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Urogenital chlamydia is one of the most common sexually transmitted diseases. Due to the clinical course, diagnostic difficulties, often ineffective treatment and numerous complications, it poses a great threat to reproductive health. Among women suffering from inflammatory processes of the genitals (non-chronic etiology), chlamydia is detected up to 60% or more.
Etiology and pathogenesis have significant features in comparison with other inflammatory diseases of the genitals. The causative agent of the disease are chlamydia (Chlamidia trachomatis in humans and Chlamidia psitaci in mammals and birds), together forming the genus Chlamidia, whose representatives have morphological similarities with bacteria and a unique breeding cycle. Chlamidia trachomatis has a number of serotypes (the most common D — K, as well as A, Ba, Vi, C, L1 – L3). In the development of chlamydia, an important role is played by immune processes. Repeated cycles of intracellular development and infection of new cells stimulate the patient's immune response and increase the degree of pathological damage. Chlamydia is transmitted mainly through sexual contact, less often non-genital (through underwear, hands). The prevalence of chlamydial infection among teenage girls exceeds 10%, and among women - 5%. In terms of age, the peak of the disease occurs in 18-30 years.
The clinical manifestations of urogenital chlamydia are very diverse, which determines several forms of the disease. Most often, chlamydial infection occurs in subacute, chronic and persistent forms, less often - as the type of acute inflammatory processes. Therefore, groups of patients with a different clinical course are distinguished. In the acute course of the disease, there is hyperemia of the mucous membranes of the genitourinary tract, mucopurulent discharge from the vagina, and frequent urge to urinate. The disease with a sluggish, lingering course is characterized by a lesser severity of symptoms, although mucopurulent discharge is noted. Women with these forms of the disease seek medical attention relatively timely. Women with a hidden course of chlamydia have no complaints, they have no discharge from the genital tract, hyperemia of the mucous membranes. Finally, there are carriers of chlamydial infection, in which changes in the genitourinary tract are not detected even with a thorough examination. The localization of lesions in women distinguishes urethral chlamydia, chlamydial bartholinitis, vaginitis, cervicitis, endometritis and adnexitis.
Chlamydial urethritis is characterized by dysuric phenomena: itching, pain at the beginning of urination, frequent urination. There is an infection of the urethra, a small colorless discharge. Paraurethritis often develops with hyperemia of the mouths of the paraurethral ducts, mucopurulent contents squeezed out in the form of a drop. The vestibule of the vagina is also involved in the process, which is manifested by itching and burning of the vulva, secretion of mucus.
Chlamydial etiology bartholinitis is characterized by periodic discharge and itching in the external genital area, hyperemia in the mouth of the excretory duct of the gland. When it is closed, a large cyst with a transparent fluid forms in the region of the large gland of the vestibule with the infiltration of surrounding tissues.
Chlamydial vaginitis (colpitis) is a rare phenomenon, since chlamydia usually does not multiply in the stratified squamous epithelium (but in the cylindrical). It can occur with hormonal disorders, accompanied by structural and morphological changes in the mucous membranes. A secondary process often develops during maceration of the vaginal mucosa, due to secretions from the upstream genitalia. Its clinical manifestations depend on the joined infection.
Chlamydial cervicitis is often asymptomatic. Manifestations of the disease are often caused by damage to other parts of the genitals. When the cervical canal is involved in the process, mucopurulent discharge from it takes place, which macerates the vaginal part of the cervix. The latter becomes hyperemic with eroded areas,
Endometritis of chlamydial etiology is clinically manifested by general and local symptoms, as well as due to other pathogens.
The defeat of the appendages of the uterus (tubes and ovary) is observed during the generalization of the process from the lower sections. Chlamydia affects the inner surfaces of the tubes, the outer shell of the ovaries, possibly with a transition to the parietal peritoneum. Clinically, the disease is manifested by symptoms characteristic of acute or acute adnexitis: pain in the lower abdomen, lower back, fever, changes in the blood (leukocytosis, accelerated ESR). On examination, enlarged, painful appendages are determined, often on both sides. Chlamydial adnexitis is prone to a chronic, recurrent course, lead to obstruction of the tubes and infertility. With the development of chlamydial pelvioperitonitis, peritoneal symptoms occur, dyspeptic disorders are possible. Often the chronic course of chlamydial adnexitis goes into the acute process with the development of pelvic peritonitis after abortion, intrauterine intervention. It is believed that chlamydia of the urogenital tract is also possible in children, both in newborns due to infection when passing through the birth canal in sick women, and subsequently in prepubertal and puberty ages. The most frequent localization of the process in girls is the urethra and rectum. It has been established that chlamydia in 20-25% of cases accompanies gonorrhea in women. A combination of genital chlamydia with its extragenital forms (urinary tract, respiratory system, eyes) is also noted.
Venereal lymphogranuloma is caused by chlamydial serotypes L1-L3. The most common disease in South and Southeast Asia, Central and South America. Recently, due to all kinds of communication connections, sporadic cases of the disease are observed everywhere. The first signs of the disease appear in the vagina, on the labia, less often on the cervix. They have the appearance of papules, pustules, superficial ulcers or erosion.
Diagnosis of chlamydial infection is carried out using various laboratory methods for indicating chlamydia in affected cells, chlamydia isolation, detection of chlamydial antibodies, etc. The following methods have been developed and used for the diagnosis of chlamydia: direct immunofluorescence, ligase chain reaction, polymerase chain reaction, DNA probes, immunoenzyme analysis, serological, microscopic and various methods for the isolation of chlamydia.
Chlamydia is treated in three ways: etiotropic pathogenetic and symptomatic.
The arsenal of agents for etiotropic therapy is currently expanding. Tetracyclines, macrolides, sulfanilamides are often used. Tetracyclines are effective for fresh, torpid urethritis, cervicitis, and ascending chlamydial infection. The course of treatment with tetracycline or oxytetracycline (0.5 g 4 times a day) lasts from 7-10 to 14-20 days. Tetracyclines are also used intramuscularly and intravenously tetracycline hydrochloride is prescribed intramuscularly in a dose of 50-100 mg in 3-5 ml of a 1-2% solution of novocoin 2-3 times a day for 10 days. With contraindications to tetracycline or with the development of side effects, macrolides are used (erythromycin, oleandomycin, oletetrin). Erythromycin is prescribed 250 mg 4 times a day for 21 days or 500 mg 2 times a day for 14-15 days. An effective concentration in the blood is achieved faster with the use of metacycline (rondomycin) and doxycycline (vibramycin). On the first day, 200 mg of the drug is prescribed in one dose, and then 100 mg once a day for 14 days. When treating with large doses of antibiotics (especially tetracyclines), dysbiosis often develops for a long time, therefore, antifungal drugs (nystatin, levorin) are simultaneously prescribed. In acute, chronic uncomplicated and complicated forms of chlamydia, a number of other antibiotics are currently used: doxycycline 100 mg 2 times a day for 7-14 days; azithromycin (sumamed), 500 mg on the first day and 250 mg in the next 9 days for complicated and chronic forms, 1.0 g once - for acute forms: ofloxacin (tarid) 300 mg 2 times a day for 7 days; pefloxocin (abactal) 600 mg once a day for 7 days; ciprofloxacin (cyprobate) on the first day 500 mg once, and then 250 mg 2 times a day for 7 days; lomefloxacin (maxaxquin) 600 mg once a day for 7 days; rifampicin on the first day 600 mg, then 300 mg 2 times a day for 7 days; rovamycin (spiramycin) 3 million ME orally 3 times a day for 10 days; clindamycin (distance C), 300 mg orally 4 times a day for 7 days or 300-450 mg 3 times a day for 7 days intramuscularly. Effective for chlamydial infections sulfonamides: sulfisoxazole 500 mg 4 times a day for 10 days; a combination of sulfamethoxazole (800 mg 2 times a day) and trimethoprim (160 mg 2 times a day), called "Bactrim", for 10-15 days; Trisulfapyrimidine 120 mg / kg per day for 10-20 days.
Treatment is more effective if pathogenetic and symptomatic agents are used along with the etiotropic. According to indications, painkillers, sedatives and stimulants are prescribed, as well as local procedures and, if necessary, surgical intervention.
Of particular importance is stimulating therapy using lycopid, pyrogenal, prodigiosan, decaris, methyluracil. Biogenic stimulants (aloe, vitreous, plasmol), autohemotherapy, etc. are also used. Of the desensitizing, antihistamines, diphenhydramine, suprastin are used. The appointment of proteolytic enzymes is recommended: oraza 1 teaspoon 3 times a day or vaginally Apilak suppositories; chymotrypsin 5-10 mg intramuscularly 1-2 times a day for 10 days; chymopsin for topical use only (25 mg in 10-20 ml of an isotonic solution on a swab to treat the urethra or bring to the cervix for 2 hours).
According to the testimony, it is possible to prescribe adaptogens (one of the following) ginseng tinctures of 20 drops 2-3 times a day; pantocrine 30-40 drops or 1-2 tablets 2-3 times a day; tincture of lemongrass 20-30 drops 2-3 times a day; Leuzea extract 20-30 drops 2-3 times a day; tinctures of Aralia 30-40 drops 2-3 times a day; liquid Eleutherococcus extract 20-30 drops 2-3 times a day; saparal at 0.05 (1 tablet) 2-3 times a day.
Local therapy is carried out in accordance with the topical diagnosis and the form of the clinical course of chlamydia. In acute processes, local manipulations, like a right-handed person, are not shown. They are suitable for acute and chronic course of the disease. For washing and processing of the cervical canal, vagina and urethra, potassium permanganate solutions, furatsilina, 2-3% solution of dimexide with tetracycline, 0.25% solution of silver nitrate, 2% solution of collargol or protargol are used. Effectively the use of a 10% solution of dibunol, which is introduced in the form of instillations and tampons (vagina, urethra, cervix). Dibunol liniment (10.0 g) is diluted in 25 ml of physiological solution of sodium chloride and used for instillations and tampons. Widely used in topical treatment of interferonogen IVS. It is introduced into the cervical canal in the form of ointment applications 1 time per day for 2-3 weeks (interferon 15 ampoules, petrolatum 90.0, lanolin 10.0). Also, in the form of ointment applications, leukocyte human interferon (50% of the drug in the ointment) is used for 2-3 weeks. It is more advisable to carry out complex treatment, including antibiotics, adaptogens, antihistamines and local treatment.
The cure criterion is the disappearance of clinical symptoms and the causative agent of infection. For evaluation, clinical, instrumental and laboratory methods are used after the end of treatment and every month for three months. The identification of the pathogen at these stages is an indication for a second course of treatment using other agents for both general and local use.
The prognosis for the timely diagnosis and treatment of chlamydial infection is favorable. Particular attention should be paid to women with chlamydial infection in the process of performing a generative function (chlamydia in pregnant and lactating women).
There is no specific prophylaxis for chlamydial infection. The basis for the prevention of chlamydia is organizational, general hygiene and anti-epidemic measures, which are the same as those for other sexually transmitted diseases. The treatment of patients, the rehabilitation of carriers and the implementation of personal protective measures help prevent the spread of chlamydia
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