
- examination for infections if there was an accidental unprotected sexual intercourse;
- notification of all sexual partners in case of confirmation of the diagnosis of chlamydia;
- examination of women planning pregnancy for latent infections (including chlamydia) and careful management of pregnancy to prevent the disease in a newborn;
- abstinence from sexual activity during the treatment.
When detecting chlamydia in one of the sexual partners, it is very important to examine and treat the other for the presence of infection, even in the absence of obvious symptoms of the disease. If one of the sexual partners infected with chlamydia does not undergo treatment, then the other, treated, may become infected again.
To control the cure, ELISA and PCR diagnostics are used 1.5-2 months after the end of the course of therapy (in women – before the onset of menstruation). The criteria for cure are negative results of tests for chlamydia and the absence of symptoms of this disease.
Acute uncomplicated chlamydia with simultaneous treatment of all sexual partners gives a favorable prognosis for full recovery. If chlamydia is started (late diagnosed, untreated, complicated), then in the future various disorders of sexual function may develop – from impotence to infertility.