Chlamydia during pregnancy: ways of infection, symptoms, treatment. Treatment of chlamydia during pregnancy: when to start, which schemes and drugs are considered safe

In a happy and difficult period of bearing a child, a woman can face many difficulties and problems that are fraught with any, even the simplest disease.

Moreover, pregnancy and medications are not entirely compatible.

That is why it is so important to prepare to become a mother, following all medical recommendations, undergo examinations for various infections and diseases, and take tests. This will insure you against unpleasant surprises during pregnancy.

One of the insidious and dangerous infectious diseases that can be asymptomatic for a long time and not make themselves felt is chlamydia. It is through the fault of its negative influence that various pathologies arise, miscarriages or infection of the fetus occur.

Urogenital chlamydial infection in the structural group of all STDs (sexually transmitted diseases) is practically the leader. The simplest microorganisms that carry it with them cause many different lesions, that is, inflammatory processes can begin not only in the genitals, but also in the joints, as well as the organs of the respiratory tract and vision.

Microorganisms have properties of both bacteria and viruses. Since they themselves do not produce energy, they need to get it from the cellular structures of the human body.

This disease is quite widespread.

The main cause of infection is unprotected sexual contact with an infected partner.

The probability of catching the disease through personal items (for example, a towel) is very low, because chlamydia is not very viable outside of its usual habitat - the mucous membranes.

During pregnancy, the infection can be transmitted vertically, that is, from mother to child. Microorganisms can enter through the amniotic fluid and infect or infect the fetus.

Symptoms

The insidiousness of the infection is that it often does not manifest itself. An infected person may not even suspect that they have chlamydia.

Sometimes there are minor symptoms, but if you have not made any attempts to detect the infection and treat it, then it will flow into a chronic form.

Also, the disease can manifest itself from time to time even after taking medications, since microorganisms have already adapted to one or another type of antibiotics.

If chlamydia managed to "infiltrate" the epithelium of a person or the cells of his immune system, then they can even exist there for years, causing various foci of inflammation.

If you did not take tests and were not examined before pregnancy, then here's what you should be alerted to (depending on the level, how and where chlamydia is located):

• the presence of permanent, but (usually they have an unpleasant odor and);
• itching and burning in the vulva;
• inflammation of the appendages, cervical canal;
• discomfort during urination, urethritis;
• chronic respiratory diseases, frequent arthritis or conjunctivitis can also become alarms;
• when combined with other bacteria and infections, similar symptoms are possible.

Be sure to consult your doctor if you find at least some manifestations of infection. Treatment of chlamydia should be timely and of high quality so that it does not lead to any more serious complications.

What is the danger of the disease, what consequences can be for a pregnant woman and fetus?

Despite the fact that antibiotic therapy during pregnancy is an undesirable phenomenon, the infection is still best treated.

The doctor will make a decision based on the individual situation. Maybe in your case you need only local treatment, or maybe a comprehensive general one.

The fact is that chlamydia, like many other infectious diseases, usually becomes very aggravated during pregnancy against the background of a decrease in the body's immunity.

That is, the rate of development and manifestation of the infection will depend on how strong your immune system is. However, doctors warn that chlamydia during pregnancy can lead to many very serious consequences for the baby:

• provocation of spontaneous abortions or miscarriages;
• the risk of intrauterine growth retardation of the fetus up to his death and;
• damage to the main systems and internal organs of the child due to or;
• violation of the supply of nutrients to the fetus (as a result, premature babies are born with clear signs of anemia or beriberi, with critically low body weight);
• infection of the baby when passing through the birth canal, that is, the child will be born with congenital chlamydia (fraught with manifestations of chlamydial pneumonia, conjunctivitis, encephalopathy and other diseases).

In addition, your water may break prematurely, and labor will not begin according to plan. Also, often chlamydia is one of the causes of habitual miscarriage of a child or even infertility.

How to diagnose chlamydia during pregnancy?

It is recommended to conduct examinations for the presence of chlamydia in the body even when planning a pregnancy.

If this has not been done, then the doctor will focus on your complaints or identified symptoms in order to refer you for analysis.

Chlamydia is diagnosed using various laboratory methods.

The sampling of the material is carried out in conjunction with the ultrasound procedure, so that you can observe how the baby behaves and how he reacts to what is happening in order to save yourself from unnecessary worries. Timely detection of infection will significantly reduce the risk of its harmful effects on the fetus.

For all types of tests for chlamydia, a collection of the necessary materials is taken: blood, urine, scrapings of the mucous membranes (from the cervical canal, vagina or urethra).

One smear in the case of chlamydia is often not enough, as they are located in colonies, which often leads to inaccuracies in the results. Since the diagnosis and treatment of infectious diseases must be carried out by both partners, men donate sperm for analysis.

polymerase chain reaction method

The study by PCR has received the definition of a kind of "gold standard" all over the world. This analysis belongs to the molecular biological group, since it determines the genetic material of the microbe.

During the study, a certain sequence of the desired region of the DNA nucleic acid is accumulated. This is done with the help of special enzymes in artificial conditions.

Doctors say that it is this analysis that is characterized by the greatest sensitivity in diagnosis (especially viral infections) and gives results with an accuracy of 80-100%.

But it is necessary to strictly observe all the rules for the delivery of material sampling, as well as clear sanitary and hygienic standards for its processing and transportation. If they are violated, false-positive or false-negative results are possible.

The PCR method will detect bacteria even at the initial stage of development or, if any, after the treatment. Normally, the test should be negative.

Linked immunosorbent assay

With the help of ELISA, doctors will be able to determine the content of chlamydia in your blood during pregnancy. Antibodies to chlamydia: IgG, IgA, IgM must be produced by the body in response to an infection. This test will require your blood and a scraping of mucus material.

In the course of the study, it is possible to identify the causative agent of the disease itself, and the stage of chlamydia (chronic, acute, asymptomatic), and the degree of its course.

That is, if certain antibodies are present in the body (usually the first of them appear 2-3 weeks after infection), then this indicates the presence of an infection.

The method is considered indispensable in the complex diagnosis of the disease, but in itself it gives very insufficient results with an accuracy of up to 60%.

Only a doctor should decipher the testimony of your tests.

The fact is that it is far from always possible to judge how intensively the inflammatory process develops, or at what stage the disease is, based only on the titer value. In any case, you will need additional examination.

According to indicators for the presence of infection, titers are distinguished:

• low - IgM (1:100 and below);
• moderate - IgA (from 1:100 to 1:200);
• medium - IgG (from 1:200 to 1:400).

It is also worth paying attention to the dynamics of individual titers, for example, if you were tested and treated before pregnancy. By combinations of antibodies, one can also judge the nature and development of the disease:

• with high levels of IgA and IgM, but a low titer of IgG, they speak of an early stage of the process;
• in the absolute absence of antibodies - about the absence of infection;
• if IgG is present, but IgM is not, then this means that you are just a carrier of chlamydia for the time being or have some immunity after the disease has already been transferred. Usually treatment in such cases is not prescribed;
• the presence of acute primary chlamydia is diagnosed in the absence of IgG, but a large titer of IgM;
• IgA appear after IgM. The presence of IgA together with IgG indicates that the disease is developing successfully. If the IgA titer is low, and there is no IgG at all, then this indicates the persistence of chlamydia in your body. With opposite indicators, we can talk about a kind of “immunological scar”, which indicates a long-standing infection that you once suffered;
• with elevated titers of all types of immunoglobulins, doctors confirm the cause of inflammatory processes or developing foci of infection.

Determining the stage of an infectious disease based on the results of ELISA studies of IgM, IgA, IgG

In addition to these studies, the following can be carried out in parallel: crops for chlamydia (cultural method), taking smears for microscopic analysis, examination for an immunofluorescence reaction, and routine blood sampling.

It is better to confirm the diagnosis using several diagnostic methods in order to be absolutely sure of the test results and get the right prescription for complex treatment or prevention.

How to treat an infection: choosing a safe treatment

During pregnancy, this task is quite difficult.

Due to the fact that microorganisms are located inside your cells, the doctor will have a difficult choice between medical means, because not all antibiotics can penetrate into the zones of chlamydia colonies.

In addition to the fact that they have various side effects, such drug therapy simply cannot be used during pregnancy (especially in its early stages).

However, it is impossible to ignore the disease and run it even further. Even if you protect yourself from possible complications of chlamydia, and the fetus is not infected in utero, there is still a high probability of infection of the child during childbirth.

Only a doctor can prescribe a course of treatment, focusing on the results of your tests, detailed examinations, the course of the pregnancy itself and the individual characteristics of your body.

• If you have a chronic form of the disease that does not cause any complications, then treatment is usually prescribed after the 20th week of pregnancy, so that all the main organs and systems of the baby have already formed.
• With a high probability of a risk to the life of the child or the slightest sign of intrauterine infection, therapy can be started after 12 weeks or even earlier.

When choosing antibiotics, the doctor is guided by the main principle: do not harm the health and well-being of the child. Macrolides are usually chosen because they are the safest (due to obstruction of the placental barrier), unlike tetracyclines. Several methods of treatment are used:

• a single dose of a drug that is highly sensitive to microorganisms;
• a short course of antibiotics;
• general therapy, which includes complex treatment measures.

In addition to antibiotics, the doctor prescribes various immunomodulatory drugs designed to boost your immunity. There will also be prescribed vitamins and minerals to promote general health, topical antimicrobial or antifungal medicines, agents to restore intestinal microflora, enzymes to promote body regeneration.

Microorganisms during pregnancy cannot be completely destroyed, but you can stop their reproduction and reduce the distribution area.

The doctor will probably ask you to make a detailed diagnosis to exclude the presence of other infections. Both partners must undergo a comprehensive course of treatment. After a month or two, it is necessary to pass tests and conduct an examination again.

Easier to prevent than to cure

Prevention measures for chlamydia are almost the same as for any other infection of this type:

• avoid promiscuity;
• if you are unsure about your partner's health, use contraceptives;
• observe basic standards of personal hygiene;
• regularly visit a doctor and undergo the necessary examinations;
• do not start your health (treat general and infectious diseases, emerging inflammatory processes, preventing them from flowing into a chronic form);
• strengthen the immune system;
• lead a healthy lifestyle.

The female body can be seriously affected by the effects of chlamydia. Infection negatively affects the state of internal organs, the health of the reproductive system. Therefore, it is often difficult to get pregnant after an illness.

Be sure to get tested before conception to protect your baby from the threat of disease. If you find an infection while already in a position, then you should make every effort to minimize its negative consequences as much as possible or eliminate them altogether. Timely access to a doctor will be the key to successful treatment.

Chlamydial infection (urogenital chlamydia) is a disease with predominantly sexual transmission caused by pathogens of the genus Chlamydia. Manifestations of urogenital chlamydia are very diverse, from urethritis to salpingitis and secondary infertility.

Before considering the effect of chlamydia on the macroorganism, it is necessary to become more familiar with the life cycle of these microorganisms and their distinctive features.

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1. Ways of infection with chlamydia

Representatives of the genus Chlamidia are intracellular obligate gram-negative microorganisms of a rounded shape. Outside, chlamydia cells are not able to independently produce energy, therefore, for an adequate energy supply, they need a living, healthy cell.

In their structure, chlamydia, unlike viruses, carry both DNA and RNA strands, and are capable of independent DNA protein synthesis.

There are several main types of chlamydia Chlamydia:

1. 1 Chlamydia psittaci, Chlamydia pecorum are classified as zooanthroponic infections and are found in faeces, urine, meat, and milk of infected animals. Most often, the infection caused by these types of Chlamydia is occupational.
2. 2 Chlamydia pneumoniae is the causative agent of the so-called respiratory chlamydia, atypical pneumonia. This type of microorganism was officially accepted only at the end of the 20th century, therefore it is considered relatively new. Target organs in this case are the respiratory tract and lung tissue (pharyngitis, bronchitis, interstitial pneumonia).
3. 3 Chlamydia trachomatis - affects mainly the urogenital tract, has a tropism for the epithelium (especially cylindrical). It is this species that is of greatest interest in the diagnosis of sexually transmitted infections.

It must be remembered that Chlamydia trachomatis has several serovars that cause a variety of clinical forms. This:

• A, B, C - serovars are the causative agents of trachoma.
• L-1, L-2, L-3 are the causative agents of tropical venereal disease and affect mainly lymphatic tissue.
• D, E, F, G, H, I, K - causative agents of urogenital chlamydia.

In their life cycle, microorganisms exist in two main states:

1. 1 Reticular bodies, in which the microorganism is inside the host cell and is inaccessible to the immune cells of the macroorganism (host);
2. 2 Elementary bodies are the initial mature state in which the microorganism is outside the host cell, actively involved in the infectious process, but at the same time accessible to antibodies, macrophages and lymphocytes. Due to this period of the life cycle of chlamydia, it is possible to detect antibodies to them in the blood of an infected person.

Infection with urogenital chlamydia in most cases occurs through unprotected sexual intercourse. The household way of transmission of infection (casuistic cases) is not excluded.

The source of infection is a carrier (infected person), with an acute or chronic course of the disease. The entrance gate is the urogenital tract.

Due to the high tropism of the pathogen to the epithelium of the cervical canal and urethra, the first signs of the disease are, as a rule, urethritis and cervicitis. The incubation period for chlamydial infection is 10 to 15 days (7 to 21 days).



Figure 1 - The development cycle of chlamydia

2. Features of pathogenesis

The basis of the pathogenesis of chlamydial infection is the development of cicatricial process. Reproducing in the epithelial cells of the host organism, chlamydia use various pathogenicity factors.

In response to the invasion of an infectious agent, complement production begins, followed by stimulation of granulocytes. The resulting inflammatory reaction is accompanied by cell destruction, edema and hyperemia of the mucous membrane, violation of the integrity of the epithelial layer with rejection of the epithelium.

At the same time, the inclusion of cellular immunity in the work, the active production of cytokines begins. This process allows chlamydial bodies to further penetrate and destroy infected cells, again at the expense of the host's immune agents.

Roughly speaking, a "vicious circle" is formed. In response to a long-term process and a violation of microcirculation, active collagen production, fibroblast proliferation and, as a result, the development of a cicatricial process begin.

An important aspect of pathogenesis is the absence of phagocytosis. This means that the interaction of chlamydia with macrophages and lymphocytes does not always end with their lysis.

This feature, in turn, determines the persistence of chlamydia, the multifocal lesion and the chronicity of the process.

During the infectious process, the humoral link of the immune defense of the macroorganism is activated, the production of specific antibodies by B-lymphocytes begins. By the nature of circulating antibodies, one can judge the stage of the process. This is what serodiagnosis (enzyme immunoassay) is based on.

Chlamydia are characterized by low immunogenicity, after a chlamydial infection, immunity is unstable. With reinfections, clinical manifestations are of the same intensity.

3. Classification of chlamydial infection

The following forms are distinguished along the stream:

1. 1 Acute (fresh chlamydia with clinical manifestations and rapid course, the period of infection in this form is not more than 2 months).
2. 2 Chronic (long-term infection with a period of infection of more than 2 months). Chronic chlamydia can be recurrent (periods of remission are replaced by periods of exacerbation) and asymptomatic (have a torpid course).
3. 3 Reactivation (activation of the infectious process).
4. 4 Reinfection (re-infection).

Classification of chlamydia (ICD-10) according to the localization of the inflammatory process is presented in the table below.



Table 1 - Classification of urogenital chlamydia by localization and ICD-10

4. Symptoms of urogenital chlamydia

One of the distinguishing features of chlamydia is its latent course. Chlamydia are able to persist in the host organism for many years, without showing themselves in any way, and make themselves felt only in a state of significant immunosuppression (for example, during pregnancy).

Nevertheless, it is possible to identify the characteristic symptoms for this infection. These include:

1. 1 Itching, burning in the anogenital region, slight swelling of the vulva. These complaints may be transient, that is, disturb for a while, subside and reappear after a while.
2. 2 Urethritis is manifested, as a rule, by painful urination, dysuria, discharge from the urethra. When bakposev urine chlamydia will not be detected.
3. 3 Endocervicitis: there are complaints of discharge from the genital tract of a mucopurulent, purulent nature, in a moderate amount. When viewed in the mirrors, it is possible to detect petechial hemorrhages of the cervix, follicular hypertrophic ectropion, and the endocervical plug may have a mucopurulent character.
4. 4 Endometritis manifests itself in the form of abundant, prolonged menstruation with a violation of the cycle (hyperpolymenorrhea), pain in the lower abdomen, regardless of the phase of the cycle, infertility.
5. 5 Salpingitis is accompanied by pain in the lower abdomen of an irregular nature, infertility (due to the development of adhesions and tubal obstruction).



Figure 2 - Chlamydial Cervicitis

Thus, a woman may not know for a long time about the presence of a chlamydial infection in her body. Often, chlamydia is detected only when registering for pregnancy.

In the same period of a woman's life, the infection can manifest itself especially clearly, since the body is in a state of physiological, rather significant immunosuppression. What is the danger for the course of such a pregnancy?

5. Effect of chlamydia on pregnancy

According to various sources, in 10-40% of cases, it is chlamydial infection that is the factor leading to spontaneous miscarriages in the early stages, the development of ectopic pregnancy.

It is chlamydial infection that can disrupt the processes of implantation of the fetal egg, placentation, lead to the fading of pregnancy, and in 10-17% of cases is the cause of habitual miscarriage.

The complications listed above are typical both with the activation of a chronic process and with an acute infection, that is, infection already during the current pregnancy in the early stages.

In the later stages of pregnancy (in the II - III trimesters), chlamydia already manifests itself in the form of placental disorders, contributes to placental abruption, causes malnutrition and fetal growth retardation.

When infected with chlamydia in the third trimester, the development of acute chorioamnionitis, rupture of membranes, and premature birth are possible.

Invasive procedures during pregnancy (for example, amniocentesis) can also provoke the activation of a latent (hidden) infection.

In the postpartum period, a woman with chlamydial infection is more likely to develop endometritis with a latent, sluggish course.

6. Why is the infection dangerous for newborns?

It should be remembered that the immune system of the fetus and newborn differs from that of an adult and is not capable of an adequate immune response to the introduction of foreign agents.

Therefore, chlamydial infection in newborns is often severe, which does not exclude a fatal outcome. Firstly, chlamydia crosses the placental barrier, so intrauterine infection plays an important role.

This leads to malnutrition, fetal growth retardation. If the affected amniotic fluid enters - to intrauterine pneumonia.

All of the above significantly increases the risk of antenatal fetal death. In 17% of cases of perinatal mortality, Chlamidia trachomatis was isolated from the internal organs of the dead.

Secondly, when passing through the birth canal of the mother infected with chlamydia, the newborn becomes infected in 40-70% of cases.

In girls, chlamydia can be localized in the vulva, urethra, rectum; in boys - in the area of ​​the urethra and rectum. One of the manifestations of intranatal infection is chlamydial conjunctivitis of newborns.

7. Laboratory diagnostics

Currently, there are several ways to diagnose chlamydial infection. Consider the most popular methods in descending order.

7.1. polymerase chain reaction

Polymerase chain reaction (abbreviated as PCR) is a popular and reliable method for detecting chlamydial infection, its sensitivity is 98-100%. The method is expensive.

The essence of PCR is to detect DNA and its fragments, as a result of which the possibility of detecting chlamydial bodies increases many times over.

This method is quite specific, gives reliable results in 97-99% of cases, both invasive (scrapings) and non-invasive (excretions, urine) media are used as a material.

When conducting PCR diagnostics, it must be remembered that after the eradication of chlamydia with antibacterial therapy, a false positive result is possible within 30 days after the therapy.

This is due to the fact that during PCR, it is not the viability of chlamydial bodies that is assessed, but the direct presence of DNA fragments. Therefore, it is necessary to take into account these terms when appointing a control analysis.

7.2. RNA Amplification Method (NASBA)

This method is also highly sensitive (98-100%, specificity is about 100%). To obtain a reliable result, material sampling is of particular importance:

1. 1 Scraping from the cervical canal in women should be taken outside of menstruation.
2. 2 Scraping from the urethra should be taken no earlier than 3 hours after the last urination.
3. 3 It is necessary to comply with the conditions of storage of samples and the rules of transportation.

Like PCR, the RNA amplification method can give a false positive result after the treatment of chlamydia with antibacterial drugs if the material was taken earlier than 14 days after the end of the course.

7.3. Enzyme immunoassay (ELISA)

It is easy to perform, fully automated, gives reliable results in 85% of cases, economical. Its essence lies in the detection of not the chlamydial particles themselves, but antibodies to them.

At the same time, according to the class of detected antibodies, one can judge the duration and nature of the process. When IgG is detected, one should talk about an ever-transferred infection, this is the so-called "immunological scar".

IgA and IgM indicate a recent process. The combination of all types of immunoglobulins speaks for the course of an acute process, and the presence of both IgA and IgG is evidence of reactivation of the infection.

7.4. Cell Culture Study

This is one of the earliest methods for detecting chlamydial bodies inside cells. Its essence lies in the direct study of a preliminary taken and stained scraping for the presence of intracellular inclusions.

The method is effective only in the acute phase of the disease, its reliability is only 10-12%. This study requires specially trained personnel. The study of cell culture is subjective, therefore it is not widely used in clinical practice.

7.5. Direct fluorescence reaction (RIF)

RIF is based on an antigen-antibody reaction. The taken material (scraping) is treated with “labeled” antibodies that bind to chlamydia antigens and, when illuminated with a fluorescent lamp, give a light green glow.

This method is also quite subjective and depends on the experience of the laboratory assistant. The reliability of this method does not exceed 70%. Also, a false-positive result is not excluded in the presence of combined infections of the urogenital tract.

Other serological reactions include: complement fixation reaction (RCC); reaction of indirect hemagglutination (RIHA). They are used extremely rarely.

With all these types of studies, it is necessary to remember the likelihood of false negative results, which is often associated with a violation of the collection and transportation of the material.

During pregnancy, an analysis for chlamydia should be carried out at any time during registration. In the third trimester, it is desirable to repeat the study to exclude an acute process, to prevent intrauterine infection of the fetus and newborn during childbirth.

8. Antibiotics allowed in pregnant women

Treatment of chlamydia in pregnant women should be comprehensive, include etiotropic, pathogenetic and symptomatic agents.

The complexity of antibiotic therapy lies in the fact that when inadequate treatment is prescribed, chlamydia turns into a state of L-forms and becomes unattainable for drugs.

Treatment in pregnant women should begin after 12 weeks of gestation with simultaneous treatment of the sexual partner.

The drugs of choice in the treatment of chlamydia in pregnant women are macrolides.



Table 2 - Treatment regimens for urogenital chlamydia in pregnant women according to Russian clinical guidelines. (Josamycin is not in the 2010 European guidelines)

An alternative drug for treatment during pregnancy is erythromycin ethylsuccinate 250 mg 4 times a day (treatment for 14 days), or 0.8 g 4 times a day (treatment for 7 days).

It is possible to use amoxicillin at a dose of 500 mg 4 times a day for 7 days (recommendations from the CDC and the European Guidelines for the management of patients with chlamydia).

After adequate antibiotic therapy, it is necessary to restore the vaginal microflora with the help of probiotics and eubiotics, for example, Gynoflor, Laktozhinal.

A combination of antibacterial and immunomodulatory therapy is not excluded. For example, "Viferon" 500 thousand units rectally 2 times a day.

9. Prevention

The main task of medicine is the timely detection and treatment of chlamydial infection in pregnant women. This infection must be excluded when:

1. 1 Symptoms of cervicitis;
2. 2 Symptoms of conjunctivitis;
3. 3 Chronic pelvic pain;
4. 4 Contact bleeding;
5. 5 In pregnant women with burdened obstetric and gynecological history.

And, of course, the main means of prevention is barrier contraception and the prevention of promiscuity, especially during pregnancy.

During pregnancy, any disease causes a lot of trouble for the expectant mother, and especially sores of the genitourinary system. On the one hand, the disease can affect the development of the fetus, and on the other hand, its treatment can turn into unpleasant consequences. So the question is always relevant: to treat or not to treat?

Chlamydia is a fairly common and very unpleasant disease. It is sexually transmitted and is caused by the microbe chlamydia, which is a "mixture" of viruses and bacteria. Chlamydia first affects the mucous membranes of the body, then enters the epithelial cells, and then into the cells of the immune system. Naturally, the body reacts to such an introduction with inflammation, which, in turn, in case of untimely or incorrect treatment, leads to a change in the structure of tissues. The danger of the disease lies in the fact that it is asymptomatic for a long time, and only in the later stages do discharges appear, pain during urination is possible.

According to some reports, up to 10% of pregnant women experience this infection. During pregnancy, treating chlamydia is even more difficult, because you need to take care of the baby in the womb. If the chlamydial infection is not treated, then it can cause many complications both during gestation and in the postpartum period. It is the cause of miscarriages, non-developing pregnancy, premature detachment of the placenta. Chlamydia also affects the development of the fetus and is transmitted to the baby at birth. Chlamydial infection in newborns leads to otitis, pneumonia, conjunctivitis.

Treatment

Many doctors believe that chlamydia should not be treated during pregnancy. In their opinion, the harm from drugs is much more dangerous for the fetus than the infection itself. Others strongly advise expectant mothers to take responsibility for the treatment of chlamydial infection. However, it is better to do this in the second half of pregnancy, having established an accurate diagnosis.

Difficulties in the treatment of chlamydia are manifested in the fact that you should choose the most effective, but at the same time safe drug that will not affect the development of the fetus. In this regard, the course of treatment is reduced to a minimum, the antibiotic is taken for only a couple of days, mainly local preparations are preferred.

It is known that antibiotics from the tetracycline group are contraindicated during pregnancy due to the mass of side effects. Macrolide antibiotics are safer for pregnant women. However, you must understand that self-medication in this case is madness. Only an experienced specialist will be able to choose a method of treatment that is safe for you. Chlamydia is usually treated in several ways:

• a single dose of an antibiotic highly sensitive to chlamydia;
• long-term complex treatment, which includes antibiotics, immunomodulators, enzymes, vitamins.

The European treatment regimen looks like this: a single oral dose of Azithromycin (1 g) or for one week 2 times a day taking Doxycycline (0.1 g).

Erythromycin, Ofloxacin, Amoxicillin, Josamycin are considered safe drugs during pregnancy.

Quite often, Viferon is prescribed for the treatment of chlamydia. It has an immunostimulating and anti-chlamydial effect, but only in combination therapy stops the growth and spread of chlamydia.

No matter how advertised and safe drugs are, almost all of them have contraindications and side effects. A pregnant woman should pay special attention to her health and consult a doctor at the first suspicious symptoms.

Both sexual partners undergo a course of treatment and for the entire period it is necessary to exclude unprotected sexual intercourse, and also observe personal hygiene measures with special care.

The best prevention of chlamydia is a regular visit to the gynecologist, special vigilance when choosing a sexual partner. And if you decide to give birth to a baby, then during the planning period of pregnancy, you should definitely carry out and cure chlamydia in advance, if the diagnosis is confirmed.

Remember, any disease is easier to prevent than to cure. If you still failed to save yourself, then you should not be upset. Be patient and proceed with the treatment with all responsibility.

Health to you!

Especially for- Tanya Kivezhdiy

Chlamydia are absolute pathogens and normally cannot be present in human tissues and organs. The latent course of the disease allows pathogens to go unnoticed for a long time. However, a thorough examination of women during pregnancy does not allow such a dangerous infection to be missed. What analysis is the most accurate for chlamydia during pregnancy, what threatens the disease and how to get rid of it?

There are about six to eight varieties of chlamydia, but two species are dangerous to humans - Chlamydia trachomatis and Chlamydia pneumonia. The latter is the cause of atypical pneumonia, including in pregnant women. But more often you have to deal with Chlamydia trachomatis, which lives in the genitourinary tract in men and women, and immune complexes to it can circulate in the blood. It is for this type of chlamydia that screening is carried out during gestation.

What is the pathogen

A feature of microorganisms is their ability to pass into "sleeping" L-forms. At the same time, they are inside cells (most often the genitourinary system), pass from one to another during division, but are not recognized by the human immune system in any way. And only under "convenient" conditions are activated and cause clinical symptoms of inflammation.

The statement that chlamydia, like the herpes virus, is constantly present in the body, but is activated at special periods, is not entirely true. In the absence of treatment or non-compliance with regimens and doses, "hidden" forms continue to be in human cells, creating the appearance of well-being. This is a chronic variant of the disease, but not a variant of the norm.

How is it transmitted

The "favorite place" of chlamydia is the mucous membranes of the genitourinary tract. Therefore, the main route of transmission is sexual, including not only vaginal, but also anal, oral contacts. The incubation period of the infection can be up to two months, the symptoms are most often extremely poor.

In addition, contact-household transmission is possible with close contact with the secretions of other people. The greatest risk is associated with visiting baths, saunas. Infection through unwashed hands is also possible, while both the clinical picture of inflammation of the genitourinary system and conjunctivitis can occur, including in children. Newborns can become infected from a sick mother when passing through the natural birth canal.

Before or during pregnancy

When chlamydia is detected during gestation, the question naturally arises when the infection occurred, which is not only of clinical importance, but also of social significance - this is a serious threat to family relationships. The algorithm is something like this. If the woman has previously been examined:

• chlamydia were found- it is possible that the woman was poorly treated before pregnancy or the pathogens passed into the L-form, as a result, they can be re-identified during gestation;
• there was no chlamydia- detection of microbes during gestation indicates infection during or after conception.

If a woman has never been examined for chlamydia before, it is impossible to indicate the time of infection, given that the disease can proceed in an asymptomatic form for many years. However, it should be borne in mind that in this case, chlamydia very often leads to infertility due to the tubal factor - adhesions are formed and obstruction occurs.

The airborne route of transmission is typical only for Chlamydia pneumonia with the onset of symptoms of an acute respiratory disease. Infection with Chlamydia trachomatis requires contact with human body fluids containing the pathogen.

Symptoms of chlamydia during pregnancy

Most often, chlamydia is an “accidental” finding during a detailed examination of a pregnant woman. Sometimes the following facts are markers of the presence of infection:

• recurrent inflammation in the vagina- during examination, leukocytes are increased in ordinary smears, gardnerella, yeast fungi are present, coccal flora prevails;
• signs of poor fetal growth- according to the results of ultrasound, there is a growth retardation for two or more weeks, there are symptoms of intrauterine infection;
• gestation pathology- threatened miscarriage, chorionic detachment, amniotic fluid leakage or premature birth - all this is an indication for additional / repeated examination for chlamydia.

First of all, chlamydial infection is localized in the vagina and cervix, especially if the infection occurred during gestation. Therefore, the clinic is dominated by the following symptoms of chlamydia during pregnancy.

• Colpitis. The amount of leucorrhoea increases, they are light milky, without much odor, reminiscent of "cream". Itching, burning, redness of the external genitalia due to irritation with secretions may join.
• Cervicitis. A woman does not feel inflammation of the cervix and cervical canal. However, during a gynecological examination, redness and increased tissue vulnerability can be detected.
• Urethritis and cystitis. Chlamydia can manifest itself in the form of frequent and painful urination, pain in the lower abdomen due to inflammation of the bladder.
• Oral injury. Chlamydia can also live on the oral mucosa. The clinical picture corresponds to gingivitis, glossitis, pharyngitis and is accompanied by pain, ulcers, bad breath.
• Pneumonia . With a serious decrease in immunity, for example, against the background of HIV, atypical pneumonia with mild symptoms and signs on x-ray examination is possible.

Other complications of chlamydia, such as trachoma (damage to the membranes of the eye), Reiter's disease (involvement of the joints) are more common in non-pregnant women.

Why is dangerous

Chlamydia is more dangerous for the child, as it can affect its normal development. For women, the risk of postpartum complications increases.

For the fetus

The main consequences of chlamydia during pregnancy for a child:

• in the early stages- fading of the development of the embryo, the threat of interruption, detachment of the chorion, with chlamydia, the likelihood of malformations increases, as well as the ectopic location of the fetal egg (ectopic pregnancy in women);
• at a later date- lag in the growth and development of the fetus, impaired functioning of the placenta, increases the likelihood of late miscarriages, polyhydramnios, leakage of amniotic fluid and premature birth;
• after birth - every fifth baby born to a woman with chronic chlamydia develops inflammation of the eyes (conjunctivitis), every tenth has atypical pneumonia, especially often such complications develop in premature babies.

In addition, intrauterine infection, inflammation of the placenta (chorioamnionitis) can occur, which can pose a threat not only to the life of the child, but also to the woman.

For woman

During pregnancy, chlamydia, in addition to the troubles associated with colpitis, is fraught with the development of a conjunctivitis clinic if personal hygiene is not observed. For a woman, untreated chlamydia is most often fraught with the following complications after childbirth:

• endometritis - inflammation of the uterine cavity, which is accompanied by a violation of its contractility and prolonged involution (recovery);
• divergence of seams- increases the likelihood of suppuration of wounds of the vagina and perineum, followed by poor healing.

If chlamydia is in the urinary system of a woman, after childbirth, the frequency of cystitis, urethritis and even pyelonephritis increases. Ignoring the problem in the future can lead to Reiter's disease (joint damage), trachoma (eye disease).

What tests need to be done

Given the dangers of chlamydia during pregnancy, its diagnosis should be taken seriously. For the detection and subsequent treatment of chlamydia, one type of examination is sufficient - polymerase chain reaction (PCR), preferably its variety - real-time PCR. The latter helps to make the study more accurate and exclude overdiagnosis associated with the detection of "dead chlamydia".

polymerase chain reaction

PCR analysis is given at any time. Material sampling (scraping, better known as a “smear”, which is not entirely true) is carried out from the following places:

• urethra;
• cervix;
• posterior fornix of the vagina.

The detection of even single microbes is considered positive. A negative result confirms the complete absence of chlamydia in the body.

Linked immunosorbent assay

ELISA is often used to diagnose chlamydia. The study involves taking venous blood and determining antibodies to pathogens - Ig G and Ig M. You can interpret the result based on the following table.

Table - How to correctly understand the result of an analysis for chlamydia

Often you may encounter the fact that only if a positive Ig G (“chlamydia in the blood”) is detected during pregnancy, antibacterial treatment is prescribed according to the standard scheme. However, such an immune status may indicate a past illness rather than an active infection.

Other Methods

Chlamydia can also be suspected or detected by other methods, however, due to the high cost and duration of studies, they are used extremely rarely in atypical cases of infection.

The following tests may be used:

• immunofluorescence reaction (RIF);
• bacteriological culture.

A standard smear can only show the presence of inflammation in the vagina, urethra and cervix, but the pathogen cannot be identified in this way.

What to do when discovered

The question that the treatment is necessarily not in doubt, however, only when it is confirmed. There are no doubts and debates, as, for example, with mycoplasmosis or ureaplasmosis. Chlamydia are clearly classified as pathogens and should not normally be detected. Absolute indications for initiation of therapy during gestation:

• detection of chlamydia by PCR;
• detection of Ig M in the blood during an ELISA study.

When to Treat

The question of when to start treatment for chlamydia during pregnancy remains debatable so that the drugs do not have a serious impact on the development of the fetus. The generally accepted start of antibiotic therapy is considered safe from 16-20 weeks. However, in the case of acute chlamydia or complicated (for example, against the background of a threat, hematoma), expectant management can lead to pregnancy loss.

Chlamydia cannot be cured without antibiotics. But pregnancy imposes serious restrictions on antibiotic therapy. For example, "Doxycycline" and "Ofloxacin" are prohibited for treatment during gestation, as they cause a violation of the development of bones and teeth in the fetus. What means are acceptable for use, the table shows.

Table - Approved drugs for the treatment of chlamydia during gestation

Depending on the timing and in what situation the treatment is carried out, vaginal suppositories, as well as drugs to maintain pregnancy (for example, Duphaston), may be additionally prescribed. In the treatment of chlamydia in a woman, an important point is the rehabilitation of the sexual partner. Schemes and doses of drugs are similar. Sexual intercourse is possible only after a full course of therapy and control of cure.

Therapy control

There is no doubt that chlamydia is treated during pregnancy. Subject to all recommendations, the infection passes without significant complications for the mother and fetus. After treatment, it is necessary to control the cure. To do this, it is recommended to take a PCR test - a woman and her sexual partner no earlier than a month after taking the last pill.

ELISA study in this case is not always informative. The effectiveness of therapy can be assessed by decreasing antibody titers, but sometimes their level remains constant in the complete absence of infection.

What if you ignore

Some women refuse to take antibiotics during pregnancy, even with chlamydia. In these cases, they risk the health of the baby and their lives. Chlamydia in a woman in 70% of cases leads to various complications of gestation and infectious pathology of the newborn.

Chlamydia is an infectious disease caused by chlamydia. These pathogens have both properties of both bacteria and virus and have a complex cycle of development inside and outside the cell. Chlamydia invades the cells of the human body and destroys them, causing inflammatory reactions leading to adhesions and depletion of the immune system.

Due to the specific intracellular reproduction of chlamydia, antibiotic treatment is not always able to completely eradicate the infection. In addition, the primary infection in general is often asymptomatic or oligosymptomatic and can presumably lead to the transition of the disease to a chronic form. Often, as a result of improper treatment, persistent, i.e. "dormant", an infection that is activated from time to time. This disease is caused by modified forms of the pathogen that are resistant to antibiotics. the consequences of chlamydia are inflammatory diseases of the genitourinary system in men and women and infertility, which often develops as a result of this, as well as arthritis, conjunctivitis, pneumonia, and even damage to the cardiovascular system.

How does chlamydia present before pregnancy?

Approximately half of the cases of chlamydia occur with symptoms, which allows for a timely diagnosis and, as a rule, good treatment results.

Chlamydia can be manifested by lower abdominal pain of varying intensity, leucorrhea, cervicitis (inflammation of the cervical canal) in women, urethritis

and prostatitis in men. Very often, with chlamydia, another pathogenic microflora is activated: Staphylococcus aureus, enterobacteria, enterococci, Candida fungi, which causes various, often pus-like discharges from the genitals. Often there is a combination of chlamydia with other sexually transmitted infections, such as gonorrhea and trichomoniasis, which also causes symptoms.

The fact that chlamydial infection can manifest itself as the so-called Reiter's syndrome is also important. Reiter's syndrome is expressed by damage to the urethra - urethritis, eye damage - conjunctiva vit, vascular damage - arthritis.

Chlamydia is the cause of recurrent miscarriage

Chlamydia leads to habitual miscarriage - the repetition of spontaneous miscarriages, to intrauterine infection of the fetus, infection of the newborn.

Among specialists, there are polar opinions about possible complications in the fetus due to chlamydial infection during pregnancy: some believe that the consequences are minimal, due to the work of the fetoplacental barrier, others that very serious violations are possible.

It is believed that chlamydia can lead to the formation of malformations during primary infection or exacerbation of the infectious process in the first trimester of pregnancy, to the formation of fetal-placental insufficiency, infection in the second and third trimester of pregnancy.

During childbirth, the consequences of chlamydia may be premature rupture of amniotic fluid, weakness of labor. In our practice, we have practically not seen an adverse effect on the fetus of chlamydia transferred during pregnancy in the case of a competent approach to the management of this contingent of pregnant women.

Who needs to be tested for chlamydia?

During pregnancy, screening for chlamydia is not mandatory, but is recommended for women with inflammatory diseases of the genitals, infertility, chronic diseases of the respiratory tract, joints and conjunctivitis, especially in combination with problems in the urogenital area. It is also necessary for women with miscarriage (previous miscarriages), who have had ectopic pregnancies and premature births.

Methods for diagnosing chlamydia

• cultural method (crops);
• molecular (DNA) diagnostics, or polymerase chain reaction (PCR), which allows you to identify elements of the DNA of the pathogen in the test material;
• enzyme immunoassay (determination of antibodies in the blood);
• immunofluorescent method (examination of scrapings under a fluorescent microscope with the detection of an antigen, in this case, chlamydia) and some others.

Despite the fact that the PCR method is the “gold standard” all over the world, “local” options for such a diagnosis are sometimes questionable. This is due to the high manufacturability and cost of this method, which requires the strictest observance of sanitary and hygienic standards (multiple air filtration mode, boxed laboratory type, sterile clothing for medical staff, etc.), expensive imported reagents. Even minor errors in technology can lead to false positive results, unjustified treatment and discredit of the method. The same applies to cultures for chlamydia: if the technology is not followed, they can also give a certain percentage of erroneous results, but already false negatives.

According to many specialists dealing with sexually transmitted diseases, a high percentage of reliability of research results from the simultaneous use of two well-known, relatively inexpensive and widely used diagnostic methods. Direct immunofluorescence (DIF), based on the detection of an antigen (chlamydia) in a scraping (vaginal smear), and enzyme-linked immunosorbent assay (ELISA), which detects antibodies to an infectious agent in the blood (blood is taken from a vein) are used in combination. Both of these methods allow you to level out some of the shortcomings that each of them individually has. In addition, ELISA provides very useful information for the doctor about the duration and severity of the infectious process in the patient's body. The tactics of treatment completely depend on this.

Treatment

chlamydia during pregnancy

If chlamydia is found in a patient in the early stages of pregnancy, there is no need to terminate the pregnancy, but mandatory treatment is required according to generally accepted schemes. Chronic forms of chlamydia (type G antibodies are found in the blood) are treated at 20 and 30 weeks of pregnancy. If the process is acute (type M antibodies are found in the blood), treatment is necessary after 12 weeks of pregnancy.

Most foreign doctors adhere to the point of view that in the absence of clinical manifestations (pain, characteristic discharge, etc.) and indicators of infection activation (IgA, IgM) in laboratory studies, there is no reason to prescribe antibiotics to the patient. After all, a person is a carrier of many pathogenic (pathogenic) and conditionally pathogenic (conditionally pathogenic) microorganisms, and carriage is not always an indication for treatment. Only when the infection is activated, appropriate therapy is carried out.

Antibiotics of the tetracycline group are used to treat chlamydial infection. During pregnancy, preference is given to macrolides, ofloxacins of the latest generation. Mandatory is the correction of the immune status, taking into account the specifics of the infection.

Recently, our attention has been attracted by a new drug - HUMAN ANTI-CHLAMIDIA IMMUNOGLOBULIN, which contains antibodies against chlamydia. Throughout the treatment, it is necessary to take medications that support liver function, to prevent a fungal infection. There is a need to supplement the treatment with enzyme therapy (enzymes), vitamins, and subsequently, to restore beneficial microflora, use eubiotics - lacto- and bifidobacteria.