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Chlamydia is a bacterial infection that causes inflammation of the reproductive organs. Chlamydial endometritis is a typical example of an ascending infection where the site of primary infection is the cervical canal.
Chlamydial endometritis
Syn.: Endometritis.
Definition: A typical example of ascending infection where the primary infection site is the cervical canal.
Epid.: It occurs in almost half of women with chlamydial cervical infection and all women with chlamydial PID. The development of the disease is favored by: an open (unobstructed) cervical canal, bleeding within the uterine mucosa (menstruation, puerperium), surgical intrauterine procedures and mucosa residues, such as abortion or temporal remnants.
Wedge.: Most inflammations do asymptomatic course. In symptomatic cases, the most common complaints include: abnormal bleeding (between periods), prolonged or heavy periods, and sometimes lower abdominal pain. On palpation, endometrial tenderness is found. Sometimes a slight increase in temperature and increased ESR.
DIG. C-3. Chlamydial cervicitis.
DL: Examination of cervical discharge for chlamydia.
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DR: Inflammation of the uterine lining of the uterus of other aetiology, eg gonococcal, tuberculous or caused by anaerobes or colitis. In middle-aged and elderly women, abnormal uterine bleeding may be a symptom of cancer of this organ.
Prognosis: In treated cases – good. Since chlamydial endometritis is usually the stage of ascending infection towards the appendages, untreated or late administration of the drug can cause pelvic inflammatory disease (PID) with all its consequences.
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Chlamydial urethritis in women
Definicja: Urethritis in women is associated with chlamydial cervicitis in almost 50% of cases.
Wedge.: Similar to cervicitis, chlamydial urethritis in women is often asymptomatic. In symptomatic cases, women complain of the need to urinate frequently and symptoms of dysuria. In some patients it is observed mucous or mucopurulent discharge appearing after massage of the urethra, as well as swelling and redness of the external opening of the urethra (meatitis).
DR: Gonorrhea, bacterial cystitis, genital herpes, vaginitis of various etiologies, pyelonephritis.
Treatment: Antibiotics as in the treatment of non-gonococcal urethritis administered over a period of at least 7 days.
Attention: Do not use tetracyclines or doxycycline in pregnant women.
Prognosis: In treated cases – good.
Chlamydial pharyngitis
Syn.: Chlamydial pharyngitis.
Epid.: Despite the theoretically favorable conditions for infection of the nasopharynx (it is covered with a cylindrical epithelium) detection of chlamydia in throat swabs is rare. There is no evidence so far that chlamydia can be transmitted by kissing. The infection occurs most often during orogenital intercourse. Mainly homosexuals and women who practice oral sex (fellatio) suffer.
Wedge.: Infection is usually asymptomatic. The symptoms of pharyngitis are rare (spontaneous or soreness when swallowing, symptoms of a scratchy throat) and do not differ much from pharyngitis on any other background.
DR: Viral or bacterial pharyngitis, including gonorrhea.
Treatment: Azithromycin in a dose of 1 g once or doxycycline 100 mg twice a day for 2 days. In addition, tetracyclines, erythromycin, davercin.
Prognosis: All right.
Chlamydial prostatitis
Syn.: Chlamydial prostatitis.
Definicja: Case reports mention the possibility of infection of the prostate gland by Ch. trachomatis, however, these data require confirmation on a larger material.
Wedge.: The clinical picture of chlamydial prostatitis does not differ from the clinical picture of the disease caused by other bacteria.
DL: Examination of prostate secretions for the presence of chlamydia.
In most cases, the secretion obtained after prostate massage is sterile or contains non-pathogenic bacteria.
DR: Inflammation of the prostate gland due to other causes, eg gonococcal or caused by bacteria causing urinary tract infections: Escherichia coli, Proteus sp., Pseudomonas sp. Bulbar-tubular gland inflammation, benign prostatic hyperplasia or cancer of this organ.
But.: Antibiotics for several weeks – depending on the result of bacteriological tests.
Genetic testing for men for sexually transmitted infections, mainly chlamydiosis, can be performed on the basis of a self-collected urethral smear. The material for testing is sent to the laboratory, and the test results are available after a few days.
Chlamydial inflammation of the greater vestibular gland
Syn.: Chlamydial Bartholinitis, bartholinitis.
Epid.: Rare complication of chlamydial infection in women due to secondary infection with cervical secretions. Usually, the orifices of the gland ducts are infected.
Wedge.: Inflammation at the mouth of the gland causes its hyperemia and swelling, which may lead to its closure and the formation of an alleged abscess. Then there is a significant swelling and enlargement of the gland, which arches the lumpy labia majora. Patients complain about annoying pain in the area of the affected gland that gets worse when walking, sitting or passing stools. In more severe cases, an increase in temperature is observed.
DR: Inflammation of the gland on a different background, most often gonococcal. Also a stagnant cyst, a hernia.
But.: Antibiotics as in the treatment of non-gonococcal urethritis administered over a period of at least 7 days. In the event of a pseudo-abscess – surgical treatment.
Chlamydial epididymitis
Syn.: Chlamydial epididymitis.
Definicja: Epididymitis caused by infection with Ch. trachomatis.
Epid.: It occurs in 1-3% of chlamydial (NGU) patients. Ch. trachomatis is the most common cause of epididymitis in men under 35 years of age.
Wedge.: Symptoms usually appear several weeks after the onset of NGU. Often, when epididymal symptoms develop, symptoms of urethritis are no longer observed. Inflammation is usually one-sided, although both epididymides may be involved in the disease process.
In the early period it is observed prickly pains within the affected epididymis and its swelling and enlargement. As the disease progresses, the pain increases, making it difficult or impossible to walk. A fever may appear. Palpation reveals swelling and significant tenderness of the involved epididymis. The accumulation of exudate between the testicular sheaths can smooth and tighten the skin of the scrotum. It is red and very warm. In general, the symptoms of chlamydial epididymitis are less dramatic than in gonorrhea and the patients’ condition improves.
DL: Examination of urethral swabs for chlamydia – Chlamydia trachomatis – laboratory diagnosis.
DR: Epididymitis of other gonococcal etiology, caused by coli bacteria or Pseudomonas aeruginosa, tuberculous or viral, e.g. after mumps. Torsion of the spermatic cord, tumors, hydrocele, hematoma or abscesses of the epididymis, as well as appendicitis or a trapped inguinal hernia.
Treatment: Doxycycline 100 mg twice daily or tetracycline 2 mg four times daily for 500-4 days or longer. If you are allergic to tetracycline, administration of azithromycin, donercin or fluoroquinolone antibiotics is recommended. Patients with epididymitis should be hospitalized until acute symptoms resolve, after which treatment can be continued at home. It is recommended that staying in bed and wearing a jockstrap. In the event of severe pain and high temperature – non-steroidal anti-inflammatory drugs, painkillers and antipyretics.
Prognosis: Good. Chlamydial epididymitis can result in post-inflammatory epididymis fibrosis, which may persist for weeks, and sometimes life-long. Another complication may be the obstruction of the seminal ducts, which in the event of bilateral inflammation may cause infertility. In general, these complications are not as common as in gonorrhea-induced epididymitis.
Chlamydial proctitis
Syn.: Chlamydial proctitis.
Definicja: Proctitis caused by Ch. trachomatis (serological type from DK or L1-L3).
Epid.: It occurs primarily in women and homosexuals. In women, it may be the result of secondary infection with secretions from the cervix or urethra, or as a result of rectal intercourse. Among homosexuals, rectal infection occurs in the ‘passive’ partner, and the serotypes most frequently detected are D and G. L-type infections are less common but tend to be more severe.
Wedge.: Wide range of symptoms. From asymptomatic cases to severe inflammation associated with inflammation of the end parts of the large intestine (proctocolitis). In severe inflammation (infection mainly with L-types) there is severe pain in the lower abdomen and anus, combined with the need to have frequent bowel movements. There may be mucopurulent discharge from the anus and a burning and stinging sensation in this area. Examination with the use of a speculum shows the presence of purulent discharge on the walls of the anus and sigmoid colon. Fragility of the mucosa is often present, favoring the formation of superficial erosions and bleeding. Mild inflammations (infection with DK types) are much more common and account for over 3/4 of chlamydial proctitis in developed countries. The clinical picture is dominated by the presence of a slight mucous or mucopurulent discharge, accompanied by slight pain and burning sensation in the anus area. Occasionally, there is spontaneous rectal bleeding or bleeding during defecation. In the rectoscopic image, slight mucosal hyperemia, the presence of mucopurulent discharge and, rarely, erosions are observed. In many cases, the rectoscopic picture is normal.
DLThe Gram stained rectal discharge test detects a large number of polynuclear leukocytes. The detection of chlamydia in the secretions is decisive in the diagnosis.
DR: Proctitis of a different etiology: gonorrhea, herpes simplex virus infection, gay bowel syndrome, haemorrhoids, anal neoplasms, post-traumatic lesions.
Treatment: Antibiotics: azithromycin 1 g once a day, or doxycycline 100 mg 2 times a day or tetracycline 500 mg 4 times a day or erythromycin 500 mg 4 times a day for 7-10 days. In severe cases, the administration of antibiotics can be extended to 2-3 weeks.
Prognosis: Good in mild cases. In severe forms caused by serological L types, complications may occur: anal stricture, fistulas, abscesses.
Chlamydial pneumonia in infants
Syn.: Chlamydial pneumonia neonatorum.
DefinicjaPneumonia in infants due to perinatal Ch. trachomatis.
Epid.: It is one of the three most commonly observed in this age group. Infection occurs during childbirth as a result of direct contact of the newborn with the cervical secretions of the infected mother. It often coexists with chlamydial conjunctivitis.
Wedge.: The first symptoms appear between 4 and 11 weeks of age. They are usually atypical and affect the upper respiratory tract. The most common catarrh of the mucous membranes of the nasopharynx and breathing difficulties. Almost half of the infants have a bulging eardrum in the ear. Involvement of the lower parts of the airways is evidenced by coughing, rapid breathing and auscultation changes: rales and crackles. The X-ray image is dominated by excessive lung expansion and bilateral, symmetrical interstitial infiltrates. The course is generally fever-free, although a slight increase in temperature may occur in some infants.
DL: Eosinophilia with total white blood cell counts within normal range. Gas analysis shows moderate hypoxia. Class G and M immunoglobulin levels are usually increased. Detection of chlamydia in airway secretions is decisive for the diagnosis. DR: Pneumonia of other etiology: bacterial or viral.
Treatment: Erythromycin suspension at a dose of 50 mg / kg body weight daily orally in divided doses 4 times daily for 14 days.
Prognosis: All right.
Chlamydial conjunctivitis in infants
Syn.: Chlamydial conjuctivitis, ophthalmia neonatorum.
Definicja: Conjunctivitis in infants caused by perinatal Ch. trachomatis.
DIG. C-2. Balanitis circinata in the course of Reiter’s syndrome.
Epid.: Chlamydia is the most common cause of conjunctivitis in the first month of life. More than 60% of newborns born to mothers with chlamydial cervicitis become infected during delivery. 20-50% of them develop conjunctivitis.
Wedge.: In most cases, chlamydial conjunctivitis is asymptomatic or symptoms are so scanty that they escape the attention of parents or caregivers. Complications are rare. In more severe cases, symptoms usually appear 5-14 days after birth. Initially, it is observed conjunctival hyperemia combined with lacrimation and watery discharge coming out of the conjunctival sac. Then the discharge turns mucopurulent or purulent. The eyelids are swollen, thick and severely red (Fig. C-2).
DL: Examination of conjunctival swabs for chlamydia. DR: Gonococcal conjunctivitis. Viral keratoconjunctivitis, conjunctivitis caused by other bacteria or viruses (e.g. herpes viruses), and conjunctivitis caused by chemical or physical factors.
Treatment: Erythromycin suspension: 50 mg / kg body weight daily orally in divided doses 4 times a day for 14 days. There is no evidence that conjunctival agents shorten treatment duration.
Prognosis: Good. Untreated chlamydial conjunctivitis can cause scarring (similar to trachoma) or corneal changes (micropannus).
Chlamydial cervicitis
Syn.: Mucopurulent cervicitis (MPC).
Definicja: Chlamydial endocervicitis is the most common form of chlamydial infection in women. From an epidemiological point of view, it corresponds to non-gonococcal urethritis in men.
Epid.: The first illnesses after the beginning of sexual life. The highest rate of disease among women under 25 years of age The risk of developing the disease is increased by sexual intercourse with men suffering from NGU, frequent changes of partners, and failure to use condoms.
Etiol.: Ch. trachomatis typ serolog. D-K.
Wedge.: In more than half of the cases, the infection is asymptomatic. In symptomatic cases there is a mucopurulent discharge in the outer mouth of the cervical canal (30%) and a hypertrophic ectopy (20%). The latter is due to the swelling and redness of the cervical disc and the ease of bleeding that occurs when the material is collected from the cervix (Fig. C-2).
DL: Due to the large number of asymptomatic infections, the diagnosis is based on microscopic examination of secretions from the cervical canal and the results chlamydia tests. Examination of the Gram-stained smears of the cervix allows the assessment of cervical inflammation. The mean number of polynuclear leukocytes> 10 seen in 5 consecutive fields of view (at 1000 x magnification plus immersion) is an arbitrary breakpoint between normal and inflammation.
DR: Gonococcal cervicitis, cervical herpes, dysplasia and early forms of cancer (in situ), vaginal infections of various etiologies.
Prognosis: Good for early treatment. Untreated cervicitis can cause complications such as endometritis, pelvic infl ammatory disease (PID), and perihepatitis.
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