Questions for a venereologist. Consequences of chlamydial infection for men

Chlamydia of the genitals is the most common sexually transmitted disease. All over the world, there is an increase in chlamydia in young women who have just entered the period of sexual activity. In this regard, the problem of diagnosis, effective treatment and prevention of this pathology is of decisive importance for ensuring the reproductive potential of women in the “childbirth reserve” group.

Early initiation into sexual activity, frequent changes of sexual partners, the use of oral contraceptives, which reduces the fear of pregnancy, as well as greater mobility of the population determine the high incidence of genital chlamydia. The slow development of symptoms of the disease, and often the complete absence of pronounced signs of infection, explain the delay in seeking medical help. Sometimes the diagnosis is made during random examinations, including during examinations of pregnant women.

Despite the asymptomatic onset of genital chlamydia, its consequences can be very severe and manifest themselves in the form of acute and chronic inflammatory diseases of the pelvic organs, followed by adhesions that lead to ectopic pregnancies and infertility.

Genital chlamydia in pregnant women complicates the course of pregnancy and can lead to its termination, miscarriage, and premature birth. In addition, chlamydia of the genitals in the mother is transmitted to the child in 40-70% of cases both during the passage of the fetus through infected pathways and during its intrauterine development.

Early diagnosis of chlamydia in women and newborns is possible only through the use of special methods for identifying chlamydia, their antigens or their genetic material. Of decisive importance are the correct collection of material from patients, taking into account the localization of the process, its rapid delivery to the laboratory and the use of adequate diagnostic methods by qualified specialists.

From the moment the etiological diagnosis is established, early prescription of etiotropic treatment is indicated, taking into account the characteristics of the pharmacokinetics of antimicrobial drugs in the body of pregnant women and newborns. The presence in the arsenal of therapeutic agents of a large number of antibiotics acting on chlamydia makes it possible to take into account the characteristics of each of them not only in relation to the pathogen, but also in relation to their effect on the human body (side effects), which is ensured by systematic monitoring of patients. The effectiveness of etiotropic treatment is determined by the cessation of detection of the pathogen. In this case, due attention must be paid to the method of identifying the microorganism, since non-viable elements of chlamydia can be detected for a fairly long period if molecular biological methods (PCR, LCR, etc.) are used for diagnosis.

Treatment should be comprehensive, etiologically, pathogenetically and symptomatically justified in compliance with general principles, as for sexually transmitted diseases (STDs). The differentiated nature of therapy depends on the type of pathogen, clinical form, topical diagnosis, duration and severity of the disease, threat or presence of complications, clinical consequences of the disease.

When drawing up an individual treatment program, the presence of chlamydia in host cells at various stages of development is taken into account (the existence of four forms of the pathogen; its phagocytosis by macrophages; the possibility of long-term persistence in the intercellular space); concomitant dysbiosis of the genital tract (in the affected area) and intestines (due to the massiveness of chemotherapy); the presence as a predisposing, triggering and complicating moment of the simultaneous existence of the herpes virus, mycoureaplasma, anaerobes, fungi, trichomonas.

Therapy for genital chlamydia is divided into general and local. It must include compliance with three basic principles: chemotherapy, immunomodulation and biocorrection.

Chemotherapy for chlamydia must meet the following basic requirements:

· have high activity against the pathogen;

· low toxicity and reasonable cost of drugs;

· the choice of drug should depend on the specific case and be focused on the timing of infection (“fresh” - up to 2 months, chronic - more than 2 months from the moment of infection) and the clinical picture of the inflammatory process (acute, subacute, torpid, subjective asymptomatic course) in different lesions with monoinfection or mixed infections;

· comprehensive examination of the patient with a topical diagnosis available to every venereologist and/or gynecologist.

A.A. Mashkilleyson et al. When developing chemotherapy strategies and tactics, the following are taken into account: 1) the clinical form of the disease (acute, chronic) and the complications that arise; 2) presence (absence) of persistent chlamydia before treatment; 3) whether antibiotics were previously used against the background of a suspected chlamydial infection; 4) the nature of immune changes during the chronic course and especially the persistence of the pathogen (evaluation of the immunogram).

Methodology of chemotherapy for chlamydia. It is well known that all antimicrobial drugs, according to the degree of their penetration into the cell, are conventionally divided into three groups: low degree - penicillins, cephalosporins, nitroimidazoles; medium - tetracyclines, aminoglycosides, rifampicin, fluoroquinolones; high - macrolides (penetrate the cell membrane and accumulate in human polymorphonuclear leukocytes and macrophages). In modern clinical practice, various basic and alternative groups of chemotherapy drugs are used to treat chlamydia: tetracyclines; macrolides and azalides; fluoroquinolones; sulfonamides (biseptol). Chemotherapy options: 1) monotherapy; 2) combined etiotropic therapy (CET).

Schemes of basic and alternative therapy. Long-acting sulfonamides (sulfisoxazole, sulfadimethoxine, sulfalene, co-trimoxazole) are rarely used in clinical practice due to their insignificant etiotropy and the ability to cause persistence of chlamydia. In case of intolerance to antibiotics, only co-trimoxazole (Biseptol-480) orally 0.96 g 2 times a day every 12 hours for 10 days is indicated (for diseases of the liver and gastrointestinal tract, the injection technique is used). Tetracyclines are the first and most effective drugs (84.2% for a “fresh” process and 73.9% for a chronic one). Tetracycline is prescribed in doses of 1.5-2 g per day for 10 (“fresh” forms) and 15-20 (chronic, complicated forms) days. The main disadvantage is the side effect on the gastrointestinal tract, the development of dysbacteriosis, candidiasis. Contraindicated for pregnant women (can only be administered intravaginally and after 12 weeks of pregnancy). Doxycycline (Unidox, Vibramycin) is prescribed orally 100 mg (capsules) 2 times a day or metacycline (Rondomycin) 0.3 g (300 mg) 4 times for 7 (uncomplicated chlamydia) and extended to 10-14 (complicated chlamydia , ascending infection) days. Due to the widespread use of drugs, their effectiveness has now decreased from 90-95 to 60-70% (the emergence of resistant strains). Macrolides of the old (erythromycin) and new (erythromycin base, josamycin, rovamycin, eracin, midecamycin) generations, as well as azalide - sumamed (azithromycin) are increasingly used. It is known that the activity of the drug is determined by the minimum inhibitory concentration (MIC) against the pathogen in in vitro studies. The lower the MIC value, the higher the activity of the chemotherapy drug. For doxycycline it is 0.125; roxithromycin (rulid) - 0.03; clarithromycin (klacid) - 0.007 mg/l.

Macrolides (azalides) are most indicated in cases of intolerance to tetracyclines or the presence of contraindications to them (pregnancy, lactation, children under 7 years of age). Erythromycin is prescribed 0.25-0.5 g 4 times a day for 10-14 days, erythromycin base (erigexal, eric, eracin) - 0.5 g 4 times a day for 7 days or 0.25 g 4 times within 14 days. Josamycin (vilprafen) is used orally 1 g (2 tablets) once, then 0.5 g (1 tablet) 2 times a day for 10 days; spiramycin (rovamycin) - 3 million IU 3 times a day for 10 days; roxithromycin (rulid) - 150 mg (1 tablet) 2 times a day for 10 days (course dose 3 g). Etiological cure occurs in 95.4-97.0%, clinical - in 84.5-95.4% of cases. Midecamycin (macropen) is used orally in a course dose of 8 g (chlamydia as a monoinfection). Clarithromycin (Klacid) is prescribed orally at 250 mg 2 times a day, regardless of meals (or 500 mg 2 times) for 6-14 days. Azithromycin (sumamed) is an active azalide. It is taken orally depending on the form of infection: 1 g once (“fresh” infection, acute, subacute and uncomplicated forms of chlamydia with cure in 84% of cases). Treatment regimens: 1st day - 1 g, 2nd - 0.5 g (course dose 1.5 g) for the same forms of the disease, but with cure in 90% of cases; 1st day - 1 g, from 2nd to 6th day (i.e. 4 days) - 0.5 g per day in a course dose of 3 g. Sumamed (1 g per course once) is equivalent in its effectiveness of a 7-day course of doxycycline with minimal side effects, including the development of dysbacteriosis. The drug is most effective for mixed infections (chlamydia, gonorrhea, trichomoniasis, syphilis). Sumamed remains in the area of ​​inflammation for 5-7 days; at a dose of 1.0 g once, it does not cover 4-6 cycles of chlamydia development (this is its disadvantage). With increasing doses and lengthening the time of administration, the effective concentration in the lesion is maintained for 10 days due to accumulation in phagocytes and phagolysosomes (sites of chlamydia localization).

Fluoroquinolones have an inhibitory effect on bacteria and interfere with DNA synthesis in the cells of the microorganism. Their effectiveness ranges from 72.7-96% depending on the nature of the process and the gender of the patient. In recent years, there has been an increase in the resistance of chlamydia to drugs and an increase in relapses, which limits their use during pregnancy, lactation, and persons under 17 years of age. The drug of choice is ofloxacin (Tarivid, Zanocin, Quintor), it is prescribed 200 mg (1 tablet) 2 times a day for 10 days. Cure occurs in 98% of patients. In complicated forms, increase the dose (400 mg 2 times a day for 10 days) or lengthen the course (14 days), change the frequency of administration (2-3 times a day). Lomefloxacin (Maxaquin) as an alternative treatment for fresh uncomplicated chlamydia is prescribed 400 mg 1 time per day after meals for 10 days (monoinfection) or 600 mg per day for 7 days (mixed infection of chlamydia with mycoplasmosis, gonorrhea, gram-negative flora ). Pefloxacin (abactal, peflobid, peflacin, perti) is prescribed orally at 600 mg per day for 7 days.

Clindamycin (Dalacin C) is effective against chlamydia and a wide range of microbes (anaerobes, gram-positive cocci, etc.). The MIC of the drug is from 2 to 4 μg/ml. It is prescribed 2 capsules (300 mg) orally 4 times a day for 7 days (acute forms of the disease). In chronic and mixed forms of the disease, clindamycin is administered intramuscularly at 300-450 mg every 8 hours for 7 days or 900 mg intravenously (30 minutes) every 12 hours for 5 days, followed by switching to oral administration of 450 mg every 6 hours until completion of the 10-day therapy cycle.

When monotherapy with one chemotherapy drug is carried out, complete cure does not occur in 25-50% of cases. This may be due to antibiotic resistance, relapse of the disease, reinfection, lack of examination and/or treatment of the sexual partner, asymptomatic infection, and low level of sexual culture of the population.

All taken together, as well as the high frequency of mixed lesions, dictate the need for CET in case of monoinfection.

Immunomodulation in chlamydia is an important factor in increasing the etiological effectiveness of treatment and preventing the persistence of the pathogen. It can be carried out before chemotherapy or in parallel with it and should be based on changes in the woman’s individual immunogram and the main immunological changes typical of chlamydia: decreased activity of the interferon system, natural killer cells, macrophages, functional activity of T4 lymphocytes, increased number and activation of the function of B lymphocytes . In modern clinical practice for the treatment of chlamydia, the widespread use of interferonogens and interferons is indicated. Among the new drugs, cycloferon (Russia), neovir (Germany) are used - superinducers of interferon in the body, which normalize the function of natural killer cells and stimulate mononuclear phagocytes. Inject 2 ml of a 12.5% ​​solution intramuscularly 1 time per day on the first, second, fourth, sixth, eighth day of antibiotic treatment (5 injections in total). The course of treatment with Neovir consists of 5-7 injections of 250 mg with an interval of 48 hours. Antibiotics in the recommended course doses begin to be taken on the day of the second injection of Neovir. After completing the course of antibacterial therapy, 5 injections according to the same regimen are recommended. In mild cases of the disease (low titer of DNA in scrapings from the urethra, endocervix), neovir monotherapy is administered with a course of 10 injections every 48 hours.

Encouraging results were obtained using the Solcotrichovac vaccine (Switzerland). This drug is used for chronic chlamydia with a decrease in the level of IgA in cervical mucus, vaginal secretions and a low response to PHA. The main goal is to stimulate the impaired nonspecific resistance of the body. The drug is administered in parallel with the antibiotic to normalize the biocenosis of the genitals. Good results were obtained when vaccinating patients with mixed infections (especially when combined with vaginosis, trichomoniasis, bacterial, and HPV viral infections). Solcotrichovac is a lyophilisate of inactivated strains of Lactobacillus acidophilus (one bottle contains 7x109 lactobacilli, 5 mg of repolymerized gelatin, 0.2 mg of phenol as a preservative). Vaccination provides one-year protection against re-infection and relapses, causes the death of pathogenic microorganisms, and normalizes the ecosystem and vaginal pH. The main vaccination is 3 injections of 0.5 ml IM with an interval of 2 weeks; after 12 months it is repeated - 0.5 ml intramuscularly once. Solcotrichovac is also used for long-term, recurrent course of the disease. The practitioner needs to remember that in outpatient gynecology and venereology, immunotherapy for trichomoniasis is carried out simultaneously with etiotropic therapy. When using this vaccine, a stable normalization of the bacterial flora of the vagina was observed in women with combined chronic pathology of the genitals (chronic endometritis + chronic salpingitis + chronic endocervicitis).

Interferon replacement therapy with inflagen (Lithuania) and viferon (“BKI”) is used in complex treatment to correct the immunological status. Inflagen (recombinant genetically engineered interferon) is administered intramuscularly at a dose of 1 million units for 10 days every 2 days (increasing serum interferon levels). Viferon contains in rectal suppositories 500,000 IU of human recombinant interferon α-2β, 5% tocopherol acetate, ascorbic acid. Use 2 suppositories rectally daily (10 days), then in the same dose every other day (3 times a week) for 3-12 months, depending on the dynamics of clinical and laboratory parameters. Cimetidines are prescribed with caution, and it is mandatory to supplement them with drugs that “mildly” stimulate phagocytosis: iodinol (local treatment of lesions); Essentiale (2 capsules 3 times a day orally in cycles of 7-10 days); methyluracil (2 g/day 20-30 days); pentoxyl (0.2-0.4 g 3-4 times a day for 10 days); lithium carbonate (1 tablet 3 times a day for a long time).

A control immunogram after treatment is required. Without indications, widespread use of lipopolysaccharides (pyrogenal, prodigiosan) for immunocorrection should be avoided. With chlamydia, they can cause additional stimulation of B-lymphocytes, the production of immunoglobulins (antibodies), excessive formation and delayed elimination of the CEC and, as a result, the occurrence of other immunopathological conditions complicating the main lesion (arthropathy, Reiter's syndrome).

Biocorrection for the disease is aimed at restoring the normal biocenosis of the genital tract and intestines and is carried out at different stages of treatment. Eubiotics of the first, second generation (powder or liquid, respectively bifidum or lactobacterin) or new ones (floradophylus, chlorella, pod’Arco, zhelemik, hilak-forte) are used - orally or topically.

Local treatment involves the use of the following procedures in a certain sequence: 1) Instillation into the vagina of 100 ml of a 2% solution of boric or lactic acid (citric acid can be used - 1/2 teaspoon per 1 liter of water), tampons of 25% dimexide. The course is 10 days in a row. If tampons are inserted twice a day, acid instillation is performed before each tampon insertion. 2) Insertion of vaginal tampons for 10-12 hours (one-time use) or for 2 hours (morning) and 8 hours at night. The composition of 10 vaginal tampons includes: clarithromycin (clacid) or any other macrolide - 2.5 g; metronidazole (tinidazole) - 8.0-10.0 g; Polyrem (Zovirax, Flacoside or analogs) - 1.5 g (4.0; 1.0 g); nystatin (clotrimazole or analogues) - 10.0 (1.0 g); synestrol (microfin) - 0.01 g; ascorbic acid - 3.0 g; borax - 2.0 g; 100% dimexide - 10.0 g; glycerin (distilled water) - 100 ml MDS. Shake this composition well before use. For one swab, take half the mixture and any oil (sea buckthorn or rose hips - 1 part, olive or sunflower - 3 parts). For burning (itching, leucorrhoea), lidocaine (1-2%), anesthesin (5%), novocaine (0.5%) is added to the composition. 3) Liposomal creams with superoxide dismutase (for example, “fleur-enzyme”) or with the addition of bee honey, infusions of medicinal herbs (for example, “Vitella”) are applied to the vulva area 2 times a day for the entire period of treatment (general and local). This composition, when administered intravaginally, perfectly relieves local inflammation (especially with concomitant genital herpes).

The general strategy and tactics for treating acute chlamydia (“fresh” infection) is to prescribe a 7-day course of doxycycline or 1.0 g of sumamed once. Clinical cure occurs in all (100%) patients, etiological - in 84%. Prescribing large doses and long-term use of drugs increases the percentage of etiological cure.

In case of chronic chlamydia, it is necessary to carefully collect anamnesis and find out whether the patient received any antibiotics before starting the planned treatment and whether she is suffering from a urogenital infection for the first time (i.e., verify that she only has a chronic process, with active forms of chlamydia or with their persistence ).

A. If the patient has not previously received treatment, does not have chlamydia, and active forms of chlamydia are detected in her, an active drug is prescribed - sumamed in a course dose of 3 g or other active macrolides, but with an extension of the course to 14 days, since the short-term (2-3 days), even highly effective or continuous (21-28 days) chemotherapy for chronic infection will be unsuccessful due to more frequent dysbiosis, candidiasis and worsening immunodeficiency. Pulse therapy with chemotherapy drugs is supplemented with immuno- and biocorrection and other methods.

B. If the patient has a persistent form of chronic chlamydia (a reservoir of infection), chemotherapy should be categorically refused. The main method is immunotherapy - stimulation of the B-cell component. The body itself will actively fight the pathogen without the use of antibiotics.

Treatment regimen for chronic urogenital chlamydial infection.

The first stage is preparatory and sanitizing.

General treatment:

Neovir (cycloferon) is administered intramuscularly every other day, 7 injections in total.

Diflucan is prescribed orally 150 mg (1 capsule) on the 7th and 14th day of treatment with rovamycin (prevention and simultaneous treatment of candidal superinfection). It is irrational and unprofitable to use nystatin (Levorin) for these purposes due to low absorption in the gastrointestinal tract (no more than 5%).

Rovamycin is added after the third injection of neovir orally, 3 million IU 3 times a day for 14 days.

Supradin (Switzerland) - a combined multivitamin complex with minerals - is prescribed orally, 1 tablet or capsule per day continuously (except for the summer months). It is possible to use any supradin analogues.

Zaditen (ketotifen) - orally 2-3 mg per day for 30-45 days during and after treatment with rovamycin.

Physiotherapy - low-frequency ultrasound (phonophoresis) using the vaginal technique through enzymes (60-80 s, 8-10 procedures).

First stage. A. General treatment includes UVOC from 3 to 5 procedures, carried out every other day, in the first phase of the menstrual cycle, exposure 7-10 minutes, anticoagulant - heparin (5000 units) in 30 ml of physiological sodium chloride solution. Neovir 500 mg IM every other day (3 injections), then 250 mg every other day (4 injections) after completing the UVOC course. Rovamycin 3 million IU 3 times a day for a course of 21 days is prescribed after the third injection of neovir. Diflucan is administered orally at a dose of 50 mg every other day for the entire period of taking rovamycin (21 days). Supradin (or analogue) - 1 tablet 2 times a day for 6 months, then 1 tablet per day (excluding summer). Finoptin (verapamil) - a calcium blocker - normalizes hemostasis, metabolic processes, opiate activity, and stress reactions. It is prescribed orally at 120 mg per day for 20 days. Instead of finoptin, it is possible to use calcitrin 3 units intramuscularly for 25 days (normalizes the metabolism of enkephalins, prostacyclin, leukotrienes during inflammation). Dalargin (an analogue of leucine-enkephalins) accelerates regeneration and is a means of preventing dystrophy and atrophy - administered intramuscularly at 1 mg per day for 25 days. Supradin, finoptin, dalargin are prescribed in parallel with rovamycin, this improves the prognosis of a woman’s regenerative function. Physiotherapy - microwaves (SMV, DMV) using the skin (salpingoophoritis) or vaginal (cervicitis) method for a course of 10 days.

B. Local treatment - “tantum-rose” in the form of vaginal baths (10 minutes) for 7 days, then cream (suppositories) Macmiror complex (Italy) as a means of protection until the end of treatment with rovamycin.

Second stage: Essentiale 2 capsules 3 times a day for 1 month; eubiotics orally (4 weeks) and locally (2-3 weeks); antioxidants are prescribed after completing the course of Essentiale and eubiotics: limontar for 3-4 weeks or antioxicaps (1 capsule per day) for up to 3 months.

Ways to optimize the treatment of chlamydia. 1) To prevent candidiasis, antimycotic therapy is prescribed simultaneously with chemotherapy: Diflucan, Pimafucin, Gyno-Daktarin, Gyno-Pevaril, Macmiror, Polygynax. 2) To enhance the effect of chemotherapy drugs, they are combined with proteolytic enzymes: α-chymotrypsin is administered intramuscularly at 5 mg for 20 days every other day; the cervical canal, urethra, and vagina are treated with a 5% solution for 10-15 days. Wobenzym is prescribed orally 6 tablets 3 times a day for the first 10 days, 5 tablets 3 times a day for 10 days, then 4 tablets 3 times a day for 15 days. Oraza is taken orally, 1 teaspoon 3 times a day in combination with antibiotics (the entire course), it is administered intravaginally in Apilak suppositories. 3) In addition to enzymes, to potentiate the effect of antibiotics, adaptogens in any form or diuretics are used (in the absence of contraindications) - furosemide 0.04 g IM for 5 days. 4) Mandatory preventive simultaneous treatment of sexual partners with antiviral and antiprotozoal drugs. 5) Antihistamines. 6) Physio- and alternative treatment: ILBI; UFOK; laser phoresis through dimexide, dibunol (vaginally, intrauterine); endovaginal electrophoresis of 25% dimexide with lidase; low frequency ultrasound.

Chlamydial infection and pregnancy

Infection of the mother with Chlamydia trachomatis causes adverse effects of the infection on the course of pregnancy and the newborn child. The disease often occurs without symptoms and is not recognized clinically.

The most common clinical manifestations of the disease in infected pregnant women are profuse vaginal discharge, itching in the external genital area, cervicitis, and urethral syndrome.

Pregnancy prognosis

1. Mother. The prevalence of chlamydial infection among pregnant women varies from 2 to 40%. Pregnancy does not affect the incidence and course of chlamydial infection.

The most typical complications of pregnancy with chlamydia are non-developing pregnancy, spontaneous abortion, premature birth, birth of low-birth-weight children, polyhydramnios, fever of unknown etiology.

2. Fetus and newborn. Registered cases of chlamydia in children do not have established timing and routes of infection. It is known that infection can occur in utero, during childbirth through contact with infected secretions from the genital tract of a sick mother.

Complications in the fetus: hypertrophy.

Diseases of the newborn: chlamydial conjunctivitis (18-50%), chlamydial pneumonia (3-18%), nasopharyngitis, urethritis, vulvovaginitis.

Treatment during pregnancy

When prescribing treatment for chlamydial infection, it should be taken into account that the characteristic pathogenetic features of the disease are changes in the functional activity of the immune system with the development of sensitization, bacterial intoxication, dysbacteriosis, therefore therapy for chlamydia in pregnant women should include antibiotics, eubiotics, and antimycotic drugs.

Antibacterial therapy:

- erythromycin 250 mg 4-6 times a day for 14 days or 500 mg 4-6 times a day for 7-10 days;

— sumamed (azithromycin): for “fresh” infection — 1 g once; for all forms on the 1st day 1 g once, on the 2nd day 0.5 g (per course 1.5 g) or on the 1st day 1 g, from the 2nd to the 6th - 0.5 g per day (3 g).

After completion of antimicrobial treatment, restorative therapy is prescribed:

— immunomodulator myelopid intramuscularly, 1 dose once a day for 5 days in combination with a complex immunoglobulin preparation (CIP), 1 suppository per day intravaginally for 5 days;

- preparations of recombinant interferons: recombinant α-interferon 1 suppository 1-2 times a day intravaginally (1 suppository contains 2x10.6 IU of interferon);

— interferon ointment in the form of applications containing at least 2x10.6 IU of interferon.

Eubiotics:

- bifidumbacterin in suppositories - 1 suppository 2 times a day for 10 days;

- acylact in suppositories - 1 suppository 2 times a day for 10 days;

— in parallel, dry acylactate (in vials) is prescribed, 5 doses per 1 dose orally for 10-30 days;

- bifidumbacterin (or bificol) dry (in bottles) 5 doses per 1 dose orally for 10-30 days.

In the presence of mycotic vulvovaginitis in pregnant women, the drug of choice is Gino-pevaril 150 (150 mg econazole nitrate) - 1 suppository per day intravaginally for 3 days.

Cure criteria

All patients undergo clinical and laboratory monitoring after completion of treatment. In our opinion, when we are talking about such an initially asymptomatic infection as chlamydia, and also taking into account the fact that bacteriological cure does not always correspond to clinical cure, there is no other way to verify the effectiveness of treatment other than conducting a control study. One of the leading methods for determining cure for urogenital chlamydia is a cultural study to isolate the pathogen.

The first control is immediately after the end of treatment. If single elementary bodies are detected, the course of treatment continues for up to 10 days with repeated laboratory monitoring.

Establishing cure should be carried out taking into account the diagnostic method, but not earlier than 4-6 weeks from the end of treatment. Re-detection of chlamydia after excluding reinfection requires the appointment of a new course of chemotherapy with drugs from other groups. It is advisable to carry out control in the same laboratory, using the same methods, or to involve arbitration laboratories with more highly sensitive tests. Cytology of control cervical and urethral scrapings is not suitable.

4 weeks after the end of treatment, to establish cure, the method of isolating chlamydia in cell culture should be used, because only this makes it possible to determine the presence of viable forms of chlamydia in the patient’s body. A positive result from other methods, including PCR, does not necessarily indicate that the dead chlamydia have not been completely eliminated. The disadvantage of the culture method is the difficulty in organizing efficient laboratory work.

Another method for determining cure is direct immunofluorescence (DIF). It can be used no earlier than 1-1.5 months after the end of treatment. However, positive results of PIF during these periods require caution in their interpretation, since reinfection cannot be excluded. Incorrect interpretation of results can discredit fairly effective treatment methods.

Serological methods, i.e., determination of the content of anti-chlamydial antibodies, cannot be used to monitor cure.

Prevention of urogenital chlamydia

Prevention methods are the same as for any other sexually transmitted disease. There are several aspects to this problem. It should be said that there is a fairly high probability of asymptomatic infection, especially in women. All women are subject to examination for chlamydia when registering for pregnancy, when referring for termination of pregnancy, for childbirth, as well as couples applying to family planning clinics regarding an infertile marriage.

In approximately 10% of cases, chlamydia in men is asymptomatic, which is also dangerous from an epidemiological perspective. It is mandatory to examine male partners if chlamydia is detected in a woman.

The main means of preventing chlamydia, like other STDs, currently remains barrier methods of contraception, in particular the use of condoms. Increasing moral responsibility for the spread of the disease, rather than the threat of prosecution, should be characteristic of the behavior of a civilized person. Thus, timely prevention of urogenital infections is the most reliable path to reproductive health in the family.

Literature

1. Abazova F.I., Khakhalin L.N. // Sexually transmitted diseases. - 1995. - No. 3. - P.23.

2. Adaskevich V.P. // Sexually transmitted diseases. - Vitebsk, 1997. - P. 309.

3. Antibacterial therapy: Practical. manual / Ed. L.S. Strachunsky, Yu.B. Belousov, S.N. Kozlov. - M., 2000. - P. 190.

4. Anchupane I.S. // Urogenital trichomoniasis and mixed trichomonas-gonococcal-chlamydial infections (features of epidemiology in Latvia, improvement of diagnosis and treatment): Abstract. dis. ...cand. honey. Sci. - M., 1992. - P. 17.

5. Gomberg M.A., Soloviev A.M., Nekrasov A.V. etc. // Sexually transmitted diseases. - 1997. - T. 4. - P. 34.

6. Zanko S.N., Arestova I.M., Rusakevich P.S., Gnedko T.V. // Genital infections of the pregravid and gravid period: Textbook. - Vitebsk, 2001. - P. 82.

7. Zanko S.N., Kosinets A.N., Suprun L.Ya. // Chronic inflammatory diseases of the uterine appendages. - Vitebsk, 1998. - P. 206.

8. Krotov S.A., Krotova V.A., Yuryev S.Yu. // Chlamydia: epidemiology, characteristics of the pathogen, laboratory diagnostic methods, treatment of genital chlamydia: Method. manual for doctors. - Novosibirsk, 1997. - P. 62.

9. Novikov A.I., Okhlopkov V.A., Shitova V.B. and others // Abstracts. report Siberian scientific and practical conf. dermato-venereologists “Modern trends in the diagnosis and treatment of urogenital chlamydia.” - Novosibirsk, 1998. - P. 20.

10. Savicheva A.M., Bashmakova A.M., Kosheleva N.G. etc. // Chlamydial infection in obstetrics and gynecology (diagnosis, clinical picture, treatment): Method. allowance. - St. Petersburg, 2002. - P. 48.

11. Semenov V.M., Kozin V.M., Dmitrachenko T.I. // Chlamydia: A Guide for Doctors. - Vitebsk, 2002. - P. 112.

12. Semenov V.M., Nikiforovsky N.K., Tomchina A.V. etc. // Chlamydial infection. - Smolensk, 1997. - P. 13-56.

13. Tomchina A.V. // The role of chlamydia in the occurrence of inflammatory diseases of the genital organs in women: Abstract. dis. ...cand. honey. Sci. - M., 1997. - P. 17.

14. Chlamydial infection. Features and diagnostic capabilities / Ed. M.A. Gomberg, O.E. Orlova. — M., 1996.— P. 31.

15. Shatkin A.A., Orfila J. // Problems of infectology. - M., 1991. - P. 188.

16.Cotter T.W., Meng O. // Infect. Immun. — 1995. — V.63. — P.4704

17.Kochler L., Nettelnbreker E., Hudson A.P. et al. // Microb. Pathog. - 1997. - V. 22. - P. 133.

18.Mittal A., Kapur S., Gupta S. // Brit. J. Biomed. Sci. - 1996. - V. 53. - P. 214.

19. Sarov I., Geron E., Shemer-Avni Y. et al.// Eur. J. Microbial. Infect. Dis. - 1991. - V. 10. - P. 199.

Medical news. - 2003. - No. 12. - pp. 41-47.

Attention! The article is addressed to medical specialists. Reprinting this article or its fragments on the Internet without a hyperlink to the source is considered a violation of copyright.

20.06.2017

Chlamydia is a ubiquitous and extremely common disease transmitted through sexual contact.

The household route of infection (through hands, towels, and underwear contaminated with infected secretions) is also possible, but is not a significant epidemiological factor. Newborns are often infected when passing through the birth canal of a sick mother (in 50% of cases); there may be intrauterine infection. In fact, it is a sexually transmitted disease, although it is more often treated by urologists and gynecologists.

According to statistics, from 30% to 60% of adult women and about half of men are infected with chlamydia trachomatis. In more than half of cases, the disease is asymptomatic.

Symptoms and treatment vary at different stages of the disease. There are two forms of chlamydia:

• “fresh” form, which lasts up to 2 months from the moment of infection and affects the lower part of the genitourinary system;
• chronic form, when the infection spreads to the upper parts of the genitourinary system and more than 2 months pass from the moment of infection.

In the “fresh” form, approximately 2 weeks after infection, a burning sensation when urinating, an increase in the amount of vaginal discharge, which acquires an unpleasant odor, may appear. Soon the symptoms go away on their own, and the woman in most cases forgets about this episode. Meanwhile, she should see a doctor: the “fresh” form is easy to diagnose and quite easy to treat.

With the development of chronic chlamydia, symptoms of diseases of the female genital area may occur. Chlamydia in women can cause inflammation of various locations:

• Bladder;
• labia minora and labia majora;
• mucous membrane of the cervix;
• Bartholin's glands;
• vaginal mucosa;
• fallopian tubes;
• endometrium of the uterus.

Chronic chlamydia can cause infertility (due to adhesions in the fallopian tubes) and pregnancy pathologies (frozen pregnancy, spontaneous abortion, premature birth, developmental disorders in the fetus when it is infected). Babies may develop chlamydia-related pneumonia and conjunctivitis soon after birth.

Manifestations of chlamydia not related to the genital area may include chronic “colds” of the upper respiratory tract, inflammation of the rectum - proctitis, conjunctivitis, reactive arthritis.

The microorganism chlamydia trachomatis is a bacteria, but its behavior resembles a virus. Chlamydia, like viruses, is embedded in the cells of the host’s body and can leave them during reproduction without destroying the cell, which explains the usually erased or asymptomatic course of the disease. With high immunity in humans, chlamydia forms inactive (latent, persistent) L - forms that do not extend beyond the host cell. In this case, chlamydia reproduces only during cell division. The immune system does not produce antibodies to them, which complicates diagnosis by enzyme immunoassay. The same feature makes it difficult to treat chronic chlamydia: chlamydia is sensitive to antibiotics, but not in all phases of its life cycle. Chlamydia began to be recognized as an independent diagnosis in 1977. Previously, numerous chlamydial inflammatory diseases of the urogenital area were classified as female diseases of unknown etiology.

The most reliable diagnostic methods today are PCR (polymerase chain reaction) - testing scrapings of the epithelium of the urogenital tract (the reliability is close to 100%) and the enzyme immunoassay of venous blood for the presence of antibodies (the reliability is about 60%). Typically, diagnosis is prescribed for existing inflammatory processes in the urogenital area, as well as before childbirth or abortion, in case of miscarriage or intrauterine fetal death. It is strongly recommended that when planning a pregnancy (on your own initiative and by both future parents), you should be tested for hidden sexually transmitted infections, including chlamydia, and if the result is positive, treat chlamydia before pregnancy. So, how to treat chlamydia in women?

The main goal of treatment is to destroy chlamydia and get rid of acute or chronic inflammatory processes. An intermediate goal may be to reduce the number of relapses of chronic inflammatory processes and reduce the likelihood of a complicated or miscarried pregnancy.

There are no universal drugs for chlamydia in women. The main treatment is antibiotics. When developing a treatment regimen, the form of the disease (acute or chronic) and the presence of concomitant infections are taken into account. The duration of the course of antibiotics is at least 6 life cycles of chlamydia, which last from two to three days, therefore, at least 12, and more often 18 days.

Antibiotic therapy for chlamydia is selected based on the requirements:

• the antibiotic must be highly active against chlamydia;
• the drug should easily penetrate into the intracellular space and create the required concentration;
• the drug must have low toxicity and be affordable for the patient.

The duration of treatment should cover 4, preferably 6 life cycles (48-72 hours) of chlamydia. Treatment will be effective if chlamydia is in a form sensitive to antibiotics (reticular cells, non-dividing forms - elementary bodies and inactive L - forms resistant to antibiotics). The choice of medication should take into account the time from the moment of infection (up to 2 months “fresh”, more than 2 months chronic), the presence of symptoms of inflammation, the presence of additional infections, whether antibiotics were used during chlamydial infection, the nature of immune changes, especially in the presence of inactive (persistent) L - forms , which is determined by the results of an immunogram. Various groups of antibiotics are used in medical practice (see Table 1). Of the sulfonamides (in case of intolerance to antibiotics), only biseptol is used.

Drugs for the treatment of chlamydia

Antibiotics used for chlamydia

Basic antibiotic treatment regimens:

• continuous course of treatment (at least 7 life cycles of chlamydia);
• pulse therapy (3 courses of antibiotics for 7 days with pauses of 7 days) for the chronic form.

Antibiotic treatment options:

• monotherapy with one drug (in 25-50% it does not completely destroy chlamydia);
• combination therapy (usually 2 antibiotics from different groups).

In most cases, and especially in the presence of mixed infection, combination therapy is used.

The effectiveness of treatment is increased by immunomodulation, which can be carried out both before the start of antibiotic therapy and in parallel with it. The regimen for using immunomodulators and the choice of drugs should be based on the results of an individual immunogram.

Immunomodulators

Interferogens (interferon inducers) and interferons are used. New interferogens cycloferon and its analog neovir stimulate the production of their interferon in the body. Of the foreign interferons, it is advisable to use viferon, which has the most gentle effect on the immune system. Viferon is available in the form of rectal suppositories and contains interferon α – 2b, vitamin E and ascorbic acid. Viferon can be used by pregnant women, debilitated patients, and for the treatment of newborns and premature babies.

In the situation of a persistent form of chronic chlamydia (inactive L forms), antibiotic therapy does not make sense. In this case, immunotherapy will be the main treatment method. The body itself will fight chlamydia.

Probiotics

All developed treatment regimens using antibiotics are quite aggressive and cause intestinal dysbiosis and also change the vaginal flora.

Intestinal dysbiosis is treated with the drugs Bifidum, Bificol, Lactobacterin, Hilak-Forte and other probiotics.

To restore vaginal flora, acylact (vaginal suppositories), bifidumbacterin (suppositories), and gynoflor vaginal tablets are used.

Hepatoprotectors

To maintain liver function, Carsil, Essentiale Forte, Phosphogliv, Legalon and others are prescribed.

Antifungal drugs

To prevent candidiasis while using antibiotics, nystatin, nizoral, levorin, and fluconazole are prescribed.

Local remedies

Can be applied locally:

• douching with weakly acidic (2%) solutions of boric, lactic or citric acid;
• vaginal tampons, which may contain macrolide antibiotics, tinidazole, nystatin, ascorbic acid, dimexide, sea buckthorn oil, olive oil and other ingredients.

On medical portals, users ask a lot of questions about the problem of chlamydia, usually starting with the words “looking for” and “being treated.” Patients who are looking for a “cure for chlamydia” or “drugs for the treatment of chlamydia in women” on the Internet should know: an effective treatment regimen for chlamydia is developed only individually, by a qualified doctor after appropriate research and medical history.

Treatment should be accompanied by a number of tests and completed with control studies, with subsequent monitoring 4 to 6 weeks after the end of treatment.

Prevention

Disordered sex life with multiple partners should be avoided. Chlamydia can easily be contracted through genital or anal intercourse without a condom. Infection through the oral route is possible, but less likely. Chlamydia does not develop immunity, and you can become infected again and again. Therefore, regular partners are treated at the same time.

It is important for women and girls to exclude household infection by observing sanitation rules and reasonable caution when visiting public places.

Although infection in this way is unlikely, you should not sit on a bench in a bathhouse without a bedding, touch your genitals with the hand that was used to cover the hook in a public toilet, and the like.

chPRTPU # 57422 TSEOEYOB chPTBUF 40

ъДТБЧУФЧХХКFE.Б RTY POLPMPZYY NPTsOP KHRPFTEVMSFSH vYUERFPM 480 .EUMY CHDTHZ RTPUFSHMB?H NEOS 2ЪМПЛБУ.ИНИС.ПРИБГИС ВШМБ Х SOCH.RPUME PVMHYUEOYE.OB DPN CHSHCHRYUBMY fBNPLUIZHEO ABOUT 5MEF.eUMMY OE vYUERFPM.FP rBOBDPM CH FBVM YMY YuFP FP DTHZPE NPTsOP RTYOINBFSH.EUMY UCHPY RSHA RPUME ЪBCHFTBLB?y 2ChPRTPU.PDYO NEUSG ЪBNEOYMB fBNPLUIZHEO ABOUT ZhBTEUFPO U 1PLFSVTS.ЪBNEFYM B.YuFP ABOUT OPZBI OBD RSFLPC Y CHSHCHYY UYOSLY.LBL VHDFP LBRYMSTSCH MPROKHMY.RPUME IYNYY CHEOSCH UKHYMYUSH Y FPMSHLP RTYIPDSF CH UEVS.Y CHPPVEE OITSE EILPMPFLY DP RBMSHGECH OPZY LBL VHDFP PFVYMY.NPTSEF LFP VSHFSH PF zhBTEUFPOB.PF fBNPLU.OE ЪBNEYUBMB.RTBCHDB NEUSG S RYMB bud.Y 11PLF HYY.TEOFZEO.BOBMMY LTPCHY.CHLMAYU POLPNBTLET. RPLBЪBMY YUYUFP.NPTSEF LFP RPUME bud?

pFCHEF:

chPRTPU # 54379 TSEOEYOB chPTBUF 70

pFDSCHIBA Y MEYUKHUSH UEKYBU CH UMPCHBLYY CH rYEYFSOSCH.VEURPLPAF RPSUOYUOSCH VPMY Y VPMY OITSE RPSUB. BOBMY NPUY RPLBBBM: charteries +++. Epitome.ploche +++. MEKLPGYFSHCH 123. Erytrocyty 1. chTBYU UTBH ULBUBMB, YuFP BOBMY PUEOSH RMPIPK Y PFNEOOMB CHUE CHPDOSHE RTPPGEDHTSCH: ZYDTPNBUUBTS, NYOTBMSHOSCH CHBOOSCH, DTSBLHY O 4 DOS , OBJECTIVE vYUERFPM 480 , RTYOINBS RP 2 FBVMEFLY KHFTPN Y CHEWETPN, FP EUFSH 4 FBVMEFLY CH DEOSH. WHAT'S NEW ABOUT LFPF UYUJF. DEKUFCHYFEMSHOP MY BOBMY PUEOSH RMPIPK. lBLYE PVUMEDPCHBOYS OBDP UDEMBFSH DPNB CH nPULCHE, LTPNE xhy, YUFPVSH RTPCHETYFSH RPYULY? URBUYVP ЪB PFCHEF. REFTYLEEECHB mADNYMB yCHBOPCHOB.

pFCHEF:

chPRTPU # 48830 TSEOEYOB chPTBUF 39

rPNPTSEF MY RTYEN " vYUERFPM " (480 ) DMS KHUFTBOEOYS UCHYEB ABOUT DEUOE ЪХВБ? CHCHYIOKHMB OYTSOYN LMSHLPN CHETIOAA "DCHPKLH", ABOUT CE ACCOUNTING DBCHYF OE DP LPOGB CHSHCHMEYYK LMSHHL, NEFSEIK ABOUT HER NEUFP, F.L. VHI OEZP NEUFB OEF. CHPF ЪХВ- "ДЧПКЛБ" И УФБМ ЛБУБФШУС, ДЭТЦИФУС О ПДОПК UMYYUFPK, LPUFY NBMP, B RPFPN CHP'OIL UCHYE. UFPNBFPMPZ RTEDMPTSYM CHULTSCHFS LBOBM "DCHPKLY", KHUFTBOIFSH YOZHELGYA ABOUT HER LPTOE, YFYZhF CHUFBCHYFSH. " vYUERFPM"RPNPTSEF UOSFSH CHPURBMEOYE Y ЪBNEDMYFSH RTPGEUU DP RPUEEEOYS UFPNBFPMPZB?

pFCHEF:

chPRTPU # 44994 nHTSYUYOB chPTBUF 63

ъДТБЧУФЧХХКФЭ...
noe 63 ZPDB.... TBOEE LPZDB OBUYOBMP RPSCHMSFSHUS ABOUT MYGE VPMEOOOSCH PVTBPBCHBOYS...CH CHYDE RTPUFKhDOSHCH..S RTYOINBM Viewerfpm...Y UTBH URKHUFS 2-3 YUBUB PEKHFYNSCHE VPMY PVTBBPCHBOYS OBUYOBMY PFIPDYFSH..B YUETE OEDEMA-RPMFPTSCH...CHPCHUE RTPRBDBMY Y MYGP UFBOPCHYMPUSH YUYUFSHCHNY OH YUESP OE VEURPLPYMP...OP LFPP ICHBFBMP HERE FP ABOUT NEUSG RPMFPTSCH ...B RPFPN PRSFSH FYIP -FYIP OBUYOBMPUSH FP TSE UBNPE....RTYIPDYMPUSH CHSHCHDETTSYCHBFSH RP CHPNPTSOPUFY OELPFPTPPE CHTENS Y PRSFSH RTYOINBFSH Viewerfpm ...
LPMYUEUFCHP vyuerfpmb..VShchMP RP TBOPNH...LPZDB 1 HRBLPCHLH..LPZDB 2...OP 2 HRBLPCHLY VSHCHBMP TEDLP...Y FBL RTYNETOP MEF 20-25....
DKHNBM U CHPTBUFPN PFPKDEF...OP KHCHSHCH...Y CHPF OEDBCHOP OBFLOHMUS CH YOFETOFE ABOUT OELYE ЪBNEOYFEMY viewerfpmb...CHPF POY (chPNPTSOSCHE ЪBNEOYFEMY RTERBTBFB UHMSHZHBNEFPLUBЪPM/ftY NEFPRTYN:
lP-FTYNPLUBPM (PF 12.00 TXV), lP-FTYNPLUBPM-bLTY (PF 15.00 TXV), vYUERFPM(PF 28.00 TXV), vYUERFPM 480 (PF 70.00 ТХВ), vBLFTYN (PF 140.00 ТХВ),
rTPYKH UPCHEFB...LBL RPUFKHRYFSH Y YUFP VKhDEF MHYUYE RTYOINBFSH....dB LUFBFY KH CHTBYEK FPTSE VSHCHBM...CHSHRYUSCHBMY LBLYE FP MELBTUFCHB...OP TE'KHMSHFBFPCH OE VSHMP YMY VSHCHMY U MBVSH...OE URTBYCHBKFE LBL OBSCHCHBAFUS OE RPNOA.. ..HCE..

pFCHEF:

chPRTPU # 26198 nHTSYUYOB chPTBUF 21

x NEOS HCE FTEFYK DEOSH PYUEOSH VPMEЪOOOSCHK ZHHTHOLM OB CHOKHFTEOOEK UFPTPOE SZPDYGSCH. eUFSH FENRETBFHTOBS TEBLGYS - 36.8-37.5. vPMEЪOOOSCH PEHEEOYS HUYMYMYUSH ЪB RPUMEDOYE 12 YUBUPCH, B FBL CE ON HCHEMYYUMUS CH TBNETE. dP bFPZP OBOPUYM lHTYPYO ABOUT RPTBTSEOOHA PVMBFSH. lZHZHELFB OE RTYOEUMP.
rP RTYNETKH RTPYMPZP TBBB (FTY ZPDB OBBD VSCHM BOBMPZYUOSCHK, CHYDYNP OE DPMEYUYUMY, RPFPNH YuFP CHPOIL ABOUT FPN TSE UBNPN NEUFE) IPUH RTYNEOIFSH UMEDHAEE MEYOOYE: vYUERFPM 480 NZ / 2 T./UHF., LPNRTEUU NBSH chYYOECHULZP / NEOSFSH KHFTPN Y CHYUEETPN.
iPFEM VSHCH KFPYUOIFSH DPYTPCHLH - OE UFPYF MY VPMEE JOFEOUYCHOKHA FETBRYA RTPCHEUFY? h RTPYMSCHK TB MEUEOYE VSHMP OBUBUEOP FETBRECHFPN Y DBMOP OERMPIPK TEKHMSHFBF, OP DPUFBFPYUOP NEDMEOOOP. nPTsEF VSCHFSH, EUFSH VPMEE LZHZHELFYCHOSHE URPUPVSC?

pFCHEF:

chPRTPU # 7113 TSEOEYOB chPTBUF 25

x NHTSB PVOBTHTSEO HTPZEOYFBMSHOSCHK IMBNYDIYPY KHTPRMBBNP. nsch PVB ZPD OBBD HCE MEYUYMYUSH PF LFPPZP CE (DPLUYGILMYO, NEFTPOYDBPM, OYUFBFYO, GYLMPCHYT). BOBMYSH UDBCHBMY YUETE 3-4 OEDEMY RPUME MEYEOYS, LBL RPMPTSEOP. rPMHYUBEFUS OE DPMEYYUMYUSH? UEKUBU ENKH OBYUMY 5 MILKINGS NEFTPOYDBPM 0.25* 4T/D 5 MILKINGS. rPUME bFPZP oEPCHYT 10* 0.2 NM, URBTZhMP 200NZ* 12 DOEC, vYUERFPM 480 4F. *11 MILKS, UBFEN tKHMID 150 2F. *5 MILKS. rMAU oYUFBFYO 500 CHUE LFP CHTENS. rP ьФПНХ РПЧПДХ Х NEOS CHPRPTUSCH: 1. YuEN MEUYFSHUS NO. 2. UIENB CHSCHIPDYF PUEOSH DPTPZBS, OBN OE RP LBTNBOH. nPTsOP MY LBL- FP RP DTHZPNH CHSHCHMEYUYFSHUS. 3. pF oYUFBFYOB, LBL S ЪOBA, IPTPYE CHTBYU DBCHOP PFLBBBMYUSH YЪ- ЪB EZP OEJZHZHELFYCHOPUFY. noe RTPYMSCHK TB RTYYMPUSH RPUME LHTUB BOFYVYPFYLPCH Y OYUFBFYOB MEYUYFSH NMPYUOIGH. YuEN NPTsOP ЪBNEOYFSH oYUFBFYO. ъBTBOEE URBUYVP.

ANSWERED: 02/22/2012

Hello, Sergey! Previously, this drug was used to treat chlamydia. Currently, it is not used due to its low effectiveness.

ANSWERED: 02/27/2012 Maystryonok Anna Mikhailovna Baranovichi 0.0 dermatovenerologist

Dear Sergey! In any case, before taking antibiotics that your doctor will prescribe for you (taking into account allergies), you need to do a test to determine their tolerance (for example, RAL). For the treatment of chlamydia at the farm. There are enough drugs of different groups on the market.

Related questions:

Urogenital chlamydia is one of the most common infectious and inflammatory diseases. According to estimates, the number of newly diagnosed cases is about 4 million per year. It affects almost half of men of active sexual age (from 16 to 40 years old) and a third of women.

The causative agent of chlamydia

The disease is caused by bacteria of the chlamydia genus. In nature, there are 4 types of chlamydia. Chlamydia trachomatis and Chlamydia pneumoniae are predominantly human pathogens, while the other two primarily infect animals. In terms of their properties, chlamydia occupy an intermediate position between viruses and bacteria. Therefore, chlamydia is still more difficult to diagnose and treat than ordinary bacterial infections. Urogenital chlamydia is a sexually transmitted disease. There is often a combination of chlamydia with other genitourinary infections - trichomoniasis, gardnerellosis, ureaplasmosis.

Symptoms of chlamydia

The incubation period for chlamydia is approximately 1-3 weeks. Women experience slight discharge from the cervical canal, and may also experience itching, pain when urinating, and bleeding during the intermenstrual period. Sometimes the general condition suffers - weakness is noted, body temperature rises slightly. It should be noted that chlamydia often occurs without pronounced symptoms or does not manifest itself at all. Even without treatment, after some time (about 2 weeks), the symptoms of the disease disappear. In this case, chlamydia becomes chronic; the chlamydial infection is, as it were, “preserved” in the body, waiting for an opportunity to remind itself again.

Complications of chlamydia

The main danger of chlamydia lies precisely in the complications it can cause. In women, chlamydial infection often causes obstruction of the fallopian tubes, ectopic pregnancy, postpartum or post-abortion endometritis. Chlamydia can get on the wall of the bladder and cause hemorrhagic cystitis. Chronic inflammation of the urethra caused by chlamydia leads to the development of its narrowing (stricture). In addition to various complications affecting the genital organs, chlamydia can cause damage to other organs. Then this disease will already be called disease, or Reiter's syndrome. With Reiter's syndrome, the eyes (chlamydial conjunctivitis), joints (usually ankles, knees and spine), skin, and internal organs (usually hepatitis, but almost any organs can be affected) can be affected.
Chlamydia is especially dangerous in pregnant women. During pregnancy, an asymptomatic course of chlamydia is typical. At the same time, the course of pregnancy is characterized by a high frequency of complications. The threat of miscarriage is observed in every second woman with chlamydia. The incidence of ectopic pregnancy, spontaneous abortion, and undeveloped pregnancy is also high. When chlamydia affects the tubes and endometrium of the uterus, the process of development of the placenta is disrupted, which leads to disruption of the proper maturation of the fetus, improper formation of organs in the early stages of pregnancy, or low birth weight of the fetus when infected with chlamydia in late pregnancy.

Diagnosis of chlamydia

Diagnosing chlamydia is more difficult than diagnosing a bacterial infection. The simplest methods have an accuracy of no more than 40%. The most accurate and accessible method for determining chlamydia today is the immunofluorescence reaction (RIF) using antibodies labeled with a special substance - FITC.
It is safe to say about chlamydia that it is much easier to avoid than to cure. Prevention of complications of chlamydial infections attracts special attention, since patients with asymptomatic disease do not seek medical help. An example of successful experience in the prevention of chlamydia is Switzerland, the only country in the world where the number of patients with chlamydia is declining. Prevention of chlamydia in the country consists of the following main provisions: creation of a network of diagnostic laboratories, free treatment, promotion of the use of condoms, increasing the moral responsibility of partners for the spread of chlamydia infection.

Treatment of chlamydia

Due to the characteristics of chlamydia, antibacterial drugs against them are not as effective as against ordinary bacteria, therefore the treatment of chlamydia is more complex and time-consuming. In addition to the course of antibacterial therapy, it necessarily includes immunomodulatory therapy, multivitamin therapy, diet, and abstinence from sexual activity for the duration of treatment. Treatment of chlamydia must be carried out for all partners. At the end of the course, control tests are carried out. If chlamydia is not detected, then tests are carried out 2 more times after 1 month (in women - before menstruation). Only after this will it be possible to talk about the effectiveness of the therapy.
The following groups of antibacterial drugs are used to treat chlamydia:
1. Group of tetracyclines (Unidox salutab, Bassado, Vibramycin, Doxylan, Doxycycline Nycomed, Doxycycline hydrochloride, Doxt, Medomntsin, Tetradox, Metacycline hydrochloride, Tetracycline hydrochloride, etc.).

Drug for the treatment of chlamydia: Unidox solutab (Yamanouchi Europe, Netherlands)

Oral form of doxycycline. After oral administration, doxycycline is almost completely absorbed from the gastrointestinal tract. Eating food or milk has little effect on the absorption of doxycycline. Doxycycline reversibly binds to plasma proteins (80-90%) and penetrates well into tissues. Accumulates in the reticuloendothelial system and bone tissue. The recommended dosage is 0.1 g (1 tablet) x 2 times a day. The half-life of Unidox Solutab after a single oral dose is 16-18 hours, after taking repeated doses - 22-23 hours. The half-life of doxycycline in patients with impaired renal function does not change, because its excretion through the intestines increases. Hemodialysis and peritoneal dialysis do not affect the concentration of doxycycline in the blood plasma.
1 soluble tablet of Unidox Solutab contains 100 mg of doxycycline monohydrate.

2. Group of co-trimoxazoles (Co-trimoxazole, Aposulftrim, Bactoreduct, Bactrim, Bactrim syrup, Berlocid 240,480,960, Bicotrim, Biseptol, Bisutrim, Groseptol, Duo-septol, Intrim, Co-trimoxazole-ICN, Co-trimoxazole-ACRI, Co -trimoxazole-TEVA, Cotrimol, Cotripharm 480, Oriprim, Rancotrim, Septrin, Septrin-forte, Sinersul, Sulotrim, Sumetrolim, Trim, Trimezol, Trimosul, Tsiplin, Expozol and others).
Co-trimoxazole - active substances - sulfamethoxazole and trimethoprim. It has a bactericidal effect against a number of gram-positive and gram-negative microorganisms, including chlamydia. The dosage regimen is set individually and depends on the type of pathogen, the severity of the infection, and the dynamics of the patient’s condition.

Drug for the treatment of chlamydia: Biseptol (Polfa, Poland)

Antibacterial agent with a wide spectrum of action. The combination of trimethoplrim and sulfamethoxazole enhances the bacteriostatic effect. Biseptol has a stronger effect on bacteria and less often leads to the formation of resistant strains than its components used in monotherapy. The drug is quickly and completely absorbed from the gastrointestinal tract. The drug should be taken with plenty of liquid, preferably after a meal. Biseptol is usually well tolerated by patients. Sometimes there are dysfunctions of the digestive tract (nausea, vomiting, less often diarrhea) and allergic skin reactions. Available in the form of tablets of 120 and 480 mg.

3. Group of macrolides - azithromycin (Sumamed, Azivok), clarithromycin (Klacid, Kriksan, Klabaks, Fromilid), erythromycin (Erythromycin), midecamycin (Macropen), roxithromycin (Rulid), spiramycin (Rovamycin), josamycin (Vilprafen) and others.

Drug for the treatment of chlamydia: Wilprafen (Heinrich Mack Nacht, Germany)

An antibiotic whose active ingredient is josamycin. When high concentrations are created at the site of inflammation, it has a bactericidal effect. After oral administration, the drug is quickly absorbed from the gastrointestinal tract. Taking the drug at intervals of 12 hours ensures that a high concentration of the active substance is maintained in tissues throughout the day. Indicated for the treatment of infectious diseases of the genitourinary system, including genital chlamydia. As a result of the studies, Vilprafen proved to be a fairly effective remedy for the treatment of urogenital chlamydia (of 68 patients observed, cure was achieved in 64 (94.1%)). Compared to other macrolides (for example, erythromycin), Vilprafen has a more favorable safety profile; it causes fewer side effects from the gastrointestinal tract. The drug is available in the form of film-coated tablets, 500 mg, 10 pcs. in packaging, and oral suspensions of 300 mg (in 10 ml), 100 ml in a bottle complete with a measuring cup.

4. Group of fluoroquinolones (Maxaquin, Ofloxin 200, Abaktal, Normax, Okatsin, Tsifran, Tsipromed, Tsiprlet, Ciloxan, Peflacine, Peflacin, Perflox, Perti, Tarivid, Zanotsin, Normax, Norilet, Girablok, Norbactin, Nolitsin, Lomflox, Raksar, Enoxor, Tsiprinol, Quintor, Quipro, Liprokhin, Tsiprobay, Tsiprosan, Ciprofloxacin, Tsifloksinal, Tsiprocinal and others).

Drug for the treatment of chlamydia: Abaktal (Lek, Slovenia)

A synthetic broad-spectrum antimicrobial agent whose active substance is pefloxacin. Abactal is rapidly absorbed (20 minutes after oral administration of a single dose of 400 mg, 90% of pefloxacin is absorbed) and reaches maximum concentration 1-2 hours after administration. Thanks to its high volume of distribution, it quickly penetrates into tissues, organs and body fluids. The drug is indicated for the treatment of infections caused by organisms sensitive to pefloxacin: urogenital infections, including chlamydia. During treatment with Abaktal, exposure to ultraviolet radiation should be avoided. Available in the form of 400 mg tablets and solution for injection.

Drug for the treatment of chlamydia: Girablok (Medochemie, Cyprus)

The drug, the active ingredient of which is norfloxacin, is an antibiotic from the fluoroquinolone group. Causes a decrease in the virulence of microorganisms, suppression of their production of exotoxins and exoenzymes, and an increase in phagocytic activity against microbial cells. When taking Girablok, high concentrations are created in the intestines, bile, prostate gland, testicles, uterus, kidneys, bladder, urethra; effective when taken orally. It has a wide spectrum of bactericidal action, is active against extra- and intracellular pathogens, including chlamydia and mycoplasmas. Girablok is also active against hospital strains, including Pseudomonas aeruginosa. Causes a long-term post-antibiotic effect. The development of bacterial resistance to the drug is very slow, “multi-stage”. Indications for use are infections of the urinary system; genital organs, including prostatitis, cervicitis, gonorrhea; acute bacterial enterocolitis. It is several times more active against urinary infections than nalidixic acid. The frequency of side effects when using the drug does not exceed 5%. Release form: film-coated tablets, 200 and 400 mg.

Drug for the treatment of chlamydia: Maxaquin (Searle, USA)

A broad-spectrum antimicrobial drug whose active ingredient is lomefloxacin. Resistance to Maxaquin rarely develops. The drug is active against strains of microorganisms that are multi-resistant to antibiotics. The drug is indicated for the treatment of acute and recurrent chlamydia (including mixed bacterial-chlamydial infection). Maxaquin is used 400 mg once a day, regardless of food intake. The duration of treatment for acute chlamydia is 14 days, for recurrent chlamydia, including mixed bacterial-chlamydial infection, 14-21 days. Maxaquin is produced in the form of film-coated tablets containing 400 mg of active substance, 5 pieces in a blister.

Drug for the treatment of chlamydia: Sparflo (Dr. Reddy's Laboratories, India)

A new antibacterial drug from the fluoroquinolone group. The main active ingredient of the drug is sparfloxacin, which has the highest activity against gram-positive bacteria without significant changes in activity against gram-negative microbes, compared to other widely used fluoroquinolones. Sparflo is relatively slowly absorbed from the gastrointestinal tract and penetrates well into various organs and tissues of the body. It is characterized by a prolonged action and provides a high concentration in the tissues and cells of the phagocytic system. The drug can be taken regardless of meals. Indications for the use of Sparflo are infections of the respiratory tract, kidneys and urinary tract, skin and soft tissues, gastrointestinal tract, surgical infections, as well as sexually transmitted diseases - gonorrhea, chlamydia. It is the drug of choice for the treatment of nosocomial infections. The drug is easy to use - it is active in low daily doses when taken orally, applied once a day. The drug is usually well tolerated. During treatment with Sparflo and for 3 days after the end of treatment, patients should not be exposed to ultraviolet radiation due to the possibility of developing photosensitivity reactions. Available in the form of film-coated tablets containing 200 mg of sparfloxacin, 6 tablets per package.

Drug for the treatment of chlamydia: Tsiprolet (Dr. Reddy's Laboratories, India)

A powerful and fast-acting antibacterial agent, the active substance of the drug is ciprofloxacin. From the group of fluoroquinolones. It acts bactericidal, inhibiting DNA gyrase of bacteria, without exerting a toxic effect on human cells due to the difference in enzyme systems. Effective against most aerobic gram-negative and gram-positive microorganisms. The drug acts on strains resistant to other antibacterial agents. Tsiprolet has a large volume of distribution in the body and creates high concentrations in tissues. It is used for various infections caused by microorganisms sensitive to the drug, in particular for infections of the respiratory system, ENT organs, genitourinary system, gastrointestinal tract, bones and joints, skin and soft tissues, sepsis, as well as gonorrhea. The use of the drug is contraindicated during pregnancy and lactation, as well as in childhood until the end of intensive growth. Tsiprolet is available in the form of tablets of 250 or 500 mg, 10 tablets per package, a solution for injection in bottles of 200 mg 100 ml and an ophthalmic solution in a dropper bottle (3 mg/5 ml).