Beauty and health of teeth 

What is chlamydia during pregnancy. Infectious complications and the impact of chlamydia on conception. Will pregnancy be normal after chlamydia

All women during the period of bearing a baby are extremely careful about all possible diseases, since any of them can cause a lot of discomfort and anxiety. Some women during pregnancy meet with a disease such as chlamydia. This infection poses a great danger to a woman who is waiting for the birth of a baby.

Chlamydia can be in the human body for a very long period of time and infect it, while not showing any symptoms. If this disease is not detected in a timely manner, then the consequences can be very deplorable, the fetus may die while still in the womb.

What is chlamydia and what are the ways of infection with it?

There is a large list of diseases that are sexually transmitted. Chlamydia is the most common of these diseases. The causative agents of the infection are chlamydia. They are endowed with features of both bacteria and viruses. The similarity of chlamydia with viruses is that they can only exist in the host's body, and outside it they die.

Chlamydia are not able to produce energy, they take energy from the cells of the person in which they exist. These microorganisms are slightly larger than bacteria, but smaller than viruses.

The most suitable and comfortable conditions for chlamydia are in the genitals, for this reason, the infection most often affects the organs of the genitourinary system. In some cases, microorganisms can be localized in the lower part of the small intestine, more precisely in its epithelial tissues, but this happens quite rarely. During pregnancy in women, chlamydia, in addition to the organs of the reproductive system and urinary tract, also affects the amniotic membranes.

The source of this infection is a person who has chlamydia. You need to know that chlamydia may not manifest itself for a long period of time. A person who is a carrier of the infection may not even know that they are sick.

Chlamydia is transmitted most often through unprotected intercourse. During pregnancy, chlamydia can be transmitted to a woman through everyday life. But this happens extremely rarely, about five times out of a hundred.

There is also a vertical route of transmission, that is, when the infection is transmitted to the fetus from an infected mother. From a pregnant woman who has chlamydia, chlamydia is transmitted to the fetus through the amniotic fluid. Chlamydia in some cases settle on the mucous membranes of the baby.

Women who have met with such a disease are wondering if they can get pregnant with chlamydia. Naturally, chlamydia is not a barrier to pregnancy and all women who have chlamydia can become pregnant without any problems. But it is worth thinking about the future health of the baby, so you still should not get pregnant until the woman gets rid of this disease. If the pregnancy was not planned, then there is still no need to fall into despair and panic.

In modern medicine, there are a lot of methods by which you can cure chlamydia, while not harming the baby.

Chlamydia. The mechanism of infection during pregnancy

Chlamydia enters the body of a healthy person after close contact with the mucous membranes of an infected person. Once in the body, chlamydia actively begin to affect epithelial cells and cells of the immune system. Chlamydia can stay there for a very long time, close to three to six years.

After some time (two - three days), the human immune system begins to respond to such an introduction - leukocytes begin to be produced. As a result of this process, an inflammatory process begins in the body. It can be expressed in different ways. In some, the inflammatory reaction is very pronounced, and in some it is practically not noticeable.

The risk of chlamydia during pregnancy

If chlamydia is not detected in time and adequate treatment is not started, then serious complications can occur. The most basic of them:

  • Chlamydia can cause pelvic inflammatory disease. They can penetrate into the uterus, into the fallopian tubes, into the uterine appendages, while provoking an inflammatory process (,).
  • Refter's disease may occur, which occurs with symptoms such as,.
  • On the mucous membrane of the urethra, cicatricial changes occur, because of this, the urethra narrows.

Women who are expecting a baby and find out they have chlamydia worry a lot about how chlamydia can affect childbearing. How is this disease reflected in pregnancy?

If the infection was transmitted to a woman in the early stages of pregnancy, the consequences can be very deplorable. A woman may have a spontaneous abortion (miscarriage) or stop the development of the fetus inside the mother. This is due to the fact that the disease provokes placental insufficiency, due to which oxygen reaches the child in insufficient quantities.

With a lack of oxygen occurs (suffocation). Hypoxia can be expressed in different ways. If the lack of oxygen is moderate, then the organs and systems of the baby will be affected. In this case, in a baby who was born, at best, light muscle tone can be detected. In a severe case, complex lesions of the nervous system can be observed. If hypoxia is sufficiently pronounced, then this leads to the death of the fetus in utero.

Also, with chlamydia, nutrients can be poorly supplied to the child. A woman who is sick with chlamydia during pregnancy can have babies with very low weight, s, s.

The baby can be infected with chlamydia in the later stages of pregnancy. The infection mainly affects the kidneys, pancreas and liver. The health of the crumbs depends on how strongly the microorganisms affected certain organs. The sooner adequate treatment is prescribed, the less harm will be done to the baby.

In children, the congenital form of chlamydia can manifest itself:

  • Ophthalmochlamydia (conjunctivitis with inclusions);
  • Chlamydial pneumonia;
  • Fitz-Hugh-Curtis syndrome. This syndrome manifests itself as perihepatitis, which is accompanied by ascites, acute form).

What are the symptoms of chlamydia during pregnancy?

Chlamydia often occurs without severe symptoms. More than half of the women who have chlamydia do not even know about it. If this disease makes itself felt, then the symptoms are so weak that a woman may not pay attention to them.

In women who are sick with chlamydia, but do not know about it, mucous or mucopurulent discharge may occur from the vagina, they differ from the usual discharge in that they have an unpleasant odor and a yellowish tint.

A woman may feel a burning sensation, a tooth and mild pain in the area of ​​​​the external and internal genital organs.

When a woman is not pregnant, her pain may increase before menstruation. Also during this period, women may have a rise in body temperature, they may feel general weakness, fatigue.

You should know that all of these symptoms may occur not only in the case of chlamydia. All infections of the genitourinary system have similar manifestations. There is no such sign by which a woman could accurately determine that she is sick with chlamydia.

Diagnostics

In modern society, women are surprised how their mothers and grandmothers gave birth to children. Wasn't there such a disease as chlamydia in those days? Of course it was. Quite often there were cases of spontaneous abortion, stop the development of the child, congenital diseases of the baby. Just in those days, doctors could not diagnose this serious disease.

But times go by and medicine improves. Today, fortunately, it is very easy to detect infections in the blood that provoke this disease. Chlamydia can be detected using serological and immunological studies. In a woman, secretions are taken from the cervix, urethra, and vagina. These strokes are completely painless.

In some cases, you need to find out if the fetus is infected. In this case, a sample of amniotic fluid is taken. This procedure is alarming for expectant mothers. But she's not really scary. When the sampling is carried out, all the manipulations of medical workers are carried out under the control of ultrasound, while observing the condition of the baby.

Naturally, any intrusion into a child's space poses a risk, but it's still small. With the help of amniotic fluid sampling, you can timely detect the danger and do everything possible to protect the unborn baby from negative consequences.

How to treat chlamydia during pregnancy?

Chlamydia begins to be treated with the fact that the patient is assigned additional diagnostics. In many cases, this infectious disease is accompanied by other infections. A woman is prescribed an examination for the herpes virus, syphilis, HIV, cytomegalovirus, gonococcus, mycoplasma (including ureaplasma). Only after all these examinations have been carried out, the doctor will be able to prescribe the correct and effective treatment.

To cure chlamydia, doctors prescribe drugs that worsen the general condition of a woman if she has any diseases of the internal organs. For this reason, it is very important before prescribing treatment to identify all non-infectious diseases, for example, chronic diseases of the liver, heart, kidneys.

The entire period of treatment for a woman is best under the supervision of a doctor. Very often there are cases when women, after the disappearance of the manifestations of chlamydia, stop taking medication. But you don't have to do that. Microbes that survive in this case become resistant to the drug that the patient took. After that, it becomes much more difficult to heal.

But how to treat this insidious disease during pregnancy? This question is of interest to many expectant mothers. After all, women in position are not allowed to use all the drugs that are prescribed for the treatment of chlamydia. Antibiotics, which belong to the group of tetracyclines, are strictly forbidden to be taken by women in position, because they can cause various side effects.

The safest are antibiotics that belong to the group of macrolides. But women should not self-medicate because it is dangerous. Only a professional doctor will be able to choose the right medications that will not affect the health of the baby and will not worsen the condition of his mother.

Chlamydia can be treated with a single dose of an antibiotic that is susceptible to chlamydia. Complex treatment can also be prescribed, which is longer in time, which involves the use of enzymes, immunomodulators and antibiotics.

In the treatment of chlamydia, enzymes are very important. They help diseased cells restore membrane permeability. Enzymes also reduce the body's tendency to allergic reactions to those drugs that are used to treat chlamydia. In addition, enzymes have a decongestant and analgesic effect. In combination with enzymes, antibiotics begin to act much more actively.

Much less often, immunomodulatory drugs can be prescribed for the treatment of chlamydia during pregnancy. They are prescribed if a woman has disorders of the immune system, they can be detected by doing laboratory tests. After an immunological examination, the doctor may prescribe medications that help increase immunity.

After the prescribed course of treatment, the pregnant woman is prescribed enzymes that stimulate the recovery processes of the body and vitamins.

Control of cure for chlamydia in pregnant women

After the course of treatment, it is necessary to check whether chlamydia has been cured or not. This can be done in several ways. One method is not enough, since the result of one must confirm the result of the second.

From the moment the woman took the last pill, two weeks should pass. After that, sowing is carried out. But in some cases, this method may show an unreliable result, so you do not need to fully trust this method.

In order to make sure that chlamydia is no longer in the body, you need to conduct a control analysis. For this purpose, the PCR method is used (polymerase chain reaction or PIF (direct immunofluorescence). These methods are carried out about a month after the last pill has been taken. But there are cases when this method shows false results - when chlamydia in the body no longer shows their presence. This is due to the fact that an infection is detected, but using this method it is impossible to determine whether it is alive or already dead.

pregnancy after chlamydia

A woman's body can be severely affected after suffering a disease such as chlamydia. The infection negatively affects the functioning of internal organs. Many women are interested in whether it is possible to become pregnant after chlamydia. Of course, it is possible, but not in all cases. Sometimes an infection can cause infertility, an ectopic pregnancy, when the fetus begins to grow not in the uterus, as usual, but in the fallopian tube.

If a woman has had chronic chlamydia, then the chances of getting pregnant are reduced. Chlamydia leads to inflammation of the inner and outer membranes of the uterus, provoking endometriosis. With such a disease, the fetus cannot normally attach to the walls of the uterus. As a result, pregnancy may not occur.

If a woman has successfully cured chlamydia and no complications have occurred, then there should be no problems with conception.

Prevention of chlamydia in pregnant women

Chlamydia, like any other disease, is easier to prevent. What to do with his treatment. Prevention of chlamydia is exactly the same as the prevention of other diseases that are transmitted through sexual contact.

The best way to avoid chlamydia infection is to change your sexual behavior. Sexual contacts with casual partners should be excluded. If a woman is not sure if her partner is healthy, then a condom should be used during intercourse. It is best to have one sexual partner, in whose health there is no doubt. In this case, the risk of infection with chlamydia and other infections is reduced to a minimum.

During pregnancy, for prevention and other diseases, it is necessary to regularly visit a doctor and be tested for the presence of chlamydia in the body. Tests should be taken two to three times a year if there is doubt about the health of your partner or if you have several sexual partners. Remember that if you detect this disease in a timely manner and begin to carry out the correct treatment, then there will be no negative consequences.

A woman and a man who plan to conceive a child must be tested for the presence of chlamydia before this. In case of detection of microorganisms that cause this disease, it is necessary to be treated before conception. Thus, future parents protect their baby from exposure to chlamydia.

Chlamydia is quite common in pregnant women. According to the data, chlamydia can be found in almost every tenth pregnant woman. Chlamydia can occur in women who are in good health and live in good social conditions.

If a woman has previously had inflammatory processes of the appendages, they have a high risk of contracting chlamydia during pregnancy. Therefore, expectant mothers, given the danger of this disease, should be very careful.

Maria Sokolova is the pregnancy expert for Coldy magazine. Mom of three children, an obstetrician by education, a writer by vocation.

Reading time: 8 minutes

A A

Chlamydia is one of the most common sexually transmitted diseases in modern society. Unfortunately, according to statistics, this infection is found in 10% of pregnant women, so the issue of the safety of chlamydia treatment during pregnancy worries quite a few women. That is what we will try to answer today.

During pregnancy, chlamydia was discovered - what to do?

Every woman wants to endure, give birth and raise a healthy child. Therefore, at the stage of pregnancy planning, expectant mothers go through complete examination, including for all kinds of latent infections . But sometimes situations occur that the disease occurs already during pregnancy. And one of the most unpleasant infections is precisely chlamydia .

The treatment of this infection during the period of bearing a child is a rather complicated and dangerous process, because during pregnancy it is not recommended to take medications, especially antibiotics, as this can provoke a violation in the development of the fetus or a miscarriage.

However, this disease cannot be ignored either. According to medical studies, women who did not undergo timely treatment experienced quite serious complications: premature birth, intrauterine hypoxia, rupture of the birth canal, premature rupture of amniotic fluid, etc.

Therefore, the diagnosis and treatment of chlamydia during pregnancy is a very urgent task.

But still, dear mothers, remember that chlamydia is not a tragedy. For its treatment in pregnant women, drugs are used that have a minimal effect on the child, or do not affect him at all.

You are required strictly follow the doctor's instructions and then you can give birth to a healthy baby. But if you ignore this infection, then it can cause not only serious complications for your health, but also be transmitted to the child during passage through the birth canal.

The risks of chlamydia for the expectant mother

The main danger of chlamydia is that it can cause mass complications in the body of a pregnant woman:

  • Severe toxicosis;
  • Anemia
  • polyhydramnios;
  • In early pregnancy it is possible fetal fading or natural termination of pregnancy;
  • Inflammatory processes on the inner lining of the uterus;
  • Inflammation of the amniotic membrane;
  • preterm birth .

Timely diagnosis and treatment of chlamydia in pregnant women is a necessity that must be met so that a woman can carry and give birth to a healthy baby .

Does chlamydia affect a child?

In addition to the fact that chlamydia can cause a lot of complications in a woman, it is very dangerous for a baby.

  1. In early pregnancy, this infection can cause severe placental insufficiency , as a result of which the fetus stops in development and freezes.
  2. Also, placental insufficiency can cause a child hypoxia resulting in a lack of oxygen for the child. And this, as you know, is not very good. At best, due to hypoxia, a child can be born with mild muscle failure, and at worst, with a severe developmental disorder of the nervous system.
  3. Chlamydia can also cause disturbance in the supply of nutrients to the fetus , which can also give disastrous results. If the violation is mild, then the child can be born with a small body weight, beriberi, highly developed anemia.

All of the above complications can develop in the first or second trimester of pregnancy. But at a later date, chlamydia can infect the baby himself. This infection affects the internal organs of the crumbs - liver, kidney, pancreas . The severity of the disease will depend on the life of your baby. However, a child can become infected not only in utero, but also during passage through the birth canal . Chlamydia can get on the mucous membranes of the eye, nasopharynx, genital organs. And the consequence of this will be conjunctivitis or chlamydial pneumonia . Therefore, if during pregnancy you were diagnosed with chlamydia, You need to start treating this disease without delay, be sure - under the supervision of a doctor. . So you can significantly reduce the harm caused to the health of the baby.

Effective treatment of chlamydia in expectant mothers

From all of the above, only one conclusion can be drawn: pregnancy and chlamydia are not best friends. So, this disease must be eliminated as soon as possible.

All information about treatment and medicines on our website is given For informational purposes only and does not constitute medical advice. .

The treatment process is quite complicated by the position of the woman, because during pregnancy, not all drugs can be taken. Since chlamydia are located inside the cells, only antibiotics can destroy them.

To date, the most modern drugs, antibiotics from a number of macrolides, are used to treat pregnant women.

  • Pregnant women are most often prescribed: Erythromycin, Amoxicillin, Ofloxacin.
  • Can also be applied candles Viferon.

In addition to you, your sexual partner should also undergo treatment, even if he does not have any symptoms of this infection.

During treatment and for two weeks after it is not recommended to have sex. The exact dosage and regimen can only be prescribed by your doctor .

Remember - self-medication is dangerous for your health, and also threatens the life of your baby.

The cost of drugs for chlamydia in pharmacies

  • Erythromycin - 70 - 100 rubles;
  • Amoxicillin - 50-80 rubles;
  • Ofloxacin - 16 - 50 rubles;
  • Viferon - 250-400 rubles.

Site site warns: self-medication can harm your health! All the tips presented are for reference, however, they should only be used as directed by a doctor!

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.

    Show all

    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 deceased.

    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.

A woman can become infected with chlamydia before pregnancy, during conception, and directly during childbearing.

Infection occurs imperceptibly, and chlamydia multiply not earlier than after 3 days. Diseases caused by chlamydia trachomatis in women during pregnancy occur in an erased form. This is especially bad, because the expectant mother may not even suspect that she is sick.

Why are chlamydia dangerous for a pregnant woman, how to recognize chlamydia and how to treat it - we will tell you the most important thing about this.

How does chlamydia appear during pregnancy?

Chlamydia can live and multiply only in the cells of the human columnar epithelium. This tissue is just lined with the cervical canal and its cavity. Therefore, bacteria “with pleasure” settle on the surfaces of these organs if they enter the body of a pregnant woman.

On the left is a normal cervix, on the right is an eroded cervix

However, there is a difference between how chlamydia occurs in pregnant women and in other people.

During pregnancy, particularly favorable conditions occur for chlamydia, because the woman's immunity during this period is simply “not up to them”. The fact is that the body's defense system is being rebuilt - it stops wasting energy on diseases if they do not threaten the child in the very near future. Therefore, in the future mother, the manifestations of diseases that "distract" from bearing disappear. As a result, chlamydia during pregnancy occurs almost without symptoms.

Symptoms of chlamydia during pregnancy appear only in 10-15% of expectant mothers. For example, when examining the cervix, the doctor may detect erosion. This is a non-healing wound on the surface of the cervix caused by chlamydia. It may be an indirect sign of chlamydia, but still does not directly indicate the presence of chlamydia.

Chlamydia during pregnancy occurs almost without symptoms

Unfortunately, there are almost no other visible or tangible signs of chlamydia during pregnancy. A sick woman looks normal, the external condition of her genitals is also normal, and her health reflects only how the pregnancy proceeds in general, without hinting at chlamydia.

As for the manifestations of chlamydia during breastfeeding, they are also practically non-existent. The condition of a woman during this period is no different from the usual, because most often the disease occurs in an erased form.

However, this does not mean that chlamydia cannot be diagnosed during pregnancy or while breastfeeding. You can detect chlamydia in a future mother or in a nursing woman in the same ways as in other people. For example, antigens against chlamydia in the blood can be detected if the infection occurred sexually - both before pregnancy and during childbearing.

Treatment of chlamydia while breastfeeding is also quite possible. There are antibiotics for chlamydia that are allowed while breastfeeding. Therefore, it is not necessary to stop it during treatment. Chlamydia itself does not penetrate into breast milk and it is impossible to infect a child in this way.

Consequences and complications of chlamydia for pregnant women

Although during pregnancy chlamydia itself is sluggish and rarely manifests itself outwardly, its complications are very dangerous both for the general health of the woman and for her pregnancy. They appear during the period of gestation, during the birth of a child and after childbirth.

Often these complications are not even associated with chlamydial infection, although it actually turns out to be the cause of many sad consequences. Let's take a closer look at the dangers of chlamydia for pregnancy.

Chlamydia and ectopic pregnancy

chance of getting pregnant after an ectopic pregnancy

When chlamydia enters the uterus (this is possible in the first half of the menstrual cycle), they reach the fallopian tubes. There they multiply and cause changes in the pipes - adhesions (that is, internal scars). Adhesions block the passage through the tube to the uterus for a fertilized egg. Because of this, the embryo does not enter the uterus, and is attached to the wall of the fallopian tube. This is how an ectopic pregnancy develops, which is interrupted for up to 10 weeks.

In an ectopic pregnancy, a tube rupture can occur and the woman is at risk of bleeding to death. If doctors manage to help, they remove the damaged fallopian tube. Unfortunately, this reduces the chances of getting pregnant again by 50%.

Miscarriage due to chlamydia

If adhesions inside the tube do not form, and a normal pregnancy occurs, can chlamydia cause a miscarriage then? Maybe at any time.

If a woman becomes pregnant without being treated for chlamydia or chlamydia enters the woman's body already during her pregnancy, then the fetal egg (the membrane that surrounds the fetus at very early stages of formation) is most likely to become infected. An inflammatory process begins, which leads to suppuration of the fetal egg and death of the fetus. Then the mother's body rejects the dead child.

Sometimes there is a state of so-called missed pregnancy- when a miscarriage does not occur, but the child has already died. This is especially dangerous for a woman's life: she still considers herself pregnant (there is no menstruation, she feels normal), but at this time the dead fetus releases highly toxic substances. This can lead to infection of the woman's blood and her death.

Chlamydia and preterm birth

If chlamydia "reached" the child at later stages of pregnancy, then premature birth may occur. This happens when bacteria invade the fetal membrane and cause it to become inflamed. It ends with a rupture of the fetal bladder: amniotic fluid departs too early.

Such a development of events threatens the death of the fetus. If doctors manage to help, the premature baby is removed by caesarean section. Unfortunately, in this case, the baby is highly likely to become infected with chlamydia. Therefore, the answer to the question: “Is it possible to give birth to a healthy child with chlamydia?” it is clear: it is possible, but the risk of infection is high.


Ways of transmission of chlamydia from mother to child

The transmission of chlamydia from mother to fetus occurs during pregnancy at different times or directly during childbirth.

Ways of transmission of infection:

  • intrauterine
  • transplacental (through the child's place - the placenta)

    • Penetration of chlamydia occurs through the vessels of the placenta - this is how chlamydia penetrate the circulatory system of the fetus.

  • hematogenous (through the blood)

    • Hematogenous infection occurs when chlamydia enters the mother's blood. This can happen during anal intercourse. In the rectum, during intervention from the outside, microcracks are always formed, through which chlamydia freely penetrate into blood cells and travel throughout the body. Including they get to the child. This can occur both through the vessels of the placenta and the uterus. It turns out that anal sex during pregnancy is a fairly common cause of chlamydia entering the bloodstream.

  • intranatal (generic)

    • The defenses of a woman's body can prevent the reproduction of chlamydia during the gestation period. But then infection can still occur - already during childbirth. When the baby passes through the birth canal, he receives all the bacteria that the mother has in her vagina. This route of infection is called intranatal (obtained during childbirth).

How does chlamydia affect the fetus?

Depending on the way in which the infection has penetrated, chlamydia in the fetus (and later in the newborn) proceeds in different ways. The beginning of the inflammatory process is different for each route of entry of chlamydia. Different consequences of chlamydia in the fetus depend on the place through which the bacteria enter the body - doctors call these places the entrance gate. Consider separately how chlamydia affects pregnancy and the fetus.

Consequences of intrauterine infection

It is important to know that chlamydia can cause miscarriage. When intrauterine infection with chlamydia first develops chorioamnionitis- purulent inflammation of the membranes, which can lead to miscarriage or premature birth.

If this does not happen, then from the fetal membrane, chlamydia enters the amniotic fluid, and from them into the fetus. Then the bacteria infect the mucous membranes: the eye (conjunctivitis), the intestines (enteritis) and the intermediate tissues of the lungs (pneumonitis). This happens because the baby makes respiratory movements, swallows amniotic fluid and thereby passes the infected fluid through the lungs.

After childbirth, when air enters the lungs of such a child, the chlamydial lesion also spreads to the alveoli - pneumonitis becomes severe pneumonia. Also, chlamydial infection affects the genitourinary system of the fetus, because the amniotic fluid is excreted from the baby's body in the urine, and before that it passes through the liver and kidneys.

Consequences of transplacental infection

If the infection of the fetus occurred through the placenta, then chlamydia immediately enters the largest vessels of the child. Therefore, when the infection enters the blood of the fetus in this way, the mucous membranes of all organs suffer from chlamydia.

In particular, the child develops:

  • intrauterine chlamydia of the meninges - meningitis;
  • chlamydial inflammation of the mucous membranes in the kidneys - pyelonephritis;
  • chlamydia of the mucous membranes of the lungs - pneumonitis.

Infection by the transplacental route can result in fetal death at any stage of pregnancy.

Consequences of hematogenous infection

The hematogenous route of infection differs from the placental one in that chlamydia enters the fetus not through the vessels of the placenta, but through the umbilical vein and in much larger quantities.

In this case, the fetus is simultaneously affected through the blood and mucous membranes of the digestive, respiratory and urinary systems. Hematogenous damage to the body can also cause fetal death at any stage of pregnancy. The child may have hemorrhages in the brain, adrenal glands, kidneys and lungs.

Complications of chlamydia in a woman after pregnancy

Chlamydia is dangerous for a woman not only during pregnancy, but also after. The changes that occur to the body after childbirth or an abortion make a woman's genitals more vulnerable to the destructive activity of chlamydia.

Chlamydial endometritis

Inflammation is manifested by an increase in body temperature up to 30-40°C. Treatment of endometritis in severe cases may result in removal of the uterus. This is what chlamydia can cause in pregnant women.

Treatment of endometritis in severe cases may result in removal of the uterus.

Cervical erosion

As we already wrote at the beginning of the article, due to chlamydia, a woman may begin to erode the cervix - even before or during pregnancy. But even worse, hormonal changes after childbirth worsen the course of erosion: anatomical changes occur in the cervix that turn the disease into a chronic form.

If outside of pregnancy, erosion can be cured with antibiotics, then after childbirth, this disease can provoke oncological problems. Therefore, it is necessary to treat only with the help of surgery.

Symptoms of chlamydia in newborns

The course of chlamydia in newborns manifests itself in two ways: either as an exacerbation of intrauterine chlamydia (i.e., which the baby acquired before birth), or as an initial acute infection - if the infection occurred during childbirth (when chlamydia passes to the child during the birth ways).

Manifestations of chlamydia in a newborn with intrauterine infection

If chlamydia is not treated during pregnancy, the baby can develop pneumonia before birth. As we have already said, the unborn baby makes respiratory movements, passing amniotic fluid into the lungs. If they contain chlamydia, then they are deposited in the lung tissue and begin to multiply actively.

On the left - normal airways, on the right - airways in bronchial asthma

After some time, these inflammatory changes lead to "sticking" of the alveolar vesicles. After giving birth, such a child cannot take his first breath and needs artificial ventilation. That's why chlamydia is dangerous for a newborn with damage to the lung tissue.

If congenital pneumonia is asymptomatic, then the child develops hypersensitivity to allergens. Children born to mothers infected with chlamydia often suffer from bronchial asthma.

A separate form of chlamydia in newborns who have received an infection through the blood (hematogenous route) leads to dangerous consequences affecting the central nervous system. These children may develop meningitis in infancy or mental retardation at school age.

Manifestations of chlamydia in children infected during childbirth

How chlamydia manifests itself in newborns can be seen on the right - in hidden photos. In this case, acute chlamydial infection in newborns occurs in the form of the following diseases:

  • conjunctivitis - inflammation of the eyelids;
  • rhinitis - runny nose;
  • pneumonia;
  • urethritis/vaginitis.

Chlamydia, obtained during childbirth, manifests itself in newborns with symptoms of conjunctivitis almost immediately after birth: abundant discharge from under the eyelids, characteristic of congenital chlamydia, has a glassy consistency.

Also, with chlamydia, babies often have a runny nose - it appears after about 4 days after birth. This is the first sign of a respiratory (respiratory) form of chlamydia infection in newborns.

Chlamydia in infants can proceed according to the same scenario as in an adult. In the chronic form, boys develop urethritis, and girls develop vaginitis.

In some cases, with a healthy immune response (in breastfed babies), chlamydia forms L-forms that do not manifest themselves. A person becomes a carrier of a sexual infection even before the onset of sexual life.

Due to the fact that during pregnancy, chlamydia occurs in an erased form, it is especially dangerous for expectant mothers: a woman does not know about her illness and infects a child either in the womb or during childbirth.

In some cases, chlamydia does not appear in a child, but he becomes a hidden carrier of the infection - in this situation, both his own health and the people he can infect by starting a sexual life suffer greatly.

Without treatment for chlamydia during pregnancy, a woman will not be able to avoid all the dangerous complications, both for the child and for her body.

In some cases, chlamydia does not appear in a child, but he becomes a hidden carrier of the infection.

To find out about the presence of chlamydia, it is very important to take tests for sexually transmitted infections before or at least during pregnancy. You can seek help from the antenatal clinic or KVD at the place of residence.

Treatment of chlamydia is possible at any period of gestation. Wherein the drugs themselves do not harm the health of the child. However, if you are late, you can face serious irreversible consequences for the baby and mother, which antibiotics will no longer be able to remove.

Examination during pregnancy reveals various infections and often those that are sexually transmitted (STIs). A pregnant woman is already very vulnerable during this period, and such a contagious disease adds problems to her and the unborn baby. Chlamydia, or chlamydial infection, is one such disease that is sexually transmitted and makes life difficult for the expectant mother.

What is chlamydia

Chlamydial infection, chlamydia is a contagious disease from the STD group. It causes inflammation of the genitourinary system, eyes, joints, respiratory tract, large intestine, and can also affect several organs at the same time: the urethra, the conjunctiva of the eyes, the synovial membranes of the joints. A feature of chlamydia is a long period of development of the disease and mild manifestations.

This is a fairly common disease. And if among the infectious diseases of the genital organs, about 80% of cases account for STIs, then in 60% it is a chlamydial infection.

It is found everywhere around the world among people of all ages. It is registered more often than gonorrhea.

Contributing to this is the fact that sexual behavior has changed in recent decades:

  • began to have sex earlier;
  • change sexual partners more often;
  • widespread use of birth control pills (oral contraceptives), which reduce the risk of pregnancy;
  • people began to travel a lot and communicate more.

And this is complemented by the fact that the disease itself develops slowly (20–30 days) and is often asymptomatic.

Who causes chlamydial infection

Chlamydia trachomatis, a microorganism from the genus Chlamydia, affects the urinary tract. This spherical, immobile pathogen lives inside the cells of the human body, which is important when choosing a treatment. Outside the body, it ceases to be contagious after 1–1.5 days.

Chlamydia die:

  • at room temperature;
  • from ultraviolet radiation;
  • boiling;
  • actions of disinfectants.

At the same time, it was found that in a humid environment they remain infectious for up to two days at a temperature of 19-20 degrees, this is important when the infection is not spread sexually.

You can only get chlamydia from someone who has the infection in their body. At the same time, he (the person) is contagious despite the fact that symptoms of the disease appear or not (asymptomatic course).

Basically, infection occurs through sexual contact, while women are more susceptible.

In pregnant women, chlamydia passes from mother to fetus either in the prenatal period or during childbirth.

Rarely, but chlamydia spreads through personal belongings, household items, with contact, i.e., the so-called contact-household route. For example, you can become infected in a public sauna or bath if you do not observe personal hygiene and use other people's things (washcloths, towels), since chlamydia live in an active state in a humid environment for up to two days. Even through hands that are contaminated with secretions with chlamydia, the infection can penetrate into the eyes, genitals.
The main way chlamydia enters the human body is sexually.

How the disease manifests itself

Since there are no specific symptoms that characterize chlamydia of the genitourinary organs, including in pregnant women, there are no characteristic complaints, and the diagnosis is made on the basis of laboratory parameters indicating the presence of chlamydia.

If pathogens are found in pregnant women in the cervix, more precisely, in the mucous membrane of the cervical canal, then this is chlamydial cervicitis - inflammation in the vaginal segment of the cervix. It usually appears no earlier than 1-3 weeks after infection.

In the acute course of chlamydial cervicitis, the manifestations are insignificant in the form of:

  • scanty mucopurulent discharge;
  • pulling pains in the lower abdomen.

In chronic cases, the course is completely asymptomatic.
The mucosa of the cervical canal is a favorite localization site for chlamydia

If the cervix and urethra are simultaneously affected, then acute urethral syndrome develops.

It manifests itself in infected pregnant women:

  • frequent painful urination;
  • frequent calls;
  • urination in small portions;
  • feeling of not emptying the bladder.

Additionally, they have:

  • the presence of blood in the urine;
  • a slight increase in body temperature, chills;
  • lower abdominal pain;
  • pulling pain in the urethra (urethra);
  • general malaise, fatigue;
  • in the general analysis of urine, leukocytes are found in a large number and there are no bacteria.

When moving chlamydia up the genitals, the uterus, appendages, and ovaries are affected.

Chlamydial endometritis - inflammation in the inner mucous layer of the uterus (endometrium), more common after childbirth or abortion.


 Inflammation in the lining of the uterus

In the acute course of endometritis, it is characteristic:

  • an increase in body temperature to 38–39 degrees;
  • pain in the lower abdomen;
  • mucopurulent discharge from the cervical canal.

In chronic course - the symptoms are not expressed, blurred.

Infectious complications and the impact of chlamydia on conception

In the early stages up to 12–16 weeks of pregnancy, the most common complications are:

  • threatened miscarriage;
  • non-developing pregnancy;
  • spontaneous abortion;
  • premature birth.

At a later date after the 16th week, the main complications are associated with chlamydia infection of the placenta, amniotic membranes. Chlamydial infection does not cause true malformations directly in the fetus, for example, as with syphilis. But it is the cause of infection of the unborn child in the womb. And after birth, such children almost always develop into chlamydial conjunctivitis, nasopharyngitis, pneumonia and other complications.

Chlamydia bodies are found in all tissues of the placenta and, in particular, the lumen of the vessels of the chorion (the germinal part of the placenta), which contributes to the transmission of infection from mother to fetus through the blood.

In the placenta of pregnant women, chlamydia contributes to the development of disorders that cause placental insufficiency, i.e., due to circulatory disorders, placental functions suffer: nutrient transfer, respiratory, excretory, hormonal, protective. And as a result, damage in the system mother - placenta - fetus.
Placental insufficiency contributes to developmental delay and oxygen starvation in the fetus

When the amniotic membranes become infected, the following develops:

  • polyhydramnios;
  • placentitis - inflammation of the placenta;
  • placental insufficiency;
  • hypotrophy and hypoxia of the fetus.

Most often, the child becomes infected (40–70%) during childbirth, when it passes through an infected birth canal. In these babies, the conjunctiva of the eyes, the nasopharyngeal mucosa are mainly affected and develop, nasopharyngitis and pneumonia. Less commonly, chlamydia causes gastroenteritis, inflammation of the rectum (proctitis), inflammation of the labia minora (vulvitis) in girls, and inflammation of the urethra (urethritis) in boys.

Women who have had chlamydia are more likely to develop an ectopic pregnancy. Basically, this is a tubal pregnancy, i.e., the fertilized egg is embedded not in the uterine mucosa, but in the fallopian tube, which leads to the death of the fetus in the future.
Severe complication of chlamydia

It is known that chlamydial infection contributes to the formation of scars and blockage of the fallopian tubes, and this in some cases leads to infertility.

How to suspect a chlamydial infection

Since there are no characteristic manifestations of the infection and often it is asymptomatic, and the pathogen is detected only by laboratory methods, the following are subject to mandatory examination for chlamydia:

  • women with mucopurulent discharge from the cervical canal, symptoms of inflammation of the ovaries and fallopian tubes (adnexitis), infertility;
  • if there was sexual contact with a patient or carrier of chlamydial infection;
  • if you are being tested for other STIs;
  • newborns from mothers who had chlamydia during pregnancy.

At the same time, the risk group for the development of chlamydial infection includes:

  • women who are engaged in prostitution;
  • sexually active adolescents and women under 25;
  • those who have previously had an STI;
  • who has been in contact with someone who has chlamydial infection or who has symptoms of urethritis or cervicitis.

Examination at the doctor's office

When examining a pregnant woman in the mirrors, an obstetrician-gynecologist often detects signs of cervicitis. Sometimes the manifestations of infection are mild or absent. With unexpressed inflammation, which is accompanied by pain during urination, discomfort or soreness in the lower abdomen and in the perineal region, it is recommended that the pregnant woman be examined for chlamydia.

Urinalysis also helps to suggest the presence of chlamydia. As a rule, in the urine of such women a large number of leukocytes and no bacteria. Therefore, purulent discharge in the urine (pyuria) and the absence of bacteria in the analysis often indicate the presence of a chlamydial infection.

How to detect chlamydia

For research in pregnant women, scrapings are taken from the mucous membranes of the urogenital tract (urethra, cervical canal of the cervix), when chlamydia is located in other organs, scrapings are taken from the rectum, conjunctiva, oropharynx.

The quality of the material taken depends on the condition of the pregnant woman.

The most informative scraping will be if the conditions for taking smears are met:

  • they are taken if there are signs of disease;
  • the pregnant woman was treated with local antiseptics (vaginal suppositories) for the last 2-3 days;
  • did not take a shower during the day;
  • have not used systemic antibiotics in the last 3–4 weeks.

If the rules and conditions for taking the material were not observed, then the results of the study may be distorted.

To determine chlamydia use:

  • Methods in which the pathogen (chlamydia trachomatis) and its antigens are directly detected:
    • PIF reaction using labeled monoclonal antibodies;
    • cultivation of the pathogen in cell culture;
    • molecular biological methods:
      • DNA hybridization;
      • real-time PCR;
      • NASBA in real time and others.
  • Methods in which the reaction of the human immune system is evaluated, i.e. specific antibodies to chlamydia trachomatis (C. trachomatis) are detected:
    • serological.

Direct immunofluorescence (DIF) method with monoclonal antibodies

Not the most difficult and acceptable method for almost any laboratory. With the help of PIF, chlamydia antigens are directly detected. The basis of the method is that monoclonal sera with antibodies labeled with fluorescins (luminous substances) are added to the biological material - scraping from the mucous membranes of the urinary organs. These smears are examined in ultraviolet rays under a fluorescent microscope. With such microscopy of chlamydia, luminous inclusions of green or yellow-green color are visible on a brown-orange background of the cytoplasm of cells.

Its sensitivity and specificity are not the highest. It depends on the quality of the luminescent sera with antibodies and the skills of the laboratory staff. PIF results are sometimes false positive. For the study of scrapings that are obtained from the nasopharynx and rectum, this method is not suitable.
Chlamydia detected with PIF - green inclusions

cultural method

For the diagnosis of chlamydia, one of the more accurate methods is cultural. The basis of this study is the sowing of the taken material on nutrient media. This is a more specific method than the PIF. And one of the few methods by which to determine the disposal of chlamydia. It allows the detection of viable microorganisms, despite the fact that other methods often give distorted results. But due to the low sensitivity, its labor intensity, the duration of the process of growing chlamydia, as well as the stringent requirements for the conditions for obtaining, transporting and storing scrapings, as well as the professionalism of the staff, it is difficult to use it in daily practice. Therefore, this method is carried out only in single laboratories.
Chlamydia are placed on nutrient media

Molecular biological methods

For the recognition of chlamydia, it is recommended to use molecular biological methods, one of which is PCR diagnostics (polymerase chain reaction). PCR is based on the amplification of nucleic acids, i.e., an increase in the number of certain DNA fragments. It is a study with high sensitivity up to 98% and specificity up to 100%. When it is carried out, not only scrapings from the mucous membranes are used, but also other materials, for example, urine, ejaculate. For diagnosis, it is not important to maintain the viability of chlamydia, but strict adherence to the conditions for the delivery of the taken material is required, since this significantly affects the results of the analysis.

PCR diagnostics is currently considered as the main method for detecting chlamydia.
PCR - a way to increase the number of certain DNA fragments

And also these methods include real-time PCR and a new, improved method - NASBA (Nucleic Acid Sequence-based Amplification), i.e. an increase in the number of copies of nucleic acids (RNA) in real time, which makes it possible to detect live chlamydia and replace laborious cultural method.

Now it is the molecular biological methods for detecting and diagnosing chlamydia that should be preferred in practical healthcare.

With the serological method, the pathogen is not directly detected, but the body's immune response to chlamydial infection is examined, that is, immunoglobulins (IgM, IgA, IgG) that have been developed in the human body to chlamydial antigens are determined. This is important for diagnosing chlamydial inflammation in the fallopian tubes, appendages, pelvic peritoneum and determining its acute or chronic course. Serological methods include microimmunofluorescence (MIF), enzyme immunoassay (ELISA) studies. But to confirm the diagnosis of chlamydia of the genitourinary organs, the diagnostic capabilities of these methods are limited. With their help, it is impossible to control the cure for the infection.

According to modern protocols for the management of infectious patients, serological methods (determination of antibodies in blood serum) are not used to diagnose chlamydia of the genitourinary system.

However, the determination of immunoglobulin M is used to confirm chlamydial pneumonia in children from birth to the first three months of life. An increase in the titer of immunoglobulin G by 4 times, when paired blood sera are examined, speaks in favor of the presence of chlamydia in pregnant women with inflammatory diseases of the pelvic organs. An increase in the concentration of IgG to chlamydia is the basis for examining women for the presence of venereal lymphogranuloma. This technique allows you to determine the stage of the disease, evaluate the effectiveness of the treatment, prove the chlamydial origin of the disease, which develops outside the genital organs.
Not an informative method for pregnant women

How is chlamydial infection treated?

Chlamydial infection is important not only to identify, but also to cure.

Purpose of treatment:

  • complete destruction of the pathogen (chlamydia trachomatis);
  • disappearance of symptoms of the disease;
  • prevention of complications.

Since chlamydia is a pathogen, and chlamydial infection is classified as an STI, which is widespread and plays a huge role in the development of complications in the mother and unborn child, the use of antibacterial agents for its treatment is mandatory.

Antibiotics are prescribed regardless of whether symptoms of the disease appear in infected women or it flows asymptomatically. In the first trimester, they are used only for strict indications, because of the possible negative effects on the fetus. The main treatment begins after 12–16 weeks.

The choice of drugs for treatment in pregnant women is significantly limited, since many of the antibiotics that act on chlamydia (tetracyclines, fluoroquinolones) cause severe side effects in the unborn child.

Among the permitted drugs, preference is given to macrolides (erythromycin, azithromycin, josamycin), which are able to penetrate deep into the cell. And also proved the effectiveness of taking amoxicillin from the group of penicillins, which, although not able to penetrate the cell, but at the same time has a detrimental effect on chlamydia. More often it is prescribed for allergies or intolerance to macrolides.

Drugs of choice (Russian standards):

  • azithromycin - 1.0 g once;
  • erythromycin - 500 mg 4 times a day for a course of 7-10 days;
  • josamycin - 750 mg 2 times a day for 7-10 days;
  • amoxicillin - 500 mg 3 times a day for 7 days.

Or prescribe one of the following means (European recommendations):

  • erythromycin by mouth for 7–10 days;
  • amoxicillin by mouth for 7-10 days;
  • josamycin orally for 10 days.

With a decrease in the effectiveness of treatment with drugs of choice, use:

  • azithromycin inside 1.0 g once;
  • spiramycin inside 10 days.

Since josamycin and amoxicillin have fewer side effects than erythromycin, their use is more preferable and effective. It is important to know that erytheocin (erythromycin estolate) is contraindicated during pregnancy. Previously, azithromycin, josamycin, spiramycin were prescribed to pregnant women only in extreme cases, but today the safety of these antibiotics for expectant mothers has been proven.

In newborns and infants, chlamydia is treated with erythromycin at an age dosage of at least 14 days.

Therapy for chlamydial infection is carried out on an outpatient basis. A pregnant woman is hospitalized in case of complications in specialized hospitals of the dermatovenerological, obstetric-gynecological, rheumatological profile.

Evaluate the results of treatment one month after the completion of the course of antibiotics. The combination of culture and PCR studies, as well as the real-time NASBA method, most accurately confirm the presence of chlamydia. These methods are offered to assess the vital activity of chlamydia and, accordingly, the cure for the disease.

Prevention of chlamydial infection in pregnant women

Prevention of chlamydial infection is not particularly different from prevention of other STIs.

It is important to follow a few rules to avoid infection:

  1. refrain from promiscuous sexual relations;
  2. use condoms;
  3. immediately after unprotected sexual contact, use disinfectants (chlorhexidine bigluconate, miramistin, mucosanin);
  4. in case of suspected infection with chlamydia, mandatory examination and treatment of all sexual partners;
  5. personal hygiene;
  6. do not use other people's things that come into contact with the body (washcloths, towels, underwear, etc.);
  7. Be sure to be treated with antibiotics so that complications from chlamydia do not develop.

What should a pregnant woman be warned about?

Every woman should be informed by her obstetrician-gynecologist that:

  • if chlamydia of the genitourinary organs is detected, then there is a high chance of infecting a sexual partner;
  • it is important to identify and treat all sexual partners of the infected person in order to prevent the spread of infection;

    • Thrush is a common disease of the female genital organs. According to statistics, 44% of women on earth suffer from this disease. Especially often young girls are interested in the question of whether it can affect ...