Chlamydia (Chlamydia infection)

What is Chlamydia (Chlamydia infection)?

Chlamydia is one of the most common sexually transmitted diseases (STDs). About 90 million people fall ill with chlamydia every year. Chlamydia is a venereal disease caused by chlamydia (Chlamydia trachomatis).

The high prevalence of chlamydia in the population, among the young population due to several main reasons. The first and main one is the characteristic non-symptomless or mild course of chlamydia. In more than half of the cases, Chlamydia is asymptomatic, without clinical manifestations and complaints from the patient. Therefore, very often sexual partners do not know that one of them has a dangerous and very common disease. A person for several years may be a carrier of chlamydia and not know it. Meanwhile, chlamydia eventually leads to very serious, alas, but often irreversible consequences: cystitis, prostatitis, pyelonephritis, erectile dysfunction, infertility, gynecological diseases of the uterus, cervix, appendages. Very often, young couples planning to have children face the problem of infertility of one of the partners. The reason for this may be Chlamydia. As is known, one in six couples suffers from infertility, and in about half of the cases this is a man’s problem. In Europe, about 600,000 cases of salpingitis are estimated as a consequence of chlamydia (Chlamydia trachomatis), leading to the problem of infertility in the fourth part of them.

Chlamydia infection affects almost half of men of active sexual age (from 16 to 40 years) and a third of women. Chlamydia infected 30-60% of women and up to 51% of men (Chlamydia is the most common cause of prostatitis in men) suffering from non-gonococcal inflammatory diseases of the urinary organs. The number of asymptomatic cases of infections caused by chlamydia (Chlamydia trachomatis) in young men and women reaches from 5 to 20%.

Chlamydia can occur with a clinic of arthritis, conjunctivitis, lesions of the cardiovascular system, pneumonia, which causes people to turn to general practitioners, ophthalmologists, rheumatologists, but not to the venereologist. Urogenital chlamydia increases susceptibility to HIV infection, syphilis. Such strains of chlamydia become very virulent (aggressive) and difficult to treat.

Chlamydia has high contagiousness. Chlamydia is detected in 80% of women who have chlamydia-infected male sexual partners.

In 70%-85% of cases, chlamydia is combined with other STIs (sexually transmitted infections) – syphilis, gonorrhea, trichomoniasis, mycoplasmosis, ureaplasmosis, thrush. Such combinations of infections enhance the pathogenicity of each microbe entering the association, complicate and lengthen the course of treatment for chlamydia.

Causes of Chlamydia (Chlamydia infection)

The cause of infection are bacteria of the genus Chlamydia. There are two types of chlamydia bacteria, but because one strikes in animal-based animals, we will only consider chlamidia trachomatis. There are fifteen varieties of these bacteria, some of which cause venereal lymphogranulomatosis and trachoma. Two of the varieties of the bacterium Chlamidia trachomatis affect the urogenital system of men and women and cause urogenital chlamydia. The causative agent of Chlamidia trachomatis is intermediate between viruses and bacteria, and because of this, the disease is extremely difficult to diagnose and difficult to treat.

Chlamydia – pathogenic gram-negative obligate intracellular bacteria. Chlamydia have sizes of 250-300 nm and, upon primary infection, infect cells of the main barrier systems of the body.

Chlamydia has all the major signs of bacteria, such as:

• contain two types of nucleic acids – DNA and RNA (deoxyribonucleic and ribonucleic acids that carry genetic information and information on protein synthesis, respectively);
• ribosomes;
• muramic acid (it is a component of the cell wall, similar to the component of the cell walls of gram-negative bacteria).

Chlamydia multiply by binary division and are sensitive to some antibiotics. Based on these facts and some others, chlamydia has been attributed by scientists to bacteria.

For a long time after the discovery of chlamydia in the process of intently studying them, there was an acute question whether the chlamydia should be attributed to viruses or bacteria. The size of the chlamydial cell is such that it occupies an intermediate position between bacteria and viruses. From the standpoint of evolution, all microorganisms are conditionally considered in the following sequence: bacteria – rickettsia – chlamydia.

Today, chlamydia is believed to be the smallest bacteria, and according to the modern classification, chlamydia is placed in the same group with the so-called rickettsia, with which they are united, in addition to size, by intracellular parasitism. Chlamydia were isolated into an independent order because of the unique intracellular development cycle that distinguishes them from all other bacteria.

Like viruses, chlamydia have external membranes, built according to the type of elementary membranes. And in the cycle of development of chlamydia, there are, along with the stages characteristic of rickettsia cellular organisms, and the stages characteristic of viruses, especially in the initial period of development.

However, the two-phase life cycle of chlamydia itself significantly distinguishes them from the actual bacteria. It occurs in the cytoplasmic vacuole in the host cell and consists in a regular change of the vegetative reproductive large non-infectious cells of chlamydia (reticular cells – RT) and small dense elementary bodies (ET) – infectious forms of the microorganism.

The reproduction cycle of chlamydia and viruses can be divided into early and late phases (periods). “Early” and “late” are convenient terms for describing the phases below, but they should not be taken too literally. For some stages, these processes are somewhat blurred.

The initial period (“early phase”) is the attachment of an elementary body to the surface (receptors) of sensitive cells (sensitive cells for chlamydia are: the cylindrical epithelium of the mucous membranes, epithelial cells of various organs, cells of the reticuloendothelium, leukocytes, monocytes and macrophages.). Then, chlamydia, like viruses, is adsorbed using the receptors of the host cell: the pathogen envelope is fused with the cell membrane, and after 4 hours, the enveloped chlamydia (as an elementary body) enters the cytoplasm of the host cell. Chlamydia, like viruses, form cytoplasmic inclusions. The formation of colonies of these microorganisms depends on the same factors in the host cell.

All changes and transformations of chlamydia, as well as viruses, occur in the cytoplasm, where all stages of the pathogen development cycle are carried out. 8-10 hours after the infection of the cells, suppression of the synthesis of DNA and RNA in the infected cells can be observed. Morphological changes accompanied by suppression of DNA synthesis are also characteristic of chlamydia, as well as viruses.

Further, as a result of contact between pathogens (both chlamydia and viruses) and cells sensitive to them, a series of similar reactions for these microorganisms leads to the appearance of free-floating genetic material of pathogens (provirus and reticular body) inside the cells. So after infection, a period of eclipse occurs (the so-called latent period of infection) during which infectivity is not detected. It continues in both viruses and chlamydia from 2 to 4 hours. This is a latent period during which it is not possible to detect the formation of a new virus or chlamydia. The success of this development cycle for viruses and chlamydia depends on whether microorganisms (or rather, their free-floating genetic material) emerge from this latent state — if they can be infectious.

At the end of the latent period, the stage begins when chlamydia, like viruses, begins to rapidly mature and rise in infectivity. This period begins with an exponential phase (that is, growth can be described by an exponential curve), when infectivity increases at a constant rate, and ends at the phase of reducing the rate of growth of infectivity, which ultimately reaches a maximum. As mentioned above, a similar development cycle occurs in both viruses and chlamydia.

Summarizing all the above, we can draw the following conclusion: at the beginning of the development cycle, when interacting with cells, chlamydia and viruses have very similar processes. Only subsequently, viruses retain a single nucleic acid until the end of the reproduction cycle, while chlamydia in the later stages of development has a second (DNA and RNA).

Chlamydia, like viruses, is not able to produce its own ATP (adenazinotrifoshornuyu acid – in other words, energy), because they do not have their own mitochondria and live off the energy of the host cell that they infected. They inhibit the synthesis of cellular DNA and depend on the energy of the cell, which is now available to them.

Chlamydia, as well as viruses, have another common ability – to leave the cell without lysis (cell destruction), which is an important factor in ensuring the possibility of moderate infection.

Pathogenesis during Chlamydia (Chlamydia infection)

Ways of transmission of chlamydia. Infection occurs through sex. Non-sexual transmission of chlamydial infection (through hands contaminated with infected discharge, underwear, etc.) does not have a significant epidemiological significance, although it must also be taken into account. The high incidence of chlamydia infection (over 50%) of newborns during their passage through infected birth canals, as well as intrauterine transmission of infection, is clearly established.

Getting into a favorable environment, Chlamydia develops and causes a number of diseases of the genital organs and appendages:

• urethritis (inflammation of the urethra)
• cystitis (inflammation of the bladder)
• cystourethritis
• paraurethritis (inflammation of paraurethral glands or paraurethral passages). Especially note that paraurethral ducts are an excellent shelter for donna Trachomatis. Once she got there, in “crisis” situations, she lies there, so that with the end of the treatment she can go out and regain the lost power.
• epididymitis (inflammation of the epididymis)
• orchitis (testicular inflammation)
• orchiepididymitis (inflammation of the testicle in conjunction with its appendages)
• chronic prostatitis (inflammation of the prostate gland)
• funiculitis (inflammation of the spermatic cord)
• vesiculitis (defeat of the seminal vesicles)
• cooperite (inflammation of the bulbourethral glands)
• vulvitis (inflammation of the external genital organs in women)
• cervicitis, endocervicitis (inflammation of the mucous membrane of the cervix uteri)
• bartholinitis (inflammation of the large glands of the vestibule)
• colpitis (inflammation of the mucous membrane of the vagina)
• erosion
• adhesions
• salpingitis (inflammation of the fallopian tubes)
• endometritis (inflammation of the endometrium)
• salpingo-oophoritis (combination of inflammation of the ovaries and fallopian tubes) and others.

Symptoms of Chlamydia (Chlamydia infection)

If a patient has an acute form of chlamydial infection, then usually the symptoms of chlamydia are vitreous discharge from the urethra, usually in the morning. The color of the discharge may be yellowish, as a rule the discharge appears in a small amount. Itching or discomfort during urination, pain and cutting sensations in the urethra, sticking of the sponges of the urethra is possible.

The general condition changes to a lesser extent – weakness, signs of intoxication, a slight increase in body temperature. However, chlamydia occurs much more often without obvious signs or does not appear at all – asymptomatic.

After some time (10 days on average), even without treatment, the existing symptoms of chlamydia disappear or may appear later periodically and in a less pronounced form. Chlamydia develops a chronic course and subsequently, under the influence of provoking agents, it can periodically worsen, affecting new organs and systems.

The signs of chlamydia are not specific and practically do not differ from other sexually transmitted infections.

When mixed infection with chlamydia and other sexually transmitted infections, acutely occurring forms of cervicitis, urethritis and cystitis are very rare.

Symptoms of fresh urethritis are almost not found, most often it is subacute, malosymptomatic forms, in which there are discharges from the urethra in men, from the vagina in women, white, yellow or transparent. The nonspecific symptoms of chlamydia include signs of dysuria – pain, burning during urination or sexual intercourse, redness, itching of the external opening of the urethra. Chronic inflammation of the urethra caused by chlamydia leads to the development of stricture (narrowing). One of the most common signs of chlamydia in women is cervicitis, characterized by specific mucopurulent secretions from the genital tract, without a strong odor, swelling and hyperemia of the cervix.

The symptoms of chlamydia in girls include vulvovistibulovaginitis with characteristic frequent urination, itching in the genital tract, and discharge. Subsequently, with further development of the disease, chlamydia complications appear and patients complain of pain, shooting in the perineum, organs of the scrotum, rectum, women suffer from lower abdominal pain, in the lumbar region, pain during sexual contact is possible.

In about 60% of cases, chlamydia is asymptomatic. With further development of chlamydial infection, the symptoms manifest themselves in the complications of chlamydia: prostatitis, epididymitis (inflammation of the epididymis, fever), endometritis, salpingoophoritis (inflammatory diseases of the uterus and appendages), which are one of the main causes of female infertility. The systemic sign of chlamydia is Reiter’s syndrome, which includes a triad: urethritis, conjunctivitis, reactive arthritis.

The chronic course of chlamydia leads to the development of female and male infertility, due to obstruction of the fallopian tubes in women, chronic prostatitis, accompanied by pain in the perineum, frequent urge and soreness during urination, the development of various pathologies of pregnancy (non-developing pregnancy, miscarriages, premature birth, pathology of fetal development ), intrauterine infection of the fetus. In newborns, chlamydial pneumonia with a chronic course without fever, with attacks of whooping cough-like cough, shortness of breath and cyanosis develops at 4-10 weeks after birth.
Extragenital symptoms of chlamydia include chronic recurrent diseases of the upper respiratory system: frequent colds with complications and prolonged cough, proctitis with characteristic mucous discharge from the rectum, accompanied by anorectal pain.

Complications
Alas, chlamydial infection is a very dangerous enemy, capable of delivering a sudden blow to the most valuable and expensive thing in the life of any family, to deprive a family of the opportunity to have children. Infertile marriages are a very frequent occurrence throughout the world. The cause of infertility often becomes chlamydia. Transferred earlier in a latent form or undertreated Chlamydia, goes into a chronic stage.

Chlamydia is often combined with other STIs – gonorrhea, trichomoniasis, gardnerellezom, ureaplasmosis, viruses.

As a result of all this, complications of chlamydia often manifest as diseases of the urogenital tract: urethritis, cystitis, pyelonephritis, epididymitis, orchitis, prostatitis, endometritis, etc.

In addition to the numerous complications of chlamydia related to the genital organs, chlamydial infection can cause damage to other organs and systems. Reiter’s disease is accompanied by damage to the eyes (chlamydial conjunctivitis), joints (ankle, knee, hip, spine) with the development of reactive arthritis, urethritis of chlamydial etiology.

Chlamydia in women causes a number of complications, including infertility (obstruction of the fallopian tubes). When ascending chlamydial infection affects the mucous membrane of the uterus (endometrium), tubes, ovaries, ligamentous apparatus of the uterus, peritoneum, liver. most often a chlamydial infection affects the tubes, and the disease carries a subacute chronic course, as a result of which the tubal obstruction and infertility develop.

Chlamydial infection can also be detected in pregnant women, and infection is possible during pregnancy or is diagnosed earlier, as a rule, it is a chronic infection. The presence of chlamydial infection in pregnant women increases the risk of threatening miscarriage, spontaneous miscarriage, non-developing pregnancy, stillbirth, premature birth, untimely amniotic fluid, complications during childbirth and the postpartum period, and infection of the fetus during passage through the birth canal.

Diagnosis of Chlamydia (Chlamydial infection)

Chlamydia tests (diagnosis of chlamydia) should be carried out in several ways due to the unique biological cycle of the microbe and its associations with other pathogenic and conditionally pathogenic bacteria.

Urologists and venereologists often see chronic diseases of the urogenital system (cervicitis, erosion, urethritis, vulvovaginitis, endometritis, cystitis, prostatitis, etc.) and, in the absence of the possibility of complex laboratory tests, refer to diseases with an unexplained cause or banal infections. In this case, the treatment is ineffective and may even lead to a worsening of the pathological process, the development of complications (impotence, infertility, intrauterine infection, etc.) and the appearance of treatment-resistant forms of chlamydia.
According to research results, up to 20% of adolescent girls suffer latent chlamydial infection for 3-5 years after the initial infection. In 70% of women, the symptoms of chlamydial infection may be completely absent. In men, 40% of cases with non-gonococcal urethritis are detected by chlamydia, the cause of endocervicitis in women is 37%, and cervical erosion in 49% is the presence of chlamydial infection.

In the diagnosis of chlamydia, the following tests are used: stain by Romanovsky-Giemsa – detection of cytoplasmic inclusions of chlamydia in epithelial cells. This method of diagnosis of chlamydia has a low sensitivity – 10-15% and almost lost its value in modern laboratory practice. In tests for chlamydia, a direct immunofluorescence method using monoclonal antibodies against the main protein of the outer membrane of chlamydia occurs. This method of diagnosis of chlamydia is simple, specific, highly sensitive. The disadvantage of the method is that the detection of the outer membrane of chlamydia is not evidence of the presence of a viable organism. In addition, this analysis for chlamydia is not sensitive enough for asymptomatic and asymptomatic infection.

Chlamydia culture analysis is a highly specific and sensitive method for diagnosing chlamydia. Sowing on Wednesday Mc-coy is the legal standard in the diagnosis of chlamydia. The use of this method for the diagnosis of chlamydia is limited by high labor intensity, high cost, laboratory equipment and preparation time.

Enzyme-linked immunosorbent assay for chlamydia – refers to the spectrophotometric methods for the diagnosis of chlamydia. This method is simple and inexpensive, but not without flaws – the possibility of false-positive results, the complexity of monitoring the quality of research, low sensitivity and specificity.

Analysis of chlamydia by the method of polymerase chain reaction – for several DNA molecules. The main advantages of this method are: high sensitivity and specificity, simple transportation requirements, the ability to identify asymptomatic and asymptomatic infections, and rapid results. To date, this method is the most sensitive among the tests for chlamydia.

Transcriptional amplification is a new method for molecular amplification of chlamydia trachomatis by determining chlamydia ribosomal RNA in endocervical and urethral samples. The sensitivity of this method of diagnosis of chlamydia will be extremely high – 99%, but all studies on the widespread introduction of this method are not yet completed.

The most sensitive tests for chlamydia include PCR (DNA – diagnostics) and culture analysis for chlamydia on the environment Mc-coy – this is today the “gold standard” for diagnosis of chlamydia. When chlamydia is detected in one of the partners (the risk of partner infection is 75-80%), it is necessary to pass tests for chlamydia to other partners, even if they have no complaints and symptoms, because asymptomatic chlamydia does not reduce the risk of its complications.

Treatment for Chlamydia (Chlamydia infection)

Chlamydia treatment is currently reduced to the use of a complex combination of antibacterial therapy, with the inclusion of modern drugs of the latest generations, penetrating through the cell membrane. Immunomodulators are used in the treatment of chlamydia, as chlamydia affect the immune system and inhibit it. In each specific case of chlamydia, an individual treatment regimen should be drawn up that will take into account the nature of chlamydial infection, sensitivity of chlamydia to antibiotics (determined based on the seeding rate of sensitivity to antibiotics), the presence of concomitant infections, its severity and duration of chlamydia, its localization — which organs were infected by .

In the treatment of chlamydia, it is necessary to use enzyme preparations, proteolytic agents, adaptogens, vitamins, hepatoprotectors, probiotics, which protect the gastrointestinal tract from the development of dysbacteriosis. Not the last role in the treatment of chlamydia is played by local treatment in the form of drug instillations into the urethra, baths, enemas, rectal suppositories, vaginal tampons and suppositories. Enzyme preparations are prescribed to restore the permeability of the membranes of diseased cells, thus, higher concentrations of antibiotics at the lower doses of their use get into the cell.

In the treatment of chlamydia recently, in the overwhelming majority of cases, numerous physiotherapeutic effects are used: quantum therapy, ultrasound, magnetic field, infrared radiation, variable frequency currents, electrophoresis, and ionophoresis of drugs.

The efficacy of chlamydia treatment depends on the route of administration of drugs: intravenous and intramuscular routes of administration of drugs are a priority, since in this case the bioavailability of the drug increases, and it is maximally distributed in the cells. The dose of antibiotics used to treat chlamydia should be carefully verified, since subtherapeutic doses, as well as some groups of drugs, lead to the formation of chlamydia forms resistant to treatment and persistence of chlamydia in the body.

Treatment of chlamydia associated with gonorrhea with penicillin drugs can cause chlamydia recurrence or asymptomatic carriage.
Chlamydia is often combined with other STDs – syphilis, gonorrhea, trichomoniasis, mycoplasmosis, ureaplasmosis, thrush.

The combination of chlamydia with trichomoniasis or gardnellosis requires immediate treatment of trichomoniasis or gardnerelleza and only then – chlamydia. At the end of the course of treatment for chlamydia after 20-25 days, control tests are performed for chlamydia.

Repeated detection of chlamydia requires an additional course of treatment for chlamydia. In case of a negative analysis for chlamydia, control is subsequently carried out 1 time per month for 2 months, for women – before or during menstruation.

Chlamydia is considered cured in the absence of clinical symptoms of the disease, morphological changes in the region of the external and internal genital organs, stable normalization of the leukocyte reaction, the presence of a clinical and microbiological cure. The establishment of a cure for urogenital chlamydia should be carried out taking into account the diagnostic method. Cultural research, it is impossible to carry out earlier 14-20 days after the end of antibiotic therapy, so as not to get a false negative result. Direct immunofluorescence, PCR – (DNA analysis) can not be performed before 3 – 4 weeks, in order not to get false-positive results due to the preservation of non-viable microorganisms or their residues.

To prevent the spread of chlamydia, all women before childbirth and abortion are tested for chlamydia. Couples intending to plan a family must be screened for hidden infections, including chlamydial infections. When chlamydia is detected, treatment for chlamydia is carried out by both partners.

If the treatment of chlamydia begins immediately, in its acute form, the treatment is usually not difficult and ends, as a rule, with a complete cure. If chlamydia has passed into the chronic form, or is constantly recurring, the treatment of these forms is quite complicated: chlamydia have time to develop “immunity” to standard treatment methods, and additional time and material costs are required to develop a successful treatment of these forms of chlamydia.

Prevention of Chlamydia (Chlamydia infection)

By and large, prevention of chlamydia is no different from the prevention of other sexually transmitted infections. However, due to the fact that chlamydial infection is currently extremely common, and chlamydia is often asymptomatic, and it’s almost impossible to notice the carrier of the chlamydia with the “naked eye”, maximum attention should be paid to preventing chlamydia.

The best way to prevent chlomidia, as well as other STIs, is to change sexual behavior. This means that it is necessary to have a discriminating attitude towards the choice of sexual partners, not to allow casual connections and use a condom if there is even the slightest lack of confidence in the partner’s health.

“Folk methods” of protection against STIs, in particular against chlamydia, such as douching, washing the external genitalia with water, the use of chlorine-containing antiseptics, are not only very unreliable, but can also have the opposite effect. The fact is that during douching all microflora is washed out of the vagina, including the one that protects the mucosa from invading pathogenic microorganisms. So indirect prevention of STIs, including chlamydial infections, can be considered as maintaining the body’s immune system at the proper level, as well as proper care of the genital organs. Therefore, compliance with the rules of hygiene of the genital organs, regular medical examinations of the physician for the condition of the vaginal microflora, as well as a healthy lifestyle that helps maintain immunity at the right level – all this can also be considered as preventive measures for many sexually transmitted diseases chlamydia.

However, even a condom does not give a 100% guarantee that infection will not occur. Therefore, people who have more than one sexual partner or who are not confident in their health need to visit a doctor at least several times a year and be tested for STIs, including chlamydia. It is good if it is customary to take an analysis of STI before young people enter into marriage – this will help strengthen the health of young families, which is very important if in the future they plan to become parents.

If the analysis of chlamydia for young spouses is desirable, then when planning a pregnancy, such an analysis is necessary for both spouses to pass. This is very important in order, if necessary, to treat from chlamydia before pregnancy. Such a responsible approach of parents to the future human health is the best prevention of chlamydial infection in the fetus and newborn.

In order to prevent chlamydia, it is very important to examine and treat chlamydia with a regular sexual partner, as well as with all family members. In some cases, alas, it is necessary to treat chlamydia even in children. The fact is that chlamydia, like most STIs, is transmitted not only sexually, but also through blood, bedding, toilet articles, etc. Therefore, if one of the family members is sick with chlamydia, then all the rest must be tested and, if necessary, treated. Until the end of the course of treatment, the patient should use only individual hygiene items.

If the patient does not have a permanent partner, then when detecting chlamydia it is imperative to notify all of his sex partners and family members about this – this is important not only so that they do not get infected from the patient, but also so that the patient himself Having treated, did not get chlamydia infection again. It is known that the risk of developing complications of chlamydia with repeated illness of chlamydia increases significantly.