Chlamydia trachomatis in pregnant women. Chlamydia in the blood during pregnancy: causes, consequences and treatment. Source and routes of transmission of infection

It is important for expectant mothers to know whether chlamydia is dangerous during pregnancy, how to identify and treat it.

Sexually transmitted diseases are not only considered shameful, they manifest themselves with unpleasant symptoms, and are often quite difficult to treat. One of these is chlamydia. It affects the genitals, urethra, rectum, and eyes of men and women. In pregnant women, the infection poses a threat to the fetus and negatively affects the course of pregnancy and labor.

Causes of chlamydia in pregnant women

The causative agents of urogenital chlamydia are bacteria from the Chlamydia family. Most often this is the species Chlamydia trachomatis (Chlamydia Trachomatis), which is found only in humans
The disease is highly contagious, it is a sexually transmitted disease and affects the genitourinary system of both sexes
There is a special strain of infection that affects the human respiratory organs. Fortunately, respiratory chlamydia is extremely rare.

Chlamydia trachomatis

IMPORTANT: Chlamydia is one of the most common sexually transmitted diseases. According to statistics from the World Health Organization, 8 out of 100 people on earth are infected with Chlamydia trachomatis

Frequent companions of chlamydia are:

trichomoniasis
bacterial vaginosis
ureaplasma

Chlamydia trachomatis is transmitted in the following ways:

IMPORTANT: Chlamydia trachomatis is not persistent in the external environment; outside the human body, they die extremely quickly. Therefore, contact-household infection with chlamydia occurs in the rarest cases. If one partner is diagnosed with an infection, the other one should also be examined for its presence.

For infection to occur, Chlamydia trachomatis must enter the body in sufficient quantities. Small amount of infection the immune system can suppress a person.

Chlamydia trachomatis in women during pregnancy. Signs and symptoms of chlamydia in pregnant women

The incubation period of the disease is 1-3 weeks.

IMPORTANT: If a pregnant woman is diagnosed with chlamydia, this does not mean that she became infected with it in the recent past. Often the disease is hidden, its symptoms do not appear. A person lives and does not know that he is a carrier of Chlamydia trachomatis until he gets tested and receives a positive result.

Pain in the lower abdomen is a symptom of chronic chlamydia.

The symptoms of chlamydia depend on the form of the disease, which can be:

acute
chronic

The expectant mother may suspect that she has an infection in acute form if you find the following symptoms:

Vaginal discharge. They are usually abundant, mucous or purulent, with an unpleasant odor. A pregnant woman should be alerted to yellowish discharge
Itching in the perineum. The vagina (inside or at the entrance), urethra, vulva, rectum may itch
Pain when urinating. This symptom is present in many diseases of the urinary system, so it is not enough to make a diagnosis of genitourinary chlamydia

Chronic chlamydia manifests itself:

Pain in the lower abdomen. It occurs when the infection spreads to bladder or the uterus. This happens in every fourth carrier of Chlamydia trachomatis
Uterine bleeding
Increasing temperature

The effect of chlamydia on pregnancy: consequences

Chlamydia poses a danger to both the pregnant woman and the fetus.

IMPORTANT: The development of infection in a non-pregnant woman negatively affects the very possibility of conception. If inflammation in the uterus spreads to the fallopian tubes, adhesions may form in them. The risk of infertility or developing an ectopic pregnancy will increase significantly

For an expectant mother, infection with Chlamydia trachomatis is fraught with:

spontaneous termination of pregnancy early stages
infection of the membranes, the threat of its rupture or premature birth at a later date

IMPORTANT: Chlamydia is one of the reasons for the birth of premature babies

The infection has an extremely negative effect on the fetus:

intrauterine infection occurs in 40-70% of cases, which is why a child may be born with pneumonia and developmental defects nervous system, gastrointestinal tract, other organs and systems
chlamydia has a negative effect on the placenta, as a result of which the child does not receive enough oxygen and nutrients, therefore he is born with low birth weight and developmental delays
During childbirth, it is also possible for the newborn to become infected, which can cause problems with vision (conjunctivitis) and lungs (pneumonia)

How to get tested for chlamydia during pregnancy? Is it dangerous if you have chlamydia antibodies during pregnancy? Chlamydia in the blood during pregnancy

Fortunately, today the expectant mother undergoes detailed examinations, including for sexually transmitted infections that pose a danger to her and the child. Several times during pregnancy she takes a vaginal smear, and immediately after registering with the LCD, she undergoes a detailed test for infectious diseases.

IMPORTANT: In analyzes of the TORCH complex, chlamydia is encrypted under the letter “O” - others. If the detection of chlamydia in a specific laboratory is not included in this complex, the pregnant woman will be offered a separate test.

Bacteriological analysis of vaginal discharge makes it possible to identify Chlamydia trachomatis itself.
A blood test shows the presence or absence of class G antibodies to this bacterium.
If anti-chlamydia IgG is detected in the blood, this means that the pregnant woman either had chlamydia in the past or has it now.

IMPORTANT: Anti-chlamydia IgG is produced by the body 2-3 weeks after infection with the bacterium, rises to its highest limit at the peak of the disease, gradually falls as recovery occurs, but can persist for months, years or even a lifetime

VIDEO: TORCH - chlamydia

Chlamydia and ureaplasma during pregnancy

Often during pregnancy, a woman is diagnosed with both Chlamydia trachomatis and Ureaplasma
Ureaplasma, a specific bacterium that causes the disease ureaplasmosis, can exist in a woman’s body for many years without making itself felt.

But with the onset of pregnancy, the immune system of the expectant mother weakens, the bacterium can become more active, which will result in the appearance of:

specific vaginal discharge
itching and pain in the genital area

Ureaplasma

IMPORTANT: Due to the fact that ureaplasmosis in the vast majority of cases is asymptomatic and does not cause harm to the human body, scientists are beginning to say that Ureaplasma is not an absolutely pathogenic, but a conditionally pathogenic microorganism

If these two infections are detected in a pregnant woman, they are treated in parallel.

Chlamydia during pregnancy: treatment

Chlamydia detected during pregnancy is treated relatively simply. If a woman gets rid of the disease before giving birth, the risk of infection of the child will significantly decrease
As a rule, antibiotics for Chlamydia trachomatis are prescribed after the 19-20th week of pregnancy, when the fully formed placenta can protect the baby from them

Depending on the form of the disease and its severity, the course of antibiotic therapy for a pregnant woman will be 2-3 weeks
At the same time as the woman, her partner should also be treated to prevent re-infection.
Along with taking antibiotics, a pregnant woman will need to undergo sanitization of the genital tract in order to cure pulpitis, endocervicitis, and other inflammatory diseases of the female genital organs caused by chlamydia.

IMPORTANT: Thrush can be a companion to chlamydia. Then it is necessary to treat both bacterial and fungal sexually transmitted infections

The prognosis of timely identified and adequately treated chlamydia is good, pregnancy proceeds normally, and the child is born healthy.

VIDEO: Live healthy! Chlamydia

Who will he look like, choose a name and look for suitable things for him - what could be better and more pleasant? It would seem that nothing should overshadow the future joys of motherhood, and then suddenly we hear the word from the doctor - chlamydia. And what is this?

It was revealed that approximately 70% of patients with chlamydia have either a blurred, nonspecific generality of symptoms, or no external signs of the disease at all.

Unfortunately, chlamydial infection is widespread, and its incidence is high, including in Russia. In pregnant women, this disease is found with a frequency of 10 to 40% of cases.. When a pre-existing disease is detected, cases of fetal infection occur in approximately 50–70%. Chlamydia, initially located in the cervical canal, successfully moves to the fallopian tubes and the surrounding endometrium, directly provoking the onset of salpingitis along with endometritis.

In the future, this leads to the development of pathological pregnancies and tubal infertility. Chlamydial disease that continues during pregnancy can lead to premature birth, death, and malnutrition of the developing fetus. Identification of chlamydia already present during pregnancy occurs through the appointment of routine tests, therapy is immediately prescribed, so that by the time childbirth occurs and the start of breastfeeding, chlamydia should already be cured.

How dangerous is this for a woman and child in the early and late stages (1st, 2nd, 3rd trimesters). Possible complications and consequences

Chlamydia found in sick women is accompanied by various complex disorders of childbearing function and multiple diseases, namely: various diseases pelvic organs, chronic miscarriage, ectopic pregnancies.

Children born to patients with chlamydia, with a frequency of 40 to 60%, have various manifestations of a previous chlamydial infection, because chlamydia most likely affects the intrauterine development of the child, the outcome of subsequent births, and the subsequent postpartum period.

Mycoplasmas and other opportunistic bacteria, which include chlamydia, exhibit their pathogenic properties in certain conditions - in the presence of a high level of contamination of the genitourinary tract, as well as reduced activity of the woman’s immune system, as well as any other infections.

The latent, non-manifest course of IUI (intrauterine infection) rarely leads to serious consequences for the mother herself during pregnancy, however, for the child, infection becomes very dangerous due to the possible onset of various lesions brain and cerebral hemorrhages, necrotizing enterocolitis, bronchopulmonary dysplasia, infant mortality and childhood disability.

In women who experience chlamydia in the early stages of pregnancy (during the first trimester), disturbances in the development of the embryo are detected, which subsequently lead to congenital malformations in the development of the fetus, as well as placental insufficiency. During pregnancy, violations lead to spontaneous miscarriages, or to frozen pregnancy.

In the future, for more later pregnancy (I and I I trimester), complicated by current chlamydia, there are: disturbances in the production amniotic fluid, threat of spontaneous abortion, further offensive placental insufficiency, as well as premature birth.

Causes of chlamydia in pregnant women. Mechanism of infection and development factors. At-risk groups

In the process of infection with chlamydia, the source of the active pathogen becomes a person suffering from an acute or chronic form of the disease with a clear or faded course of the disease. The most common method of transmission of infection is sexual, as well as vertical and household contact (extremely rare).

Due to the similarity of the routes of infection of various sexual diseases, together with chlamydia, there is a risk of getting other microorganisms, for example, gonococci, myco- and ureaplasmas, trichomonas, etc.

Due to the fact that the principle of the spread and transmission of chlamydia is not fully understood, it is roughly divided into five stages:

infection and damage to mucous membranes
primary local infection
further spread of microorganisms with damage to epithelial cells and possible appearance of external symptoms of the disease
decreased general immunity and the appearance of associated conditions;
the appearance of symptoms of consequences, with the appearance of changes in different organs and their systems. Along with an acute infection, the development of a chronic process may begin.

The type of development and course of the disease directly depends on the patient’s level of immunity, the number of pathogen cells present and many other reasons and factors. Complications when suffering from chlamydia will most likely be observed together with serious disorders of general immunity.

People with a high risk of contracting STDs are the first to be at risk. These are patients who have a large number of sexual partners, who have previously suffered from or are already suffering from various sexual diseases. The largest number of patients with urogenital chlamydia are ordinary young women.

External manifestations and development of the clinical picture of chlamydia

Asymptomatic and latent chlamydia is more often observed in women (about 80%). Acute course of the disease during pregnancy is found quite rarely; chronic is much more common, during which constant growth and release of the pathogen continues, but external symptoms of the disease may be absent.

Still, possible manifestations:

Dryness and burning
Redness
Medium mucous discharge

Thus, there are no signs clearly characterizing the disease, and those listed above do not cause concern even if they appear.

Inflammation of the vagina during chlamydia is not common, but its development is detected if there is pathological activity in the production of hormones during pregnancy.

Diagnostics, methods and methods. Tests and procedures

Dr. Komarovsky about chladymiosis

Dr. Komarovsky about chladimiosis, mycoplasmosis and ureaplasmosis.

Nowadays the most in effective ways Diagnosis of genitourinary infections is considered a combination of the PCR method and various cultural methods.
For a correct diagnosis and subsequent diagnostic monitoring of treatment, it is necessary to have (preferably at least two) different diagnostic methods.

In women, during examination, material for analysis is taken with a special brush from the cervical canal only after the mucous plug present in it is removed.

Taking material for laboratory testing from the urethra, in addition to the analysis already taken from the cervical canal, is necessary when trying to establish the characteristics of the current infectious process and helps to increase the likelihood of finding an infection.

Treatment (antibiotics, enzymes, folk remedies, etc.)

The need for immediate treatment of chlamydia in pregnant women, especially if it could not be carried out before pregnancy, is not in doubt among doctors. A naturally necessary condition that must be observed when choosing proper therapy for pregnant women is strict adherence to medical recommendations.

In general, any assignments medicines in modern medical practice must comply with these principles, but in cases of treating pregnant women, these requirements must be observed without fail - to avoid serious consequences.

Antibiotics

It is the intracellular presence of chlamydial organisms that leads to the use of antibiotics that have the ability to penetrate into cells, accumulate inside them and stop intracellular protein synthesis.

During pregnancy, the list of available medications is always very limited. In this case, most often, therapy for ascending genitourinary chlamydia is long-term (from 10–14 days); It is also necessary to determine the sensitivity of the infection to antibiotics in each case.

Eubiotics

When intestinal dysbiosis manifests itself, in addition to the existing difficulties of treatment, the infectious process enters into an even more protracted course, and this, in turn, requires repeated courses of antibiotics and, as a result, further aggravates the dysbiosis. When preventing intestinal dysbiosis, various eubiotics are used: Bifidumbacterin, Lactobacterin and others during antibiotic therapy, as well as for at least 10 or more days after it ends.

During the course of therapy, regular local treatment of the vagina with various disinfectants is necessary. Upon completion of taking antibiotics, correction of the composition of the vaginal flora is also necessary. In such cases, various antifungal drugs, such as fluconazole, can be used to prevent candidiasis.

Along with antibacterial therapy, it is desirable to use enzymes (Wobenzym), and various adaptogens (tinctures of eleutherococcus, radiola, as well as lemongrass or ginseng, echinacea and others), courses of multivitamins and antihistamines in order to maintain the patient’s immunity at an optimal level.

Approximate regimen for taking adaptogens:

Taking pharmaceutical tinctures should start with 5-10 drops, strictly in the morning. The next week, add another 5 drops and so on until the maximum is reached - 30 drops. The maximum long-term use is a month, after which you need to take a break of at least 10 days.

Restoring immunity with the help of folk stimulants is a logical and correct addition to treatment, but in no case is it a replacement!

Does the disease affect the method of delivery? Where do women with chlamydia give birth?

In the vast majority of cases, chlamydia detected during pregnancy has already been cured by the time of birth, and delivery should be carried out in the observation department of the maternity hospital.

If chlamydia is completely cured, the next pregnancy after the current one is planned in as usual, taking into account the woman’s health after childbirth and the method of her delivery (natural birth or cesarean section).

Prevention

Prevention of genitourinary chlamydia does not differ significantly from the prevention of other STDs. This is, of course, a complete and certainly timely cure of patients and carriers of the pathogen who do not have external manifestations of the disease, a thorough examination of their partners, the presence of mandatory preventive treatment, additional use of barrier contraceptives, and sanitary work among the population.

Chlamydial infection is a disease belonging to the group of STIs, characterized by multifocal lesions involving the genital organs, and sometimes joints, the organ of vision and the respiratory tract in the inflammatory process.

SYNONYMS

Chlamydia; urogenital chlamydial infection.
ICD-10 CODE
· A55 Chlamydial lymphogranuloma (venereal).
· A56 Other chlamydial sexually transmitted diseases.
· A56.0 Chlamydial infections of the lower genitourinary system.
· A56.1+ Chlamydial infections of the pelvic organs and other genitourinary organs.
· A56.2 Chlamydial infection of the genitourinary system, unspecified.
· A56.3 Chlamydial infection of the anorectal area.
· A56.4 Chlamydial pharyngitis.
· A56.8 Chlamydial sexually transmitted infections, other localization.

EPIDEMIOLOGY

Chlamydial infection occupies one of the first places in the structure of all STIs.

According to the observations of European researchers, 80% of cases of acute inflammatory processes in the pelvic organs develop as a result of STIs, 60% are caused by Chlamydia trachomatis.

The prevalence of urogenital chlamydia varies widely among different age groups of the population in different regions of the world, but everywhere this disease is recorded much more often than gonorrhea. Such a wide spread of the disease is facilitated by the existing changes in people’s sexual behavior observed in recent decades: early entry into sexual activity, frequent change of partners, use of oral contraceptives, reducing fear of pregnancy, high population mobility and numerous contacts. The slow development of clinical manifestations of the disease, often the complete absence of pronounced symptoms, lead to a delayed visit to the doctor or to an accidental diagnosis during examinations, especially during pregnancy. Asymptomatic infection occurs, depending on the location, with a frequency of up to 80%.

The consequences of genital chlamydia in the form of chronic inflammatory diseases of the uterine appendages, tubal infertility, ectopic pregnancy in women, as well as the adverse effect of chlamydial infection on the course and outcome of pregnancy for the mother and fetus are one of the main problems in the structure of urogenital and systemic diseases, all of which affects reproductive function of women. Since 1994, chlamydia in Russia has been classified as a group of diseases subject to mandatory statistical recording.

CLASSIFICATION OF CHLAMYDIOSIS

· Chlamydial infection of the lower genital tract.
· Chlamydial infection of the upper genital tract.

ETIOLOGY (CAUSES) OF CHLAMYDIOSIS

Damage to the genital tract is caused by the species Chlamydia trachomatis, belonging to the order Chlamydiales, family Chlamydiaceae, genus Chlamydia. The source of infection for urogenital chlamydia is a person with acute or chronic form diseases, with manifest or asymptomatic course of the process.

The main routes of transmission of infection are sexual, household contact (rare), vertical (from mother to fetus during childbirth or antenatally). Due to the common routes of transmission of pathogens in STIs, chlamydia is often found in association with other microorganisms, such as gonococci, Trichomonas, mycoplasma, ureaplasma, etc.

PATHOGENESIS

Chlamydia has a pronounced tropism for columnar epithelium, lining the mucous membrane of the urethra, cervical canal, rectum, conjunctiva of the eyes and the nasopharynx. However, like gonococcus, chlamydia can affect the vulva in newborn girls, as well as the vaginal vault in women after hysterectomy.

Infection occurs with the elementary bodies of chlamydia. Reticular bodies do not have such properties.

Adhesion of elementary bodies on the host cell membrane and their penetration inside is the first stage of interaction between chlamydia and the cell. Penetrating into the cell, chlamydia turns off its most important protective mechanism, preventing the fusion of the lysosome with the phagocytic vacuole. Elementary bodies are introduced into the cell by pinocytosis (phagocytosis), protected from destruction by the phagosomal membrane. Several elementary bodies can be present in a cell at the same time, i.e. There may be several microcolonies of chlamydia in the cytoplasm of cells. Being in the endoplasmic vacuole (endosome), elementary bodies are successively transformed through the stage of intermediate bodies into reticular bodies, which, in turn, undergo binary fission.

Subsequently, upon completion of the period of growth and division, the reticular bodies undergo reverse transformation into elementary bodies. Newly formed elementary bodies leave the cell, destroying it, and infect new cells.

The complete intracellular development cycle when studied in vivo lasts 48–72 hours and depends on several factors, in particular the chlamydia strain, the nature of the host cells and environmental conditions. Outside the body, chlamydia loses its infectious properties after 24–36 hours when room temperature, die from ultraviolet radiation, boiling, action of disinfectants. At the same time, the possibility of maintaining the infectivity of contaminated material for up to two days at a temperature of 18–19 °C has been established.

The study of the immune response to this infection has shown that many complications are combined with severe disturbances of immunoregulation. The immune response to chlamydia is diverse and is characterized by the production of IgM, IgG, secreted IgA, inflammatory mediators - cytokines, such as interferon, IL-1, IL-4, IL-6, tumor necrosis factor and many others. In addition to hyperimmunoglobulinemia, polyclonal activation of B lymphocytes and the HRT response play an important role in the pathogenesis of chlamydial infection. In this case, chlamydia are absorbed by peripheral phagocytes. Monocytes settle in tissues for a long time, turning into tissue macrophages, and the chlamydia found in them becomes an antigenic stimulator. The type of development of the disease depends on the state of the person’s immunity, the severity of the infection, the pathogenicity and virulence of the infectious agent and many other reasons.

Complications of urogenital chlamydia are most often combined with severe immunoregulation disorders, in particular with a decrease in the number of T-lymphocytes, T-helper cells, and a deterioration in the patient’s interferon status. Research in recent years has established that the presence of chlamydia is accompanied by a violation of the functional activity of universal regulatory systems (immune, antioxidant, endogenous opiate, cyclic nucleotides, PGs, leukotrienes), which ultimately leads to chronicity of the process and many serious complications. Along with acute infection, a chronic process may develop.

Special attention of specialists in last years was devoted to the study of the persistence of chlamydia. In persistent forms, not only the morphology is changed, but also the expression of the main chlamydial Ags: a decrease in the synthesis of the main cellular components that impart special strength to the cell wall: lipopolysaccharides and MOMP (Mayor Outer Membrane Protein, a cell wall protein weighing 60 kDa) was found. Against this background, there is a continuous synthesis of heat shock protein with a molecular weight of 60 kDa. This protein plays a major role in the immunopathogenesis of persistent infection and the maintenance of a persistent inflammatory response. The presence of heat shock protein leads to: · antigenic overload of the body and the launch of a secondary humoral response with hyperproduction of IgG and IgA; · activation of a delayed-type hypersensitivity reaction, causing infiltration of mucous membranes by lymphocytes and monocytes; · triggering an autoimmune cross-response, since the heat shock protein is similar to eukaryotic proteins; · the effect of “heat shock” in the host cell, stimulation of the development of a stress reaction in the microorganism with arrest of the cell cycle at the stage of reticular bodies.

Activated macrophages also produce TNF-a, which indirectly through IL-1 activates the proliferation of principal cells connective tissue, promotes fibrin formation, and also increases the adhesive ability of lymphocytes in relation to the vascular endothelium and reactivates macrophages.

Thus, the main mechanism preventing the redifferentiation of reticular bodies into elementary bodies is the action of a special spectrum of cytokines, leading to a deficiency of components and/or blockade of the synthesis of proteins of the outer membrane of the elementary bodies of chlamydia under the influence of factors contributing to the formation of persistent forms.

Pathogenesis of gestational complications

The consequences of chlamydia in pregnant women manifest themselves in the form of chronic inflammatory diseases of the genitourinary tract, cervix, pregnancy pathology with possible infection of the fetus.

Most often, an ascending infection develops from the lower parts of the genitourinary organs with infection of the OB and the development of chorioamnionitis. Aspiration or ingestion of infected agents leads to lung infection, digestive tract fetus with the development of an infectious process even before the birth of the child. This can occur both with PROM and with intact membranes, for example, during the birth of a child through CS surgery.

Infection of the fetus with chlamydia occurs both in utero (antenatally) and through contact with an infected birth canal during childbirth (intranatally).

CLINICAL PICTURE (SYMPTOMS) OF CHLAMYDIOSIS IN PREGNANT WOMEN

From 5% to 13% of pregnant women in cities are infected with chlamydia; in 4–11%, genital chlamydia is asymptomatic. Because the clinical symptoms, pathognomonic for genital chlamydia, including in pregnant women, does not exist; its frequency must be assessed on the basis of laboratory data on the detection of chlamydia in the cervical canal.

The progression of pregnancy in the presence of urogenital chlamydia without adequate treatment increases the number of perinatal complications and diseases of the newborn. The highest rates of preterm pregnancy were observed in those women whose blood serum contained IgM to chlamydial Ag, and C. trachomatis was found in the cervical canal of the uterus, which indicates a fresh active infection. The presence of IgG in the absence of IgM in the blood serum and the absence of C. trachomatis in the cervical canal of the cervix indicates an inactive form of infection and a certain degree of immunological protection of the body, and, accordingly, a lesser degree of influence on the fetus.

Possible complications pregnancy:

· premature birth;
· spontaneous miscarriages;
· non-developing pregnancy.

The most common clinical form of genital chlamydia in pregnant women, as well as in non-pregnant women, is cervicitis, but in pregnant women this disease is more difficult to clinically diagnose. Special attention pregnant women suffer from acute urethral syndrome, often associated with chlamydial lesions of the cervix and urethra.

Endometritis occurs in the postpartum or post-abortion period. In an acute process, the temperature rises to 38–39 °C, pain in the lower abdomen, and copious mucopurulent discharge from the cervical canal appear. Possibly chronic course endometritis without pronounced clinical symptoms.

The frequency of infection of a newborn with a diagnosed infection in the mother reaches 40–70%. During childbirth, chlamydia is transmitted through direct contact of the fetus with an infected birth canal. In newborns and young children, chlamydia most often affects the conjunctiva and nasopharyngeal mucosa. In this case, conjunctivitis, nasopharyngitis and pneumonia develop. In some cases, chlamydia causes gastroenteritis, proctitis, vulvitis in girls, and urethritis in boys.

DIAGNOSIS OF CHLAMYDIOSIS DURING PREGNANCY

Due to the fact that the clinical manifestations of chlamydia are not pathognomonic, asymptomatic forms of the disease are widespread, laboratory methods are of paramount importance in the diagnosis of these infections.

The following are subject to examination for chlamydial infection:
· women with mucopurulent discharge from the cervical canal, symptoms of adnexitis, infertility;
· persons who have had sexual contact with a patient with chlamydial infection;
· persons undergoing screening for other STIs;
· newborns from mothers who have had a chlamydial infection during pregnancy.

Factors and risk groups for developing the disease:
· prostitution;
· sexually active teenagers and women under 25 years of age;
· previous STIs;
· contact with a patient with chlamydial infection or with symptoms of urethritis/cervicitis.

PHYSICAL INVESTIGATION

When examined in the mirrors, signs of cervicitis can be detected. In some cases, there are no clinical manifestations of the disease.

It is recommended to examine the ducts of the paraurethral glands, and if there are symptoms of mild inflammation, pain or burning sensation when urinating, prescribe a test for chlamydia. As a rule, the urine of such women contains leukocytes and does not contain bacteria, so pyuria in pregnant women in the absence of bacteria in the urine is very suspicious in terms of chlamydia, described in the literature under the name acute urethral syndrome.

LABORATORY RESEARCH

The material studied in women is scrapings of the mucous membranes of the genitourinary organs (urethra, cervical canal of the cervix), in extragenital forms - scrapings from the rectum, conjunctiva, oropharynx.

The quality of the obtained clinical material depends on the physiological state of the patient at the time of collection.
sample. Clinical material can be the most informative if it is obtained under the following conditions:
· swabs taken if available clinical signs diseases;
· the patient has not used local therapy for at least the last 48–72 hours;
· the patient did not shower for 24 hours;
· the patient has not taken systemic antibacterial drugs over the past 3–4 weeks.

If it is not possible to adhere to the mentioned conditions, then it should be remembered that all of them can affect the quality of the study and distort its results.

Clinical material can be obtained using a Volkmann spoon, a special brush or a cotton/Dacron swab. In all cases, preference should be given to Dacron tampons.

When performing surgical interventions, it is possible to study surgical materials (endometrium, fallopian tubes, adhesions, peritoneal fluid, etc.).

In newborns, discharge from the conjunctiva, nasopharynx, and vulva in girls and the first portion of urine in boys are usually examined. In case of death of children, sectional materials (trachea, lungs, liver, spleen, etc.) can be examined.

Diagnostic methods such as cell culture, PIF, PCR, ELISA are used to study materials obtained from the cervical canal, urethra, rectum, nasopharynx, conjunctiva, biopsy and surgical materials. To study the first portion of urine and vaginal discharge, only the PCR method is used.

Among the methods laboratory diagnostics One can distinguish methods for determining the pathogen and its Ag, as well as methods for detecting a specific antibody response to C. trachomatis.

Pathogen detection methods
· PIF reaction using monoclonal antibodies labeled with fluorescein isothiocyanate.
· Molecular biological methods:
- DNA hybridization;
- real-time PCR;
- NASBA in real time, etc.
· Cultivation of the pathogen on cell culture (McCoy, HeLa-229, L-929, etc. lines). This method can be used to determine the sensitivity of chlamydia to antibiotics. PIF: the method is relatively simple and available to almost any laboratory. The sensitivity and specificity of the method depend on the quality of the luminescent antibodies used. Due to the possibility of obtaining false positive results, the PIF reaction cannot be used for forensic examination. In addition, this method is not recommended for studying materials obtained from the nasopharynx and rectum.

Nucleic acid amplification methods are highly specific and sensitive and can be used for screening, especially for the study of clinical materials obtained non-invasively (urine, ejaculate).

The specificity of the methods is 100%, sensitivity is 98%. These methods do not require preservation of the viability of the pathogen, but it is necessary to follow strict requirements for the conditions of transportation of clinical material, non-compliance with which can significantly affect the result of the analysis. These methods include PCR and real-time PCR. A new and promising method - NASBA (Nucleic Acid Sequence-based Amplification) in real time allows you to determine a viable pathogen and replace the cultivation method.

Cell culture is a priority method for laboratory diagnosis of chlamydial infection, especially for forensic examination; it is more specific than PIF and is indispensable in determining whether chlamydia is cured, since other methods can give distorted results. However, the sensitivity of the method remains low - within 40–60%.

A test to determine the sensitivity of chlamydia to antibiotics is not practical. Due to low sensitivity, ELISA is rarely used to detect chlamydia Ag. Methods for detecting a specific immune response are serological studies that can determine IgM, IgA, IgG to chlamydial Ags, which is especially important for diagnosing chlamydia in ascending infections (salpingitis, salpingoophoritis, pelvioperitonitis, perihepatitis).

Serological methods (microimmunofluorescence, immunoenzyme) have limited diagnostic value and cannot be used to diagnose urogenital chlamydial infection and, especially, to monitor cure. Detection of IgM can be used to diagnose pneumonia in newborns and children in the first three months of life. When examining women with PID, the detection of a 4-fold increase in IgG titer when examining paired blood sera is considered diagnostically significant. An increase in the concentration of IgG to chlamydia (to serovars D–K) is the basis for examining the patient to exclude lymphogranuloma venereum.

The diagnosis of cervicitis is established based on the detection of two criteria simultaneously: mucopurulent discharge from the cervical canal and the number of polymorphonuclear leukocytes in the material from the cervical canal, exceeding 10 in the microscope field of view at a magnification of 1000 times (when viewing at least five fields of view).

The diagnosis of urethritis in women is established based only on laboratory data: the presence in the material obtained from the urethra of more than 10 polymorphonuclear leukocytes in the field of view of a microscope at a magnification of 1000 times (when viewing at least five fields of view).

DIFFERENTIAL DIAGNOSTICS

Differentiate with similar diseases of non-chlamydial etiology (gonococcal, trichomonas, nonspecific infection).

EXAMPLE OF FORMULATION OF DIAGNOSIS

Chlamydial cervicitis.

TREATMENT OF CHLAMYDIOSIS IN PREGNANCY

TREATMENT GOALS

· Eradication of the pathogen.
· Disappearance of symptoms of the disease.
· Prevention of complications.

Since Chlamydia trachomatis is a pathogenic microorganism, and urogenital chlamydial infection is classified as an STI, the prescription of antibacterial drugs for treatment is mandatory. Antibacterial therapy is carried out regardless of whether clinical manifestations of the disease exist or not. Antibacterial therapy for urogenital chlamydial infection in the first trimester of pregnancy is undesirable. Treatment is prescribed after 12–16 weeks of gestation.

DRUG TREATMENT OF CHLAMYDIOSIS DURING PREGNANCY

If chlamydia is detected in pregnant and lactating women, one of the following drugs is prescribed:
Erythromycin 500 mg orally four times a day for 7–10 days;
Amoxicillin 500 mg orally every 8 hours for 7–10 days;
· josamycin orally 500 mg twice a day for 10 days.

Alternative schemes:
Azithromycin orally 1.0 g once;
· spiramycin orally, 3 million IU three times a day for 10 days.

Compared to erythromycin, it is preferable to use josamycin or amoxicillin, since they have less side effects and more effective.

Attention! Erythromycin estolate is contraindicated during pregnancy. It was previously thought that azithromycin, josamycin, and spiramycin should be prescribed cautiously to pregnant women, but there is evidence from many experts about the safety of these drugs during pregnancy.

For chlamydia in newborns and infants, treatment is carried out with the following drugs.
· In the first week of life:
- with body weight<2000 г - эритромицин 20 мг/кг в день внутрь в равных дозах не менее 14 дней;
- for body weight >2000 g - erythromycin 30 mg/kg per day orally in equal doses for at least 14 days.
· From 1 week to 1 month of life:
- erythromycin 40 mg/kg per day orally in equal doses for at least 14 days.

PREVENTION AND PREDICTION OF GESTATION COMPLICATIONS

Timely antibacterial treatment of chlamydial infection.

FOLLOW-UP

· Identifying sexual contacts is mandatory and important.
· Treatment of the sexual partner is mandatory.
· Registration: send an emergency notification to the KVD using form 089/ukv.

INDICATIONS FOR HOSPITALIZATION

If complications develop, treatment is carried out in specialized hospitals of dermatovenerological, obstetric-gynecological, and rheumatological profiles. The duration of inpatient treatment is determined by the nature of the clinical manifestations and the severity of the inflammatory process and ranges from 2 to 6 weeks.

ASSESSMENT OF TREATMENT EFFECTIVENESS

INFORMATION FOR THE PATIENT

· Patients should be warned that if they have a urogenital chlamydial infection, they can infect a sexual partner. Search and examination of sexual contacts is carried out depending on the clinical manifestations of the disease and the expected duration of infection (from 15 days to 6 months).

· Treatment of the patient and her sexual partner is a prerequisite for preventing the spread of infection. Patients should be informed that with inadequate treatment, complications may develop in the form of an ascending infection of the pelvic organs, and during pregnancy, premature termination of pregnancy, as well as infection of the fetus and newborn, is possible.

· If chlamydia is diagnosed in a pregnant woman, a woman in labor, or a woman in labor who has not received timely treatment, the newborn is examined and material is taken from the conjunctival sacs of both eyes. If a chlamydial infection is detected in a newborn, its parents are examined.

· Perinatally acquired C. trachomatis can persist in a child up to 3 years of age.

During the process when the expectant mother is expecting the birth of her baby, she may encounter big amount dangers.

Unfortunately, it is during this period that a woman’s body becomes most vulnerable, so the expectant mother can expect ailments that she did not previously know about.

One of these serious diseases is chlamydia during pregnancy. The consequences for the child can be different, it all depends on the nature of the disease and the characteristics.

The disease is insidious in nature; based on studies, it has been shown that the presence of this disease has the worst effect on the state of the reproductive system.

There is a high probability of infertility.
Opportunity .
Termination of pregnancy.

In connection with these threats, it is necessary to promptly investigate and identify the disease in order to be able to prevent the disease.

General information about the disease

The advantage for pregnant women is that there is no negative impact on the health of mother and baby.

Before making such a decision, it would be a good idea to consult a specialist to prevent possible risks.

Garlic infusion. This natural antibiotic has excellent antibacterial properties for many years. The infusion is taken in the amount of a teaspoon and diluted with honey and water and used for douching.
Douching infusion of calendula flowers will help you avoid negative consequences illness during an “interesting situation”. The duration of the douching course is 10 days.

Some means traditional medicine are used for oral administration, but in pregnant women they can cause heartburn and stomach problems.

Disease prevention

We have looked at how chlamydia (chlamydia) affects the fetus; it remains to take into account preventive measures designed to help avoid the disease.

It is also necessary to visit your doctor in a timely manner and take the necessary tests on time; it is this approach that will allow you to achieve amazing results in terms of treating the disease.

Chlamydia during pregnancy, which has a great impact on the fetus, must be eliminated quickly enough, otherwise it will cause you a lot of inconvenience.

With a competent approach to therapy, the result will pleasantly surprise and delight you.

In contact with

Chlamydia is one of the infectious diseases that are sexually transmitted.

This disease provokes the development of an inflammatory process in the organs of the genitourinary system. Often during pregnancy the disease is asymptomatic, but, nevertheless, can cause complications during pregnancy or childbirth.

Against the background of a physiological decrease in immunity, the likelihood of infection increases, as well as the activation of chronic infections, so a woman may develop acute chlamydia during pregnancy. The consequences for the child, as well as for the mother, depend on the extent of the disease.

The clinical symptoms of the disease can vary significantly. The following variants of the course of chlamydia during pregnancy are possible:

Chronic, persistent infection. This variant is characterized by asymptomatic carriage of the infection with periodic development of exacerbations.
Acute chlamydia.
Asymptomatic carriage of chlamydia.

Also, the clinical picture of the disease directly depends on which part of the genitourinary area is involved in the inflammatory process. When the lower parts are involved, the disease proceeds through the clinical variant of urethritis and vulvovaginitis. Patients note the development of pain, itching and burning when urinating, as well as the appearance of pathological discharge.

Symptoms of erosion and pseudo-erosion of the cervix are represented by pathologically increased bleeding and the appearance of bloody discharge from the genital tract.

In case of inflammation of the cervical canal, appendages and uterine wall, women note painful sensations lower abdomen, lower back, as well as pain during sexual intercourse. Often the inflammatory process leads to an increase in temperature, general weakness and an increase in symptoms of intoxication. Chlamydia, which develops during pregnancy, can lead to a number of complications in the mother's body.

Most often the disease provokes the development of:

Pseudo-erosion or true erosion of the cervix. With the development of genital infections in women, the causative agent of the disease penetrates the cervix and stimulates the formation of erosive defects. Further, the erosion itself becomes the entrance gate for the further spread of the disease in various ways (hematogenous, lymphogenous, contact).
Endometritis (inflammation of the endometrium of the uterus).
Salpingo-oophoritis (inflammation of the fallopian tubes and ovaries).
Chlamydial urethritis. The mucous membrane of the genitourinary system is the most favorable place for the proliferation of chlamydia at one of the stages of the life cycle of the pathogen. Therefore, chlamydial urethritis is a common complication chlamydia during pregnancy and can lead to the development of undesirable consequences during pregnancy and for the child.
Cervicitis (inflammation of the cervical canal). The development of the inflammatory process is very often due to the previous formation of erosive defects.
Colpitis (inflammation of the vaginal mucosa).

Consequences of chlamydia for the fetus

Considering that the disease can lead to complicated childbearing, chlamydia should be diagnosed as early as possible during pregnancy. The consequences for the child include infection of the respiratory system, pneumonia, chlamydial conjunctivitis and otitis.

Chlamydia can provoke the development of placental insufficiency. This pathological condition leads to the development of oxygen starvation of the fetus (hypoxia). Therefore, after birth, the child may lag behind in physical and psycho-motor development. Often parents focus on the fact that the child is lethargic, often gets sick and does not do well at school.

Chlamydia during pregnancy leads to serious consequences for the child, so treatment should be prescribed during pregnancy. The main thing in conservative therapy is the prescription of antibacterial agents. It is very important to use only those medications that do not pose a risk to the child’s health. The administration of immunomodulatory drugs is effective. With timely and high-quality treatment of the disease, it is possible normal course both current and subsequent pregnancies.

While carrying a child, a woman’s body is weakened by the course of the infectious process. Therefore, pregnancy can be considered aggravated by a concomitant disease.

Due to the negative impact of chlamydia on the mother, fetus and pregnancy, there is a high risk of developing:

Spontaneous abortion (miscarriage).
Premature birth.
Development of placental abruption.
Premature rupture of fruit membranes.
Polyhydramnios.
Weaknesses of labor.
Prematurity.

Also, chlamydia during pregnancy is dangerous because during the passage of the fetus through the birth canal, the child can become infected with this infection. This is due to the fact that the baby’s immunity is not sufficiently developed to resist the disease. In order to prevent the development of this disease You should plan your pregnancy and undergo a timely examination by a gynecologist.

It is recommended to conduct an examination of all those in contact with a patient with chlamydia, as well as all women after termination of pregnancy and childbirth. Medical workers sanitary and educational work should be carried out, since every woman who is sexually active should know the dangers of chlamydia during pregnancy.