According to statistics, about 2 million new cases of chlamydial infection are registered annually worldwide. This is facilitated by the fact that the symptoms of chlamydia in men and women are more pronounced compared to traditional sexually transmitted infections such as gonorrhea, trichomoniasis.

In the Russian Federation, chlamydia ranks second after trichomoniasis in terms of prevalence among all sexually transmitted infections.

The main route of transmission of urogenital chlamydia is sexual. This is due to the tropism of the pathogen to the epithelial cells of the genitourinary organs, where the main focus is often located.

Transmission of infection from mother to child during fetal development (antenatal) and during childbirth (intranatal) is the main route of infection with chlamydia in childhood.

Non-sexual transmission routes, such as household and airborne, are not clinically significant in the adult population.

Classification

According to ICD-10, urogenital chlamydia (A.56) is classified:

- chlamydial infection of the lower genitourinary system:

• cystitis;
• cervicitis;
• vulvovaginitis;

- chlamydial infection of the upper genitourinary system:

• epididymitis;
• orchitis;
• inflammatory diseases of the small pelvis in women;
• chlamydial infection of the genitourinary system, unspecified;
• chlamydial infection, sexually transmitted by other localization.

Clinic

It should immediately be noted that in 25% of men, urogenital chlamydia is asymptomatic.

But even if there are signs of inflammation of the genitourinary system, characteristic of chlamydia, there are no signs by which the diagnosis can be reliably established.

Consider the main inflammatory diseases of the genitourinary system and pelvic organs, which can be considered as symptoms of chlamydia in men.

Urethritis

This is an inflammation of the urethra.

Urethritis is manifested by a sensation of itching and burning in the urethra. During the act of urination, pain appears, which can be both insignificant and pronounced, bringing significant discomfort.

Examination reveals hyperemia and adhesion of the sponges of the terminal section, as well as purulent or mucopurulent discharge.

It should be noted that in acute and subacute course, the first symptoms of chlamydia in men, as a rule, manifest with urethritis.

Inflammation of the epididymis is a fairly common complication of urogenital chlamydial infection. The highest frequency is observed in men aged 20 to 40 years.

In 80% of cases, the disease is asymptomatic or with poor symptoms, manifested only by a slight swelling of the appendage.

However, there are cases of acute epididymitis with symptoms of intoxication, febrile fever, severe pain in the epididymis, radiating to the spermatic cord, sacrum and groin. On examination, there is swelling, edema and redness of the epididymis.

In subacute course of epididymitis, a blurred clinic is noted with a slight increase in temperature and an unexpressed pain syndrome. Most often, a subacute form of inflammation of the appendage is complicated by orchitis.

Prostatitis

Inflammation of the prostate gland in urogenital chlamydia in men, most often (46% of cases) occurs in tandem with inflammation of the urethra - urethroprostatitis.

With chlamydia, as a rule, prostatitis rarely manifests itself in an acute form with hectic fever, intoxication, severe pain and dysuric disorders.

As a rule, chlamydia in men gives meager symptoms of prostatitis in the form of subfebrile condition, minor urinary disorders and discomfort in the perineum.

To diagnose inflammation of the prostate, transrectal massage is used with the collection of prostate secretion and its subsequent bacterioscopic analysis.

Vesiculitis

Inflammation of the seminal vesicles is recorded in 16% of patients with chlamydial urethroprostatitis during additional examination.

In the vast majority of cases, vesiculitis is asymptomatic, only occasionally causing minor discomfort in the perineum and frequent urination.

There is a violation of sexual function in 60% of cases, of which 30% have problems with arousal.

In addition to erectile dysfunction, there are significant hormonal changes associated with a decrease in testosterone levels and an increase in prolactin levels.

In the semen in the presence of symptoms of chlamydia in a man, in the photo from the microscope are determined:

• pathological forms of spermatozoa;
• an increase in the number of cells with an amorphous head and anomaly of the flagellum;
• decrease in the number of viable spermatozoa.

All these factors lead to the development of infertility and sexual weakness in young men.

Reiter's syndrome

Reiter's syndrome refers to the systemic manifestations of chlamydial infection and is manifested by a triad of symptoms:

• arthritis;
• conjunctivitis.

The first manifests urethritis 2 to 4 weeks after infection. Then the symptoms of inflammation of the conjunctiva join. As a rule, inflammation of the joints develops last.

Chlamydial arthritis is characterized by asymmetric damage to the joints, mainly knee and ankle. Also, the Achilles tendons and plantar fascia of the foot are often involved in the inflammatory process.

It should be noted that Reiter's syndrome develops 10 times more often in men than in women.

Diagnostics

Given that the clinical picture of chlamydial infection is not specific, most often erased or asymptomatic, the leading place in the detection of the disease belongs to laboratory diagnostics.

Suspect and send for examination allows the presence of inflammatory diseases of the genitourinary system:

• orchitis;
• epididymitis;
• cystitis.

Laboratory diagnostics

Cultural method

The essence of the technique is to determine the pathogen on special cell cultures (L-929, McCoy, HeLa).

The most accurate and sensitive of all available diagnostic methods. But it is limited in use due to its high cost and labor intensity.

It is used mainly in the persistent course of urogenital chlamydia.

Linked immunosorbent assay

The definition occurs with the help of special enzyme-labeled antibodies to the chlamydia cell wall.

The sensitivity of the method is 60 - 90%.

Due to the ease of execution and automation of the test, it is used for screening detection of urogenital chlamydia.

Direct immunofluorescence

Fluorescein-labeled antibodies to cell membrane proteins are used. The method is specific, but shows only the components of the chlamydial cell, not indicating the presence of viable microorganisms.

A molecular diagnostic method that allows you to identify the components of the DNA and RNA of the pathogen.

Sensitivity 70 - 95%.

The method is simple to perform and effectively used for the diagnosis of urogenital chlamydia.

Serological study

Specific chlamydial antibodies (IgG and M) are determined in the blood of the subject. It is used in the acute course of the disease.

It is important to note that antibodies do not appear immediately, but only a few weeks after infection.

Treatment

It should immediately be noted that at the moment there is no approved treatment regimen for chlamydia.

The treatment regimen for uncomplicated chlamydia in men includes:

1. Drugs of choice:

• azithromycin 1.0 g once - with chlamydial lesions of the lower parts of the genitourinary system;
• azithromycin 1.0 g once a week for three weeks - with chlamydial lesions of the upper genitourinary system and pelvic organs;
• doxycycline 100 mg twice a day for seven days - with chlamydial lesions of the lower parts of the genitourinary system;
• doxycycline 100 mg twice a day for two weeks - with chlamydial lesions of the upper genitourinary system and pelvic organs;

2. Alternative drugs:

• ofloxacin 400 mg twice a day for a week;
• roxithromycin 150 mg twice a day for ten days;
• erythromycin 500 mg four times a day for ten days.

It should be noted that for the treatment of complicated chlamydia in men, a treatment regimen has been officially developed only for the original azithromycin - "Sumamed". Therefore, all generics of azithromycin can only be used to treat uncomplicated forms of urogenital chlamydial infection.

For the treatment of clinical complications of chlamydia in men (prostatitis, urethritis, vesiculitis, epididymitis), additional methods are used:

• drugs to increase immunity;
• physiotherapy procedures;
• instillations into the urethra.

At the end of the course of antibacterial treatment, laboratory control of the cure must be carried out. Moreover, it is desirable to carry out the same research method that was used to identify the pathogen initially.

The treatment regimen for chlamydia in men is provided for informational purposes only!

In no case should you self-medicate, since, depending on the characteristics of the course of the infection and the state of the body, the doses and duration of antibiotic therapy are almost always adjusted.

Prevention

Primary

It consists in preventing the introduction of C. Trachomatis and the development of the disease:

• use of barrier means of protection (condoms);
• limit the number of sexual partners;
• maintain a trusting relationship with a partner;
• Avoid knowingly having sexual contact with infected people.

Chlamydial infection is a sexually transmitted disease (sexually transmitted infection) caused by the bacterium Chlamydia trachomatis.

Etiology and epidemiology of chlamydia

Genitourinary chlamydia is one of the most common STIs in the world. In connection with the improvement of diagnostic methods in many developed countries, more cases of the disease are being recorded. The greatest risk of the disease is in young people who are sexually promiscuous, without the use of STI prophylaxis. in Russia, the incidence of chlamydia is also high, while the statistical data do not reflect the real situation with this disease, since a large number of cases remain unregistered.

Classification of chlamydia

• • A56.0 Chlamydial infections of the lower urogenital tract.

• • A56.1 Chlamydial infections of the pelvic organs and other genitourinary organs

• • A56.3 Chlamydial infection of the anorectal region

• • A56.4 Chlamydial pharyngitis

• • A56.8 Chlamydial sexually transmitted infections, other sites

• A74.0 Chlamydial conjunctivitis (H13.1)

Ways of infection with chlamydia:

adult population

• sexual contact (any form of sexual contact).

Children:

• • perinatal;

• • sexual contact;

• contact-household (in rare cases, little girls are infected from sick parents, if hygiene rules are not observed when caring for a child).

Symptoms of chlamydia

Chlamydia of the lower genitourinary system:

For the female:

Complaints about (subjective symptoms):

• mucopurulent discharge from the urethra and / or vagina;
• spotting (outside of menstruation);
• Painful sensations during sexual contact;
• Pain, itching, burning, during the act of urination;
• Pain and discomfort in the suprapubic region of the abdomen.

On examination, the following objective symptoms are revealed:

Objective symptoms on examination:

Chlamydial infection of the anorectal region

In men and women in most cases it is asymptomatic.

The following complaints are possible:

• with damage to the rectum, itching, burning in the anorectal region, painful tenesmus, soreness during defecation, mucopurulent discharge, often mixed with blood, constipation.

Objective symptoms:

• redness and swelling of the skin in the anus;
• mucopurulent discharge from the rectum.

Chlamydial pharyngitis

Complaints about:

• dryness in the oropharynx;
• pain aggravated by swallowing.

Objectively:

• redness and swelling of the mucous membrane of the oropharynx and tonsils.

Chlamydial conjunctivitis

Complaints:

• moderate soreness in the area of ​​the affected eye;
• dryness and hyperemia of the conjunctiva;
• photophobia;

Objectively:

• redness and swelling of the conjunctiva of the eye;
• scanty mucopurulent discharge at the corners of the eye.

Chlamydial infections of the pelvic organs and other urinary organs

Subjective symptoms of chlamydia in women

• vestibulitis: scanty mucopurulent discharge, redness and swelling in the vulva, soreness;
• salpingo-oophoritis: cramping pains in the lower abdomen, mucopurulent discharge; there is a violation of the menstrual cycle; in a chronic course, there are more erased complaints and manifestations.
• endometritis: pain of a pulling nature in the lower abdomen, mucopurulent discharge;
• pelvioperitonitis: nausea, vomiting, abdominal pain, impaired defecation.

Objective symptoms:

• vestibulitis: scanty mucopurulent discharge, hyperemia of the openings of the ducts of the vestibular glands, soreness and swelling of the ducts;
• salpingo-oophoritis: in acute course - enlarged, painful fallopian tubes and ovaries, shortening of the vaginal arches, mucopurulent discharge from the cervical canal; in the chronic course of the process - slight soreness, compaction of the fallopian tubes;
• endometritis: in acute course - painful, enlarged uterus of soft consistency, mucopurulent discharge from the cervical canal; in the chronic course of the disease - a dense consistency and limited mobility of the uterus;
• pelvioperitonitis: appearance - facies hypocratica, high body temperature, hypotension, oliguria, sharp abdominal pain on palpation, in the lower sections, muscle tension of the abdominal wall and a positive symptom of peritoneal irritation are determined.

Subjective symptoms of chlamydia in men

• epididymoorchitis: mucopurulent discharge from the urethra, urination disorders, dyspareunia, pain in the epididymis and inguinal region on the affected side; pain in the perineum with irradiation to the rectum, in the lower abdomen, in the scrotum; pain can spread to the spermatic cord, inguinal canal, lumbar region, sacrum;
• prostatitis: pain in the perineum and in the lower abdomen radiating to the rectum, impaired urination.

Objective symptoms

• epididymo-orchitis: mucopurulent discharge from the urethra, enlarged, dense and painful testicle and its appendage are determined on palpation, redness and swelling of the scrotum in the affected area are observed;
• prostatitis associated with urethritis: on palpation, a painful, compacted prostate gland is determined.

In men and women - chlamydial lesions of the paraurethral glands

Subjective symptoms:

• itching, burning, pain during urination;
• mucopurulent discharge from the urethra;
• pain and discomfort during intercourse;
• soreness in the region of the urethral opening.

Objective symptoms:

• mucopurulent discharge from the urethra, the presence of dense painful elements the size of a millet grain in the ducts of the paraurethral glands.

Chlamydial infections, sexually transmitted, other localization

Reactive arthritis is an inflammation of the synovial membrane of the joint, ligaments and fascia. The disease often manifests itself in the form of a triad of symptoms: urethritis, conjunctivitis, arthritis. In this case, damage to the skin and mucous membranes is possible (keratoderma, circinary balanoposthitis, ulceration of the oral mucosa), as well as with symptoms of damage to the cardiovascular, nervous system and kidney pathology. In reactive arthritis, the following joints are affected: knee, ankle, metatarsophalangeal, toes, hip, shoulder, elbow and others. The disease is characterized by a course in the form of monoarthritis. The average duration of the first episode of the disease is about 6 months. Half of the patients relapse. In 20% of patients, there are signs of intestinal damage.

With disseminated chlamydial infection in patients of both sexes, pneumonia, perihepatitis, and peritonitis may develop.

Indications for examination

• persons with clinical and / or laboratory signs of inflammation of the genitourinary system, if indicated - with diseases of the rectum, oropharynx, conjunctiva, joints;
• pregravid examination;
• examination of pregnant women;
• upcoming surgical manipulations on the organs of the genitourinary system
• persons with perinatal losses and infertility in history;
• sexual partners of STI patients;
• survivors of sexual violence.

With an unknown source of infection, it is recommended to conduct a second serological test for syphilis after 3 months, for HIV, hepatitis B and C - after 3-6-9 months.

Clinical material for laboratory research is:

• in women: discharge (scraping) of the urethra, cervical canal, the first portion of urine
• in men: discharge (scraping) of the urethra, the first portion of urine, the secret of the prostate gland;
• in children and women who did not have a history of sexual intercourse with penetration - discharge of the urethra, posterior fossa of the vestibule, vagina; when examined using children's gynecological mirrors - cervical canal discharge.

For the reliability of the diagnosis, the following requirements must be met:

• Sampling of material for cultural studies no earlier than 14 days after taking antibacterial drugs; with PCR diagnostics - not earlier than in a month.
• Sampling of clinical material not earlier than 3 hours after the act of urination; with a pronounced clinical picture with copious discharge, after 15-20 minutes.
• Taking material outside of menstruation;
• compliance with the conditions for the delivery of samples to the laboratory.

Carrying out any kind of provocations in order to improve the efficiency of diagnostics is impractical.

The recommended methods for diagnosing chlamydia are PCR diagnostics and culture studies, while the latter method is not used in routine practice due to the complexity and time duration. PCR is by far the most optimal diagnostic method with a sensitivity of up to 98-100%.

Diagnostic methods: direct immunofluorescence (DIF), enzyme immunoassay (ELISA) to detect antibodies to C. trachomatis, microscopic and morphological methods should not be used to diagnose chlamydial infection.

In various clinical forms of chlamydia, consultation of the following specialists may be required:

Differential Diagnosis

Manifestations of urogenital chlamydia are not specific, and therefore it is necessary to differentiate this pathology from other STIs. it is advisable to include the entire list of sexually transmitted diseases in the survey plan.

Chlamydial epididymo-orchitis is differentiated from dropsy of the testicle, infectious epididymo-orchitis of a different etiology (tuberculous, syphilitic, gonococcal, etc.), a tumor of the scrotum, with torsion of the testicular leg, etc.

The differential diagnosis of chlamydial infection of the upper reproductive system of women is carried out with ectopic pregnancy, endometriosis, complicated by an ovarian cyst, diseases of the abdominal organs (pancreatitis, cholecystitis, etc.).

Treatment of hamidiosis

Indications for treatment

The indication for treatment is the detection of the pathogen by PCR or culture. All sexual partners of the patient should receive treatment.

Treatment Goals

• • eradication of C. trachomatis;

• • clinical recovery;

• • preventing the development of complications;

• preventing infection of others.

General notes on therapy

When prescribing treatment, the following factors must be taken into account: allergic reactions, individual intolerance to drugs, the presence of concomitant diseases, including STIs.

During the period of treatment, it is desirable to exclude sexual intercourse or use barrier means of preventing STIs.

Indications for inpatient treatment

Common chlamydial infection (pneumonia, perihepatitis, peritonitis).

Treatment regimens

Treatment of chlamydial infections of the lower genitourinary system (A56.0), anorectal region (A 56.3), chlamydial pharyngitis (A 56.4), chlamydial conjunctivitis (A 74.0)

Drugs of choice:

• doxycycline monohydrate 100 mg
• azithromycin 1.0 g
• josamycin 500 mg
• ofloxacin 400 mg

Treatment of chlamydial infections of the upper genitourinary system, pelvic organs and other organs (A 56.1, A 56.8) is carried out with the same drugs, but longer - from 14 to 21 days.

Special situations

Treatment of pregnant women:

• josamycin 500 mg
• azithromycin 1.0 g

treatment of pregnant women should be carried out at any time, but always in conjunction with gynecologists.

Treatment of chlamydia in children (less than 45 kg):

• josamycin 50 mg per kg of body weight per day,
• treatment of newborns only in conjunction with neonatologists.

Therapy for chlamydia in children weighing more than 45 kg is carried out similarly to the treatment of adults.

Expected results of treatment

• • eradication of chlamydia from the body

• disappearance of symptoms

To clarify the fact of cure, PCR diagnostics is used, but not earlier than 1 month after the end of treatment. If the results of the study are negative, patients do not need further observation.

Tactics in the absence of the effect of treatment

• exclusion of re-infection;
• choice of an antibacterial drug of another group.

Methods of laboratory diagnostics:

• Direct immunofluorescence (DIF) is a relatively simple method and is available to almost any laboratory. The sensitivity and specificity of the method depends on the quality of the luminescent antibodies used. Due to the possibility of obtaining false positive results, the PIF method cannot be used in a forensic medical examination. In addition, this method is not recommended for examination of materials obtained from the nasopharynx and rectum.
• The cultural method - sowing on cell cultures, is considered a priority for laboratory diagnosis of chlamydial infection, especially for forensic examination, it is more specific than PIF, it is indispensable in determining the cure for chlamydia, since other methods can give distorted results. However, the sensitivity of the method remains low (within 40–60%).
• Enzyme-linked immunosorbent assay (ELISA) for the detection of antigens due to low sensitivity is rarely used for diagnosis.
• Nucleic acid amplification methods (NAATs) are highly specific and sensitive; they can be used for screening, especially for the study of clinical materials obtained in a non-invasive way (urine, ejaculate). The specificity of the methods is 100%, the sensitivity is 98%. These methods do not require the preservation of the viability of the pathogen, however, it is necessary to comply with strict requirements for the conditions for transporting clinical material, which can significantly affect the result of the analysis. These methods include PCR and real-time PCR. The new and promising NASBA (Nucleic Acid Based-Amplification) method in real time allows you to determine a viable pathogen and replace the culture method.
• Serological methods (microimmunofluorescence, enzyme immunoassay) have limited diagnostic value and cannot be used to diagnose urogenital chlamydial infection and, moreover, to control cure. Detection of IgM antibodies can be used to diagnose pneumonia in newborns and children in the first 3 months of life. When examining women with PID, infertility, the detection of an increase in IgG AT titer by 4 times in the study of paired blood sera is diagnostically significant. An increase in the level of IgG antibodies to chlamydia (to the serotype of lymphogranuloma venereum) is considered the basis for examining the patient in order to exclude lymphogranuloma venereum.

Conducting a test to determine the sensitivity of chlamydia to antibiotics is impractical. Taking clinical samples is carried out:

• in women, samples are taken from the cervical canal (diagnostic methods: cultural, PIF, PCR, ELISA) and / or urethra (cultural method, PIF, PCR, ELISA) and / or vagina (PCR);
• in men, samples are taken from the urethra (cultural method, PIF, PCR, ELISA) or the first portion of urine is examined (PCR, LCR). The patient must refrain from urinating for 2 hours prior to sampling;
• in infected newborns, samples are taken from the conjunctiva of the lower eyelid and from the nasopharynx; also examine the discharge of the vulva in girls.

The sampling technique depends on the methods used.

Currently, the following terminology is used in making a diagnosis: fresh (uncomplicated chlamydia of the lower urogenital tract) and chronic (long-term, persistent, recurrent chlamydia of the upper genitourinary tract, including the pelvic organs). Further, the topical diagnosis should be indicated, including extragenital localization. Chlamydial infection appears after an incubation period of 5 to 40 days (median 21 days).

With the development of complications, consultation of related specialists is required.

The order of actions of the doctor in the established diagnosis of chlamydial infection

1. Telling the patient about the diagnosis.
2. Presentation of information about behavior during treatment.
3. Collection of sexual history.
4. Identification and examination of sexual contacts is carried out depending on the clinical manifestations of the disease and the estimated duration of infection - from 15 days to 6 months.
5. If chlamydia is detected in a woman in labor, a puerperal or a pregnant woman who has not received timely treatment, a newborn is examined with taking material from the conjunctival sacs of both eyes. If 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, sexual abuse should be suspected. It should be borne in mind that perinatally obtained C. trachomatis may persist in a child up to 3 years of age. Siblings of an infected child should also be examined. The fact of sexual violence must be reported to law enforcement agencies.
7. Epidemiological measures among contact persons (rehabilitation of the epidemiological focus) are carried out jointly with the district epidemiologist:
   • inspection and examination of contact persons;
   • statement of laboratory data;
   • decision on the need for treatment, its volume and timing of observation.
8. In the case of residence of contact persons in other territories, an order-pass is sent to the territorial KVU.
9. In the absence of results from treatment, it is recommended to consider the following possible reasons:
   • false positive test result;
   • non-compliance with the treatment regimen, inadequate therapy;
   • repeated contact with an untreated partner;
   • infection from a new partner;
   • infection with other microorganisms.

For a long time, scientists did not attach due importance to these microorganisms, since they did not have a severe history. Chlamydia trachomatis is not a virus, but it is not a bacterium either. It is noteworthy that chlamydia are more complex organisms compared to viruses, they are able to simultaneously affect both internal and external genital organs, blood vessels, the surface of joints, the heart, teeth, as well as organs such as vision and hearing.

Chlamydia trachomatis mainly affects the urinary tract. According to statistics, about 100 million people are infected every year in the world. That is why much attention is paid to the development of medicines and tests aimed at treating and early recognition of the disease.

Symptoms of the disease in women

The insidiousness of these bacteria lies in the fact that in women, chlamydia can occur without obvious symptoms. In other cases, the following symptoms may appear: mucous or mucopurulent vaginal discharge, which may be yellow and foul-smelling. Also, infection can be accompanied by mild pain in the pelvic area, burning, itching, intermenstrual bleeding. But all these symptoms indicate the diagnosis only indirectly, since many diseases of the genitourinary tract can have the same symptoms.

After completing the course of treatment, the patient should be observed by a doctor for another 20-30 days. During this period, control tests are given. The complexity of the treatment of chlamydia lies in the ability of chlamydia to become resistant to antibacterial drugs. Therefore, it is necessary to strictly follow the recommendations and prescriptions of the doctor, do not take alcohol during this period, eat right and avoid stressful situations.

Azithromycin(Sumamed) - effective for uncomplicated and sluggish course of the disease. In the first case, 1.0 g of the drug is prescribed once a day. With a sluggish course, the drug is prescribed according to the scheme, designed for 7 days. 1 day - 1.0 g, 2 and 3 days - 0.5 g each, from 4 to 7 days - 0.25 g each.

Ciprofloxacin(sifloks, tsiprobai) - effectively fights complicated forms. The course is 10 days, 1st dose - 500 mg, then every 12 hours - 250 mg.

In any case, your attending physician should decide on the appointment of drugs in each case!

Causes

Chlamydia is sexually transmitted in 50% of cases. Women are more susceptible to infectious agents. Ways of infection - vaginal, anal and oral sexual contact. Even during oral sex, you must wear a condom. Children can become infected with chlamydia during childbirth from a sick mother. Some sources deny the household route of infection. However, scientists have proven that chlamydia can exist for about two days on the bed and other household items at a temperature of 18-20°C. Therefore, infection of the eyes by contact through the hands is not excluded.

Types of disease

Urogenital chlamydia in acute and chronic form

mini test- a simple and cheap option, you can buy it at a pharmacy and test for chlamydia at home. The minus of the mini-test is its accuracy is not more than 20%.

Cultural method. otherwise - sowing on chlamydia is carried out simultaneously with the detection of sensitivity to antibiotics. Today it is the longest and most expensive analysis. But its results can be trusted completely, moreover, it allows you to choose the most effective antibacterial drug for the treatment of chlamydia.

Prevention of chlamydia

Chlamydia in the program of Elena Malysheva "Live healthy!".

CLASSIFICATION OF CHLAMYDIOSIS

According to the severity of the current, they distinguish:

fresh chlamydia (uncomplicated chlamydia of the lower urinary tract);

chronic chlamydia (long-term, recurrent, persistent chlamydia of the upper genitourinary tract, including the pelvic organs).

According to the topography of the lesion, there are:

chlamydial lesions of the lower urinary tract (urethritis, bartholinitis, endocervicitis, vaginitis);

ascending chlamydial infection (endometritis, salpingitis, salpingo-oophoritis, pelvioperitonitis, perihepatitis).

ETIOLOGY AND PATHOGENESIS OF CHLAMYDIOSIS

Chlamydia are unstable in the external environment, sensitive to high temperatures and quickly inactivated when dried. Highly sensitive to 70% ethanol, 2% lysol, 0.05% silver nitrate, 0.1% potassium iodate, 0.5% potassium permanganate, 25% hydrogen peroxide, 2% chloramine, UV rays.

The humoral immune response is characterized by the production of specific IgM, IgG, IgA. IgM can be detected in the vascular bed as early as 48 hours after infection. Only 4-8 weeks after infection, IgG class antibodies are detected. Secretory IgA is produced locally. The production of antibodies, as well as phagocytosis by macrophages, is possible only when chlamydia are in the stage of elementary bodies (ET) in the intercellular space. Therefore, when chlamydia persists inside the cell in the PT stage, the amount of IgG antibodies in the blood is usually small.

The chronic course of chlamydia is characterized by the presence of IgA and IgG. Low, permanent titers of IgG antibodies indicate a long-term chlamydial infection.

The most common clinical forms of chlamydia: acute urethral syndrome, bartholinitis, cervicitis, endometritis, salpingitis, conjunctivitis, salpingoophoritis, pelvioperitonitis. A formidable complication of chlamydia is infertility.

Asymptomatic chlamydial infection is noted depending on localization with a frequency of up to 60-80%. Due to the common ways of transmission of pathogens in STIs, chlamydia is often accompanied by other bacteria and viruses (gonococci, trichomonas, myco, ureaplasma, HSV, CMV, human papillomavirus), which in association increase the pathogenicity of each microorganism and its resistance to treatment.

In the pathogenesis of chlamydial infection, the following stages are distinguished:

infection;

the formation of the primary focus of infection;

progression of the inflammatory process with multiple lesions of epithelial cells and the appearance of clinical symptoms of the disease;

functional and organic changes in various organs and systems against the background of developing immunopathological reactions.

SCREENING AND PRIMARY PREVENTION OF CHLAMYDIOSIS

Screening is carried out by PCR and enzyme immunoassay. Subject to examination:

persons who have had sexual contact with patients with urogenital chlamydia;

people being tested for other STIs;

women with muco-purulent discharge from the cervical canal, symptoms of adnexitis, infertility, miscarriage;

newborns from mothers who had chlamydial infection during pregnancy;

men with mucopurulent discharge from the urethra, symptoms of dysuria.

Preventive measures should promote a healthy sexual lifestyle, inform the population about the ways of infection, early and late clinical manifestations of infection and ways to prevent them (safer sex).

DIAGNOSTICS OF CHLAMYDIOSIS

Diagnosis of urogenital chlamydia is based on an assessment of the epidemiological history, clinical picture, and laboratory examination results. There is a high risk of infection in people with multiple and casual sexual relationships.

Clinical manifestations of urogenital chlamydia are quite wide: from the absence of specific symptoms to the development of manifest forms of the disease. Moreover, the asymptomatic course of the disease does not exclude ascending infection of the uterine cavity and its appendages. The clinical picture of chlamydial infection is determined by the virulence of the pathogen, the duration of chlamydia persistence, the localization of lesions and the state of the human immune system.

The following variants of damage to the lower genitourinary tract are possible:

urethritis (more often in children and men);

paraurethritis;

bartholinitis;

endocervicitis;

vaginitis.

Ways of spread of ascending infection:

canalicular (through the cervical canal, uterine cavity, fallopian tubes to the peritoneum and abdominal organs);

hematogenous (extragenital foci; for example, pharynx, articular bags);

lymphogenous (through lymphatic capillaries);

spermatozoa;

through VMK.

Clinical forms of ascending chlamydial infection:

salpingitis and salpingoophoritis (most often have a subacute, erased long course without a tendency to worsen);

endometritis (rarely acute, more often chronic);

infertility (sometimes this is the only complaint of the patient).

Complications of chlamydia:

ectopic pregnancy;

complete or partial obstruction of the fallopian tubes;

adhesive process in the small pelvis;

chronic pelvic pain syndrome;

miscarriage;

perihepatitis;

Reiter's disease (cervicitis, arthritis, conjunctivitis).

LABORATORY RESEARCH

For the diagnosis of chlamydial infection, methods are used both for direct determination of the pathogen and indirect - serological examination.

The cultural method - sowing on cell cultures (is considered a priority, especially when determining the cure for chlamydia, for forensic examination, if a persistent infection is suspected).

PCR method (highly specific and sensitive).

Direct immunofluorescence method.

Serological method - detection of antichlamydial antibodies in blood serum (IgG, IgA). Based on serological methods alone, it is impossible to make a diagnosis of UHC, since IgG to C. trachomatis can remain in the body for a long time (5–10 years) after the illness. Only the presence of specific IgA or IgG seroconversion (a 4-fold increase in AT titer in the study of paired sera) may indicate an ascending chlamydial infection. Only a simultaneous combination of two different methods, one of which is PCR, provides the necessary accuracy in diagnosing UHC, both for primary diagnosis and for monitoring cure.

Conducting a test to determine the sensitivity of chlamydia to antibiotics is impractical. Monitoring the evaluation of the effectiveness of treatment is carried out 1 month after the end of antibiotic therapy.

DIFFERENTIAL DIAGNOSTICS OF CHLAMYDIOSIS

Carried out with other STIs.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

With the development of complications, consultation of related specialists is required (for example, in case of Reiter's disease - an oculist, an orthopedist).

TREATMENT OF CHLAMYDIOSIS

GOALS OF TREATMENT

Etiotropic, complex therapy aimed at eliminating the pathogen.

Treatment of concomitant genitourinary infection, intestinal dysbacteriosis and immune system disorders.

MEDICAL TREATMENT OF CHLAMYDIOSIS

azithromycin, inside 1 g once with an uncomplicated form, with a complicated one - 500 mg 2 times a day for 7-10 days;

doxycycline, inside 100 mg 2 times a day for 7 days;

josamycin, orally 500 mg 3 times a day for 7 days;

clarithromycin 250 mg orally twice daily for 7 days;

roxithromycin 150 mg orally twice a day for 7 days;

ofloxacin 200 mg orally twice a day for 7 days.

In a complicated form of urogenital chlamydia, the same drugs are used, but the duration of treatment is at least 14–21 days.

Alternative treatment regimens for chlamydia:

erythromycin, orally 250 mg 4 times a day for 14 days;

lomefloxacin 400 mg once a day for 7-10 days.

In order to prevent candidiasis during antibacterial therapy of chlamydia, it is advisable to prescribe antimycotic drugs: nystatin, natamycin, fluconazole, itraconazole. In case of co-infection with C. trachomatis, trichomonads, urea, mycoplasmas, anaerobic microflora (in pathogenic concentration), protistocidal preparations should be included in the treatment regimen from the very beginning: metronidazole 500 mg orally 2 times a day for 7 days. Prevention of intestinal dysbacteriosis is carried out with drugs of the eubiotic series inside 30 drops 3 times a day during antibiotic therapy and 10 days after its completion.

The use of immunomodulators in recurrent chronic chlamydia is pathogenetically justified, since they normalize the immune status and participate in the elimination of chlamydia by directly inhibiting their replication and transcription:

• meglumine acridonacetate, 12.5% ​​solution 2 ml intramuscularly every other day from 5 to 10 injections;
• sodium oxodihydroacridinyl acetate (neovir ©), 250 mg intravenously per 1 ml of 0.5% procaine solution daily 10 injections;
• IFN alfa2, 1 suppository vaginally at night every day for 10 days. Enzyme preparations are used: Wobenzym ©, chymotrypsin.

Medicines for the treatment of chlamydia*

Treatment of chlamydia should include compliance with three basic principles: chemotherapy, immunomodulation, restoration of the natural biocenosis of the vagina.

I. Chemotherapy for chlamydia

Treatment will be successful if:

¦ drugs with high anti-chlamydial activity and well penetrating inside the cell in which chlamydia vegetate will be used;

¦ the timing of infection (“fresh”, chronic), the clinical picture of inflammation (acute, sub-acute, torpid, asymptomatic), topical diagnosis will be taken into account.

All antichlamydial drugs, according to their ability to penetrate the cell, are divided into three groups:

¦ low degree - penicillins, cephalosporins, nitroimidazoles;

¦ medium degree - tetracyclines, fluoroquinolones, aminoglycosides;

¦ high degree - macrolides and azalides.

Chlamydia chemotherapy methods:

¦ continuous course - must cover 7 cycles of pathogen development - 14-21 days (use one antibiotic or change it to another during treatment);

¦ "pulse therapy" - three courses of intermittent treatment for 7 days, followed by a break of 7 days; during a pause, the destruction of ET in the intercellular spaces by phagocytes occurs.

Azalides and macrolides:

¦ azithromycin (sumamed) - on the 1st day 1 g (2 tablets of 500 mg) once; on the 2nd-5th day - 0.5 g 1 time / day;

¦ midecamycin (macropen) - 400 mg each. 3 times/day 7 days (course dose 8 g);

¦ spiramycin (rovamycin) - 3 million units, 3 times / day. 10 days;

¦ Josamycin (Vilprafen) - 500 mg 2 times / day. within 10-14 days;

¦ Rondomycin - 0.3 g 2 times / day. within 10-14 days;

¦ clarithromycin (clacid, fromilid) - orally 250-500 mg 2 times / day. within 10-14 days;

¦ roxithromycin (rulide, roxide, roxibid) - inside 150-300 mg 2 times / day. 10 days;

¦ erythromycin (erythromycin - teva, eracin) - 500 mg 4 times / day. before meals inside, for 10-14 days;

¦ erythromycin ethyl succinate - 800 mg 2 times / day. 7 days.

¦ clindamycin (dalacin C) - an antibiotic of the lincosamide group; 300 mg 4 times / day. after meals, 7-10 days or / m 300 mg 3 times / day. 10 days.

Tetracycline group:

¦ tetracycline - inside 500 mg 4 times / day. within 14-21 days;

¦ doxycycline (unidox, vibramycin) - 1 capsule (0.1 g) 2 times / day. within 10-14 days;

¦ metacycline (rondomycin) - 300 mg 4 times / day. within 10-14 days.

Fluoroquinolone preparations:

¦ ofloxacin (zanocin, tarivid, ofloxin) - 200 mg 2 times / day. after eating, within 10-14 days;

¦ ciprofloxacin (tsifran, cyprinol, cyprobay, cipro-bid) - orally, intravenously, 500 mg 2 times / day. within 7 days;

¦ pefloxacin (abaktal) - 600 mg during meals 1 time / day. within 7 days;

¦ levofloxacin (nolicin, urobatcid, norbactin) - 400 mg 2 times / day. within 7-10 days;

¦ lomefloxacin (maxakvin) - 400 mg 1 time / day. 7-10 days.

Local treatment of chlamydia:

¦ tetracycline ointment (1-3%) - on tampons in the vagina 2 times / day. 10-15 days;

¦ erythromycin ointment (1%) - on tampons in the vagina 2 times / day. 10-14 days;

¦ dalacin C (2% vaginal cream) - 5 g in the vagina (dispenser) at night, for 7 days;

¦ betadine - suppositories of 200 mg of polyvidone iodide in the vagina at night, 14 days.

I. Immunomodulation

It is carried out before chemotherapy for chlamydia or in parallel with it. The basis for the appointment of immunomodulation is the presence of immunological changes in the body of people affected by chlamydia: a decrease in the activity of the interfron system, natural killers, macrophages, T-lymphocytes, etc.

For immunomodulation use (application):

¦ preparations of interfronogenesis: reaferon, alfaferon, vi-feron, velferon, kipferon, laferon;

¦ interfron inductors: neovir, cycloferon, engistol, likopid, myelopid;

¦ drugs that modulate the reactions of cellular and humoral immunity: amixin, groprinosin, polyoxidonium, immunomax, gepon;

¦ cytolysins: thymalin, taktivin, timoptin.

Sh. Restoration of the natural biocenosis of the vagina (see Section "Colpitis")

FURTHER MANAGEMENT

A control study is carried out 3-4 weeks after treatment and then for 3 menstrual cycles.

Cure Criteria:

• negative laboratory test results;
• absence of clinical symptoms of the disease.

In the absence of a positive effect of treatment, possible reasons should be considered:

• non-compliance with the outpatient treatment regimen;
• inadequate therapy;
• false positive test result;
• repeated contact with an untreated partner;
• infection from a new partner.

FORECAST

With inadequate treatment, complications may develop.

Source: Gynecology - national guidelines, ed. IN AND. Kulakova, G.M. Savelieva, I.B. Manukhin 2009

*Practical gynecology Likhachev V.K. 2007

Diagnosis of balanoposthitis according to ICD 10 - urology and its prevention

The diagnosis of balanoposthitis according to the International Statistical Classification of the Tenth Revision (ICD-10), adopted by Russia in 1999, belongs to the 14th class of diseases.

If we decipher the numeric and alphabetic codes of ICD 10 used for designations in medical documents, then balanoposthitis refers to urology. In the ICD 10 register, balanoposthitis is registered under the code N48.1

Urology is the clinical discipline dealing with the organs of the urinary tract. Therefore, with inflammation of the glans penis and its foreskin, men should consult a urologist. After all, it is they who are engaged in the diagnosis and treatment of diseases of the penis.

In order not to be mistaken in the diagnosis, it is first necessary to distinguish the symptoms from other diseases that are similar in clinical picture.

Balanitis Zuna. lichen sclerosus, penis cancer, psoriasis, leukoplakia of the genital organ, Reiter's syndrome - this is an incomplete list of diseases with similar symptoms that you can confuse this disease with if you make a diagnosis yourself, without contacting a urologist.

The doctor can easily diagnose balanoposthitis with a visual examination of the penis. But it is more difficult to identify the cause of the inflammatory process. For this, the doctor prescribes the following laboratory tests:

• Analysis of the level of glucose in the bloodstream;
• Bacterial sowing from the surface of the head and leaf of the foreskin, as well as discharge from the urethra;
• Tests for syphilis and candidal balanoposthitis;
• Tests for HIV infection and human papilloma virus;
• If the disease often recurs, then a biopsy is taken from the head of the penis;

Based on the results of the study, the urologist will be able to make an accurate diagnosis and select an effective treatment.

Prevention of balanoposthitis

Preventing disease is the wisest decision. So what should be done to prevent balanoposthitis:

• Stop promiscuity. If this is contrary to your principles, then with intimacy it is necessary to use barrier contraception.
• The best prevention of diseases of the genital area will be an annual scheduled examination by a urologist, and a sexual partner by a gynecologist.
• Personal hygiene using neutral detergents that cannot cause allergies is the main principle of preventive measures.
• Do not abuse the intake of antibiotics and hormonal drugs.
• Control and prevention of high blood glucose levels.

Chlamydia

Symptoms of chlamydia

Symptoms of the disease in men

In men, chlamydia is either asymptomatic, or there may be a mild inflammation of the urethra - the urethra. In the process of urination, burning and itching can be felt, scant discharge is observed, especially in the morning, the so-called "morning drop". Can hurt the scrotum, lower back, testicles. At the time of intoxication, the temperature can rise to 37 °, the urine becomes cloudy, during ejaculation and urination, bloody discharge can be observed. Any of these symptoms should be a serious reason to visit a doctor.

Treatment of chlamydia in men and women

In addition to complex drug treatment, local treatment is also indicated: baths, vaginal tampons and suppositories, douching. In parallel, physiotherapy is prescribed, for example, electrophoresis, ultrasound, iontophoresis, magnetic exposure, quantum therapy. Only a doctor should prescribe treatment, doses and method of taking drugs. Priority is given to intravenous and intramuscular administration of drugs.

Medicines for the treatment of chlamydia

Doxycycline(unidox solutab) - is prescribed for uncomplicated forms of chlamydia inside. At the first admission - 0.2 g, then twice a day, 0.1 g for 7-14 days. It is recommended to observe equal time intervals between doses.

Metacycline(Rondomycin) - is used for uncomplicated and acute form. The recommended dose for the 1st dose is 600 mg, then for 7 days with an interval of 8 hours - 300 mg.

Pefloxacin(abaktal) - is prescribed for uncomplicated fresh chlamydia 1 time per day, 600 mg for 7 days. The chronic form will require a course designed for 10-12 days.

The microorganism Chlamydia trachomatis exists in 15 varieties, only humans are susceptible to its pathogenic effect. This microorganism can cause the following diseases: urogenital chlamydia, venereal lymphogranulomatosis, trachoma, lesions of the rectum, eyes, and many others. others

Another type of Chlamydia Pneumoniae usually becomes the causative agent of pneumonia, pharyngitis, acute respiratory infections and other respiratory diseases. Species of chlamydia Chlamydia Psittaci and Chlamydia Pecorum are transmitted to humans through contact with animals and birds, can cause a fatal disease for humans - psittacosis.

Chlamydia of the genitourinary system is the most common disease of all types. Urogenital chlamydia can occur in acute and chronic form. Before the onset of the chronic form, the latent phase of urogenital chlamydia always proceeds, it can last 7-20 days. The chronic form may not manifest itself in any way until some complication occurs. This can be inflammation of the prostate and bladder, impotence in men, cystitis in women, and infertility in patients of both sexes. Often, improper therapy and the use of antibacterial drugs (antibiotics) in an acute course leads to a chronic form, so self-medication can lead to serious consequences. Chlamydia should be treated according to the prescribed course of therapy and under the supervision of a doctor.

Diagnostics

General smear(microscopic analysis) - with this method, the analysis is taken in men from the urethra, in women simultaneously from the cervix, vagina and urethra.

Immunofluorescence reaction - RIF. With this method, material taken from the urethra is stained and viewed with a special (fluorescent) microscope. If chlamydia is present, they will glow.

Immunoassay - ELISA. This technique uses the ability of the body to produce antibodies to infections. To conduct an ELISA, blood is taken and examined for the presence of antibodies that have appeared in response to infection with chlamydia.

Polymerase chain reaction - PCR. PCR analysis is based on the study of the DNA molecule. PCR for the detection of chlamydia is carried out within 1-2 days and has 100% reliability.

Preventive measures to prevent chlamydia are similar to any other sexually transmitted infections. First of all, you need to think about safety and not lead a disorderly lifestyle, use condoms, and maintain hygiene. Together with a regular partner, you need to undergo an examination and exclude the possibility of infection. It is especially necessary to think about the examination before conceiving and giving birth to a child. It is necessary to be examined and treated together, since the treatment of one of the partners threatens to re-infect in the future.

Useful video

Epidemiology

Causes of Respiratory Chlamydia

Symptoms of Respiratory Chlamydia

Respiratory chlamydia in children often occurs as conjunctivitis, bronchitis and pneumonia.

Chlamydial conjunctivitis begins with redness in both eyes and a purulent discharge. On the conjunctiva, especially in the region of the lower transitional fold, large, row-by-row bright red follicles are constantly found; pseudomembranous formations, epithelial punctate keratitis are possible. The general condition suffers slightly. The parotid lymph nodes are often enlarged, sometimes they are painful on palpation. When sowing discharge from the eyes, the bacterial flora is usually not detected. The course of chlamydial conjunctivitis can be acute or chronic. In the acute course of the phenomenon of conjunctivitis, after 2-4 weeks, they completely disappear even without treatment. In a chronic course, clinical manifestations are found over many months and even years.

Chlamydial bronchitis begins gradually, usually at normal body temperature. The first symptom of the disease is a dry cough, often paroxysmal. The general condition suffers insignificantly. Sleep and appetite are preserved. On auscultation, scattered, mostly medium bubbling rales are heard. Percussion changes in the lungs are usually not detected. After 5-7 days, the cough becomes wet, its attacks stop. Recovery occurs in 10-14 days.

Chlamydial pneumonia also begins gradually, with a dry unproductive cough, which gradually intensifies, becomes paroxysmal, accompanied by general cyanosis, tachypnea, vomiting, but there are no reprises. The general condition suffers slightly. Shortness of breath gradually increases, the number of breaths reaches 50-70 per minute. Breathing is grunting, but respiratory failure is mild. By the end of the first and during the second week, a picture of bilateral disseminated pneumonia is formed in the lungs. On auscultation, crepitant rales are heard in these patients, mainly at the height of inhalation. An objective examination draws attention to the discrepancy between clinically pronounced pneumonia (dyspnea, cyanosis, scattered crepitant rales over the entire surface of both lungs, etc.) and a relatively mild general condition with minimal symptoms of intoxication. At the height of clinical manifestations in many patients, the liver and spleen are enlarged, enterocolitis is possible.

An x-ray examination reveals multiple fine-mesh infiltrative shadows up to 3 mm in diameter.

In the blood of patients with chlamydial pneumonia, pronounced leukocytosis is detected - up to 20x10 9 / l, eosinophilia (up to 10-15%); ESR is sharply increased (40-60 mm/h).