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Urogenital chlamydia is one of the most common sexually transmitted diseases. Due to the peculiarities of the clinical course, the difficulties of diagnosis, often ineffective treatment and numerous complications, it represents a greater threat to reproductive health. Among women suffering from inflammatory processes of the genitals (non-neuropathic etiology), chlamydia is found 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 is chlamydia (Chlamidia trachomatis in humans and Chlamidia psitaci in mammals and birds), which together form the genus Chlamidia, representatives of which have a morphological similarity to bacteria and a unique cycle of reproduction. Chlamidia trachomatis has a number of serotypes (the most common D — K, as well as A, Ba, We, C, L1 — L3). In the development of chlamydia, immune processes play a large role. 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 with extra-sex (through underwear, hands). The prevalence of chlamydial infection among adolescent girls exceeds 10%, and among women 5%. In the age aspect, the peak of the disease falls on 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 - by the type of acute inflammatory processes. Therefore, isolated groups of patients with different clinical course. In the acute course of the disease, there is hyperemia of the mucous membranes of the urogenital tract, mucopurulent discharge from the vagina, frequent urination. The disease with a sluggish, protracted course is characterized by less severe symptoms, although mucopurulent discharge is noted. Women with these forms of the disease seek medical care 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 urogenital tract are not detected, even with careful examination. According to the localization of the lesion in women, chlamydia of the urethra, chlamydial bartholinitis, vaginitis, cervicitis, endometritis and adnexitis are distinguished.
Chlamydial urethritis is characterized by dysuric phenomena: itching, pain at the beginning of urination, frequent urge to urinate. There is an infection of the urethra, a small colorless discharge. Often, paraurethritis develops with hyperemia of the mouths of the paraurethral ducts, mucopurulent contents, squeezed out in the form of a drop. The eve of the vagina is also involved in the process, which is manifested by itching and burning of the vulva, secretion of mucus.
Bartholinitis chlamydial etiology is characterized by periodic discharge and itching in the region of the external genital organs, hyperemia in the mouth of the excretory duct of the gland. When it closes, a large cyst is formed with a clear liquid in the region of the large gland of the vestibule with infiltration of the surrounding tissues.
Chlamydial vaginitis (colpitis) is rare because chlamydia usually does not reproduce in a stratified squamous epithelium (but in a cylindrical epithelium). It can occur with hormonal disorders, accompanied by structural and morphological changes in the mucous membranes. More often a secondary process develops with maceration of the mucous membrane of the vagina, due to secretions from the higher regions of the genitals. Its clinical manifestations depend on the infection that joined.
Chlamydial cervicitis is often asymptomatic. Manifestations of the disease often caused by damage to other parts of the genitals. With the involvement of the cervical canal in the process, there is a mucopurulent discharge from it that macerates the vaginal part of the cervix. The latter becomes hyperemic with eroded sites,
Chlamydial etiology of endometritis is clinically manifested by general and local symptoms, as well as due to other pathogens.
Affection of the uterus appendages (tubes and ovary) is observed when the process is generalized from the lower parts. Chlamydia affect the inner surface of the tubes, the outer lining of the ovaries, possibly with the transition to the parietal peritoneum. Clinically, the disease is manifested by symptoms characteristic of acute or acute adnexitis: lower abdominal pain, lower back, fever, changes in blood (leukocytosis, accelerated ESR). On examination, enlarged, painful appendages are determined, more often on both sides. Chlamydial adnexitis has a tendency to a chronic, relapsing course, leading to obstruction of the pipes and infertility. With the development of chlamydial pelvioperitonitis, peritoneal symptoms occur, dyspeptic disorders are possible. Often the chronic course of chlamydial adnexitis goes into an acute process with the development of pelvioperitonitis after abortion, intrauterine interventions. It is believed that chl amidiosis of the urogenital tract is possible in children as well as in newborns as a result of infection during passage through the birth canal in sick women, and later in prepubertal and adolescent age. The most frequent localization of the process in girls is the urethra and the rectum. It is established that chlamydia in 20-25% of cases accompanies gonorrhea in women. There is also a combination of genital chlamydia with its extragenital forms (urinary tract, respiratory organs, eyes).
Venereal lymphogranuloma is caused by serotypes of chlamydia L1 — L3. The most common disease in South and Southeast Asia, Central and South America. Recently, thanks to all sorts of communication links, sporadic cases of the disease have been 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 the indication of chlamydia in affected cells, isolation of chlamydia, 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, immunoassay analysis, serological, microscopic and various methods of isolation of chlamydia.
Chlamydia treatment is carried out in three directions: etiotropic pathogenetic and symptomatic.
The arsenal of agents for etiotropic therapy is currently expanding. Tetracyclines, macrolides, sulfonamides are used more often. Tetracyclines are effective in fresh, torpidly flowing urethritis, cervicitis, and ascending chlamydial infection. The course of treatment with tetracycline or oxytetracycpine (0.5 g 4 times a day) lasts from 7-10 to 14-20 days. Tetracyclines are also used intramuscularly and intravenous tetracycline hydrochloride is administered intramuscularly in a dose of 50-100 mg in 3-5 ml of a 1-2% solution of novokoin 2-3 times a day for 10 days. For contraindications to tetracycline or for the development of side effects, macrolides (erythromycin, oleandomycin, oletetrin) are used. Erythromycin is prescribed 250 mg 4 times a day for 21 days, or 500 mg 2 times a day for 14-15 days. Faster effective blood concentrations are achieved using metacycline (rondomycin) and doxycycline (vibramycin). On the first day, 200 mg of the drug is administered at one time, and then 100 mg once a day for 14 days. In the treatment with large doses of antibiotics (especially tetracyclines), dysbacteriosis often develops for a long time, therefore antifungal drugs (nystatin, levorin) are also prescribed at the same time. 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 with complicated and chronic forms, 1.0 g once - for acute forms: ofloxacin (tarvid) 300 mg 2 times a day for 7 days; Pefloksotsin (abaktal) 600 mg 1 time per day for 7 days; Ciprofloxacin (Ciprobat) on the first day, 500 mg once, and then 250 mg 2 times a day, 7 days; lomefloxacin (maksakvin) 600 mg 1 time per day for 7 days; rifampicin on the first day of 600 mg, then 300 mg 2 times a day for 7 days; rovamycin (spiramycin), 3 million IU orally 3 times a day for 10 days; clindamycin (C-dosage) 300 mg orally 4 times a day for 7 days or 300-450 mg 3 times a day for 7 days intramuscularly. Effective with chlamydial infection 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; trisulfapirimidine 120 mg / kg per day for 10–20 days.
Treatment is more effective if, along with etiotropic, pathogenetic and symptomatic agents are used. According to the indications, painkillers, sedatives and stimulants are prescribed, as well as local procedures and, if necessary, surgery.
Of particular importance is stimulating therapy using licopid, pyrogenal, prodigiosan, decaris, methyluracil. Biogenic stimulants are also used (aloe, vitreous body, plazmol), autohemotherapy, etc. Of desensitizing, antihistamines, use dimedrol, suprastin. It is recommended the appointment of proteolytic enzymes: oraz 1 teaspoon 3 times a day or vaginal candles "Apilak"; chymotrypsin 5-10 mg intramuscularly 1-2 times a day for 10 days; himopsin for topical use only (25 mg in 10–20 ml of isotonic solution on a tampon for treating the urethra or leading to the cervix for 2 hours).
According to indications, it is possible to assign adaptogens (one of the following) of ginseng tincture, 20 drops 2-3 times a day; Pantocrin 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; extract of Eleutherococcus liquid, 20-30 drops 2-3 times per day; saparala 0.05 (1 tablet) 2-3 times a day.
Local therapy is carried out in accordance with the topical diagnosis and the clinical course of chlamydia. In acute processes, local manipulations, as right-handed, are not shown. They are appropriate for acute and chronic disease. Potassium permanganate, furatsilina, 2-3% solution of dimexide with tetracycline, 0.25% silver nitrate solution, 2% solution of collargol or protargol are used for washing and processing the cervical canal, vagina and urethra. Effectively using a 10% solution of dibunol, which is introduced in the form of instillations and tampons (vagina, urethra, cervix). Liniment dibunol (10.0 g) is diluted in 25 ml of physiological sodium chloride solution and used for instillations and tampons. Widely used in the local 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 is used (50% of the drug in the ointment) for 2-3 weeks. It is more expedient to conduct a comprehensive treatment, including antibiotics, adaptogens, antihistamines and local treatment.
The cure criterion is the disappearance of the clinical symptoms and the infectious agent. Clinical, instrumental and laboratory methods are used for evaluation after the end of treatment and every month for three months. Identification of the pathogen at these stages is an indication for re-treatment with other means for both general and local use.
The prognosis for timely diagnosis and treatment of chlamydial infection is favorable. Particular attention should be paid to women with chlamydial infection in the process of performing the generative function (chlamydia in a pregnant and lactating woman).
Specific prevention of chlamydial infection is not available. The basis for the prevention of chlamydia is in organizational, general hygiene and anti-epidemic measures that are the same as those for other sexually transmitted diseases. Treatment of patients, sanitation carriers and the implementation of measures for personal protection help prevent the spread of chlamydia
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