Chlamydial infection (chlamydia), which is provoked by specific microorganisms - chlamydia, can adversely affect many systems and organs of an individual. Chlamydia occurs in men, women, children, including newborns (in the latter group, the pathology is often the cause of blindness). When the urogenital tract is affected, urogenital chlamydia is referred to. Every year, about 90 million people fall ill with this disease.
Causes of Chlamydia
The causative agents of the disease are chlamydia, which is a specific parasite, derived from the word “Chlamyda”, meaning a “cape” (so to say, they “cover” the nuclei of the affected cells).
Three kinds of such parasites can be found in humans. Urogenital chlamydia in men is predominantly sexually transmitted and is provoked by Chlamydia trachomatis, or more exactly, by its several serotypes (particular groups). Pathogens of this species, like viruses, can live exclusively inside/at the expense of the cells of the infected organism, affecting the epithelial tissue of certain organs (urogenital tract, conjunctiva, etc.). At the same time, due to the peculiarities of the structure, these microorganisms refer to bacteria, which makes it possible to treat the disease with chlamydia by means of antibacterial drugs.
Another species, respiratory chlamydia, also sometimes can be detected in the urinary tract induced by oral-genital sex.
Thus, men can get infected with chlamydia as a result of sexual intercourse (traditional, anal-oral-genital). Newborn boys can become infected from mothers aborning. In theory, it is possible (although, there is a lack of evidence) to get infected through non-sexual contact. The probability of the latter option is very low, since the causative agent of the infection cannot survive in the external environment for a long time.
An increased risk of infection is reported:
• upon frequent change/several sexual partners;
• at a young age (from 15 to 24 years old);
• in adoptive boys;
• in non-European persons ;
• under poor socio-economic conditions;
• after unprotected sexual intercourses;
• in lonely persons;
• if there is a past/present other sexually transmitted infection;
• with congenital/acquired immunodeficiency, etc.
Types and Symptoms of Chlamydia
The symptoms may appear one to three weeks after contamination. In 50% of men, the infection proceeds asymptomatically, and in 20% of episodes, chlamydia is diagnosed with gonorrhea.
Urogenital recent (when duration of the disease does not exceed two months) and chronic chlamydia can be distinguished. Recent disease is found in subacute, acute or paucisymptomatic forms.
Stages of the disease progression:
• primary contamination;
• permanent carriage/relapse;
In men, the urogenital chlamydia usually occurs in the form of urethritis (proctitis also is possible, which is inflammation of the mucous membrane of the rectum/sigmoid colon, conjunctivitis, pharyngitis). In a similar situation, mild itching, milky and/or mucopurulent discharge (sometimes, in the morning hours only, after the massage of the urethra) can be noted. Pain sensations are not characteristic or very mild. The patient can merely miss the onset of the disease.
Since chlamydia often occurs combined with gonococcal, trichomonas, ureaplasma and other microorganisms, the manifestations may be more pronounced (typical for other pathologies).
Sometimes, especially when a complication arises such as Reiter's, chlamydial balanoposthitis may develop, which is inflammation of the balanus and prepuce. In most cases, the balanus (balanitis) is affected, with the distinct foci visualized. It is interesting to note that chlamydia are absent in the affected areas. Probably, the infection activates opportunistic pathogenic microflora, which normally present, however do not cause disease.
Asymptomatically (chlamydia “live” as specific microcolonies in the body) no manifestations of the disease can be noted; the pathogen can be identified only by using high-precision diagnostic techniques.
With no or inadequate treatment of chlamydia in men, the symptoms can disappear gradually, but renew from time to time under favorable conditions, it can be said of a relapse. Such imaginary well-being is far from being safe for the body!
Methods of Diagnostics and Detection of the Disease
There are several techniques to diagnose the pathology:
• culture-based method (bacteriological swab test), which is not recommended by WHO for diagnosis in everyday practice, including due to time duration and high cost, but allows identifying viable pathogens and determining their sensitivity to antibiotics;
• microscopic study – the technique is fast and inexpensive, but rather judgmental;
• enzyme immunoassay (abbreviated as ELISA) – a fast, but expensive and requiring special equipment technique, it is of value only to verify the primary infection, and is not recommended in the world practice for diagnosing urogenital chlamydia
• polymerase chain reaction (in other words, PCR diagnostics) is the most sensitive and highly accurate, albeit costly, chlamydial analysis, a false negative result is possible only with a deeply localized pathological process, for example in the prostate, does not allow differentiating viable/non-viable microorganisms;
• determination of HSP 60 (the so-called chlamydia heat shock protein); the amount of such protein rises sharply with a persistent, constantly present form of the infection, which enables one to diagnose this type of the pathology;
• The latest NASBA method is more sensitive than PCR in revealing viable pathogens, but it is difficult to employ and expensive; it is recommended to resolve controversial points when the results obtained by other methods differ.
The following supplementary methods of examination (the necessity, number and scope will depend on the severity and nature of the symptoms) can be used:
• examination by a specialist, history taking;
• blood tests – clinical/biochemical analysis, HIV, RW, hepatitis blood tests;
• urinalysis – clinical/biochemical;
• defining the immune status;
• consultation by specialists in related profiles
Very detailed methods of detection of infections described here - viewtopic.php?f=14&t=13
Methods and Options of Treatment of Chlamydia
The urologist will select the treatment regimen for chlamydia on the basis of the following:
• clinical evidence;
• localization of the infectious process;
• duration of the disease;
• presence/absence of complications.
Simultaneously, examination and, if necessary, treatment of the sexual partner is required. For the duration of the therapeutic course, it is important to abstain from having sex, or use condomsю
The main treatment option is adequate antibiotic therapy. The drugs are prescribed that contain doxycycline and/or azithromycin (first line), josamycin, erythromycin, ofloxacin, roxithromycin. Dosage and duration of drug administration is prescribed by the doctor. If there is no effect, the drug is replaced with another one or a combination of several medicines (culture-based test may be needed to determine the sensitivity of the pathogen).
In addition, the following procedures may be recommended (although not always evidence-based):
• symptomatic treatment (anti-itch, pain medication);
• enzyme therapy;
• local treatment (washing the urethra with solutions of antiseptics such as chlorhexidine, potassium permanganate).
Traditional medicines, which can be used only in addition to antibiotics and only upon consulting a doctor, include:
• herbal decoctions (oak bark, calendula, chamomile, yarrow, etc.);
• lubrication of affected areas with a water infusion of garlic;
• baths with decoctions of walnut, juniper berries, etc.
According to world standards, control of healing process is to be carried out about a month after the completion of the therapeutic course, by means of PCR diagnostics (or three weeks later, if culture-based survey is employed). Hospitalization is required only if any complications arise, and/or with a significant manifestation of the inflammatory process.
A serious issue in the treatment of chlamydial infection is its combined course with trichomoniasis.
Trichomonas are known to have a tendency to “swallow” (phagocytosis) of some microorganisms (for example, gonococci, which has long been confirmed with an electron microscope). It was believed that the causative agents of genital infections that enter the trichomonas are not sensitive to antibiotics. As a result, first of all, it was required to cure trichomoniasis, and only then proceed with a concomitant disease. In this case, since Trichomonas proper are difficult to detect, antitrichomonad drugs were prescribed by default when another sexual disease was detected.
Later, a group of British researchers proved that trichomonas actually can absorb mycoplasmas, ureaplasmas and gonococci, however, the vital capacity of the latter within the “absorber” was only 3, 3 and 6 hours, respectively. Since the effect of antibacterial medicines persists more than this time, pathogens will die anyway. With regard to chlamydia, these same scientists have established that they are not phagocyted by Trichomonas at all. Thus, today, preventive treatment with anti-trichomoniasis drugs is not advisable. When mixed infections (Trichomonas chlamydia and others) are detected, treatment with the appropriate drugs must be carried out simultaneously. If in addition to chlamydial infection, concurrent candidiasis is detected, antifungal agents are used.
However, you cannot help recalling that the phrase “British scientists” has been already become a meme, which often cannot be taken seriously, even when they conduct their studies in such serious areas. In contrast to the research of English scientists, hundreds of participants of our forum (forum section discussing the treatment of chlamydia) argue the opposite: trichomonas infection absorbs chlamydia thus complicating the treatment. That is why many episodes of successful treatment of chlamydia, claimed at the forum, involved a consistent treatment of trichomoniasis, and then chlamydia.
Quite often a relapse of the disease leads to complications. Thus, chlamydia is a common cause of epididymitis in men (inflammation of the epididymis), orchiepididymitis (with the testicle involved in the inflammatory process). Orchiepididymitis, in turn, causes the narrowing of spermatic tracts, impaired sperm production and, eventually, infertility.
Also the following complications can develop:
• chronic chlamydial prostatitis (inflammation of the prostate gland), with or without corresponding symptoms, erectile dysfunction;
• chronic chlamydial vesiculitis (inflammatory pathology of seminal vesicles);
• chlamydial colliculitis (inflammation of seminal tubercle);
• stricture/narrowing of the urethra due to the formation of scars on the mucous membrane of the organ (the problem is treated surgically, however not always successfully);
• Reiter's syndrome, a very serious problem leading to disability, manifested by urethritis, joint damage (arthritis), conjunctivitis occurring simultaneously (sometimes balanoposthitis, skin lesions can also be revealed).
It has been conclusively established that urogenital chlamydia increases susceptibility to HIV.
Currently, no specific vaccine against chlamydial urogenital infection has been developed. Some prototypes of TRACVAX vaccine are passing preclinical trials.
Preventive measures include:
• healthy lifestyle;
• safe sex using condoms;
• timely detection/competent treatment of sexual infections;
• examination and treatment, if necessary, of a sexual partner.
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