Clamidiosis at women
Clamidiosis at women — the urogenital venereal disease caused by hlamidiya. More than in half of cases proceeds asymptomatically. At a manifest current or a recurrence of the patient can complain of an itch to a vagina, gripes at an urination, mucous or it is purulent - mucous bleach, hurt in the bottom of a stomach, a waist, inguinal area. At a long persistirovaniye of a disease of the only symptom of clamidiosis there can be infertility. For diagnostics use gynecologic survey and laboratory methods of a research. The scheme of treatment includes etiotropny antibiotics, antimikotichesky, eubiotichesky and immunomodulatory medicines.
Clamidiosis at women
Clamidiosis is the most widespread disease, sexually transmitted. Annually in the world register more than 105 million new cases of an urogenital chlamydial infection. The disease is revealed at 30-50% of patients with inflammatory damage of genitals and at 10-40% of the pregnant women taken on the account. Usually women at the age of 16-25 years catch. In recent years pathology is diagnosed even more often for the teenage girls who early began sexual life. Importance of timely detection and treatment of a chlamydial infection is directly connected with its prevalence, a frequent asymptomatic or latent current, significant influence of clamidiosis on reproductive function of the woman.
The clamidiosis reasons at women
The causative agent of a disease — a high-contagious gramotritsatelny bacterium of Chlamydia trachomatis, tropny to a cylindrical and transitional epithelium. Hlamidiya is an obligate intracellular parasite and exists in two cellular forms (little bodies) — high-infectious extracellular elementary and reproductive intracellular retikulyarny. The full cycle of development of a microorganism borrows from 1 to 3 days and comes to the end with final fracture of the struck epitelialny cage. There are two main ways of infection with clamidiosis:
- Contact and sexual. The sexual partner with clinical displays or the asymptomatic course of a disease becomes a source of infection. Infection occurs during vaginal, anal or oral sexual contacts.
- Vertical intranatalny. Hlamidiya can be transmitted from mother to the newborn child when passing through the ways affected with an infection patrimonial. Cases of antenatalny (pre-natal) spread of a disease are not recorded.
The probability of infection with hlamidiya with a contact household way is improbable, but is not excluded. The bacterium differs in extremely low resistance to action of the destroying environment factors: to drying, ultra-violet radiation, high temperature, alcohol and antiseptic solutions. At the same time, on natural fabrics at a temperature up to +18 °C the microorganism can keep the viability up to two days. Therefore in families with the low level of hygiene in the presence of the person who is actively allocating hlamidiya transmission of infection through bed or toilet accessories is theoretically possible.
The contributing factors for infection with hlamidiya are prostitution, frequent change of sexual partners, sex without use of barrier contraceptives, abuse of psychoactive agents. The risk of infection is increased at the women having the low social and economic status.
Allocate several stages of development of clamidiosis in women. At first the activator in the form of elementary little bodies gets to an organism, gets into cages of a cylindrical epithelium and passes into an intracellular retikulyarny form. Primary center of a chlamydial infection is usually localized in mucous the tservikalny or urethral channel. Intensive intracellular reproduction of a bacterium leads to destruction of an epitelialny cage and further spread of an infection. In process of accumulation of the activator clinical symptoms of a disease can be shown and amplify. In most cases clamidiosis proceeds asymptomatically, the patient becomes an infection source for partners.
At decrease in immunity and existence of the contributing factors (istmiko-tservikalny insufficiency, abortions and other invasive interventions, installation of Naval Forces) hlamidiya extend in the ascending way. The uterus, uterine appendages, a peritoneum are involved in inflammatory process. The limfogenny or hematogenic way of spread of an infection is not excluded that is confirmed by identification of the centers of clamidiosis in other bodies and fabrics (joints, a conjunctiva of eyes and so forth). Often hlamidiya are associated with other STD activators (trichomonads, gonokokka, pale treponema, a virus of genital herpes, etc.) that aggravates the course of a disease.
At allocation of separate clinical forms consider prescription of infection, expressiveness of manifestations and involvement in process of various bodies. Depending on sharpness of a current and prescription of infection experts in the sphere of gynecology distinguish the following options of clamidiosis at women:
- Fresh. Infection occurred no later than two months ago, mainly lower departments of an urogenital path (the tservikalny channel, a vagina, an urethra) are surprised.
- Chronic. The disease lasts two and more than a month, is characterized by an asymptomatic or recidivous current with distribution of an inflammation on pelvic bodies.
Taking into account topography of distribution of infectious process allocate:
- Local defeat of urogenital bodies: endotservitsit, uretrit, the colpitis, bartolinit.
- The ascending spread of an infection: the endometritis, salpingit, adneksit, pelvioperitonit, perigepatit, peritonitis.
- Ekstragenitalny defeats: pharyngitis, conjunctivitis, inflammation of anorektalny area, arthritis, etc.
Clamidiosis symptoms at women
Duration of the incubatory period at which symptoms of an infection are absent makes from 5 to 35 days (on average — 3 weeks). More than at 60% of patients the asymptomatic current is observed. At fresh clamidiosis the woman can note discomfort and burning in a vulva and a vagina, gripes during an urination and urine turbidity (when involving in process mucous the urethral channel), the increased quantity of mucous or yellowish mucopurulent is more white. Sometimes temperature increase to subfebrilny figures comes to light.
In the period of an aggravation at recurrent clamidiosis signs of the ascending spread of a disease with involvement in process of a uterus and appendages appear. The woman complains of the aching or nagging pains in the lower part of a stomach, inguinal area, a waist. Painful feelings amplify before monthly, at sexual intercourse, the sharp movements and physical activities. Menstrual function is usually not broken. At considerable prescription of infectious process and development of a chronic adneksit endocrine function of ovaries and an ovarialno-menstrual cycle can be broken. Monthly become irregular, painful, rare, plentiful or, on the contrary, poor. Often the only sign of a long asymptomatic course of urogenital clamidiosis is infertility.
The chlamydial infection at women most often is complicated pipe by infertility owing to an obliteration solderings of uterine tubes and adhesive process in a cavity of a small pelvis. At patients with clamidiosis spontaneous abortions, extra-uterine pregnancy, horioamnionita, a fruit hypotrophy, premature izlity amniotic waters are more often observed. A serious complication is distribution of an inflammation on a peritoneum with emergence of a periappenditsit or sharp fibrous perigepatit (a syndrome Fitz-Hough-Kurtis). At women with hereditary predisposition the syndrome of Reuters at which defeat of the urogenital sphere is combined with specific conjunctivitis and asymmetric arthritis can develop.
As the clinical symptomatology at clamidiosis at women is poor and not specific, the leading place in diagnostics is played by results of researches. For confirmation of the diagnosis to the patient appoint:
- Survey on a chair in mirrors. At a fresh infection it is hyperemic, on its surface erosion, and in a zone of an external uterine pharynx — specific lymphoid follicles can be found. At patients with chronic clamidiosis at a bimanualny palpation the tyazhisty, condensed, painful appendages are probed.
- Detection of hlamidiya in dab. A priority method of diagnostics crops of dab on flora are considered, sensitivity of hlamidiya to antibiotics in the course of the research usually is not defined. Molecular and genetic diagnostics (PTsR) is directed to identification of fragments of DNA of the activator in urogenital scrape.
- Serological methods. Antibodies to hlamidiya come to light in blood serum even after the postponed disease. By means of RSK estimate existence of anti-chlamydial IgA and a serokonversiya of IgG (at the ascending infection the caption of antibodies in pair serums accrues in 4 and more times). The REEF and IFA methods differ in high specificity.
The diagnosis of urogenital clamidiosis can be considered authentically confirmed at positive results of at least two different methods, one of which is PTsR. It is necessary to consider that the ascending chlamydial infection is complicated by development of solderings in a small basin and fallopian pipes. In the presence of indications for assessment of pipe passability to the patient carry out an ultrasonic gisterosalpingoskopiya, a gisterosalpingografiya, salpingo-and a falloposkopiya, a laparoscopic hromosalpingoskopiya. Differential diagnostics is carried out with other STD (gonorrhea, trichomoniasis, ureaplasmosis etc.). In the presence of ekstragenitalny defeats consultation of the ophthalmologist, rheumatologist, orthopedist, surgeon, urologist, dermatovenerologist can be required.
Treatment of clamidiosis at women
As sensitivity to antibiotics only retikulyarny forms of a microorganism have, the main method of therapy is use of the ftorkhinolon, tetratsiklin and macroleads capable to collect intracellularly. At uncomplicated forms of clamidiosis the course of etiotropny treatment makes 7-10 days, in the presence of complications — 2-3 weeks. In parallel with antibiotics medicines for prevention of complications and normalization of immunity are shown. Usually are for this purpose appointed:
- Antimikotichesky means. Use of nystatin, a flukonazol and other medicines of this group allows to prevent development of candidiasis.
- Eubiotiki (probiotics). Reception of pro-biotic medicines against the background of a course of antibacterial treatment and within 10 days after its termination is directed to prevention of dysbacteriosis.
- Immunomodulators. Normalization of the immune status improves elimination of bacteria due to oppression of their reproduction in cages.
After end of a course of antibiotic treatment the means restoring a natural biocenosis of a vagina are shown to the patient. For confirmation of treatment in 3-4 weeks upon termination of reception of antibiotics and after 3 subsequent periods the control laboratory research is conducted. Before recovery of the patient it is recommended to refrain from the unprotected sex.
Forecast and prevention
At timely detection and adequate treatment forecast favorable. Usually in the absence of complications clamidiosis at women completely recovers in 1-2 weeks. Late diagnostics and the chronic persistiruyushchy course of process are accompanied by high risk of formation of solderings and development pipe infertility. For prevention of a chlamydial infection it is recommended to abstain from sexual contacts with unfamiliar partners, to use means of barrier contraception. For the prevention of possible complications at a chronic infection it is important to have regular examinations at the gynecologist and to honestly accept the appointed medicines.