Pathogenesis, Diagnosis And Treatment Of Chlamydial Urethritis

THE CAUSATIVE AGENT OF INFECTIOUS DISEASE

UrethritisChlamydia (Chlamydia) – is an intracellular parasite that does not have their own power systems (mitochondria), and therefore uses energy cells “master”. Asome point in the life cycle of chlamydia lives in the mucous cells of the genitourinary system, which triggers the development of chlamydial urethritis.

Chlamydia are the initiators of the development of the body’s inflammatory processes and diseases of the sexual sphere.

These parasites can cause damage to the digestive and respiratory systems.

Ignoring or improperly treating chlamydia can cause infertility, and both men and women.

If chlamydia got the body of a pregnant woman, the pathogens can be transmitted to the fetus, causing inflammation in it. The main complications of chlamydia – epididymitis and prostatitis. In exceptional cases, chlamydia cause Reiter’s syndrome – that is, the defeat of the joints, urethra, conjunctiva of the eye.

Chlamydial urethritis – a disease that is characterized by the development of inflammation in the urethra, provoked by chlamydia. Chlamydial urethritis occurs due to contact and activity in humans’ chlamydia trachomatis. These pathogens provoke the development of non-specific urethritis in men and women.

It is typical for men and women, but in this article we discuss the diagnosis, treatment, complications, preventive measures and analyze the causes of the disease for men. Chlamydia trachomatis acts in the role of the causative agent. Clinical manifestations are swelling, inflammation and discharge. Many infections of such kind are asymptomatic. Sexual partners of the infected person should also be treated.

CLASSIFICATION OF CHLAMYDIAL INFECTIONS.

The adopted in most countries the International Classification of Disease X revision (ICD-X) urogenital chlamydial infections are divided:

  1. In the lower divisions of chlamydial infection (uncomplicated):
  • endocarditic;
  • urethritis;
  • cystitis;
  • vulvovaginitis.
  1. The infection of the upper genital tract (complicated):
  • epididymitis;
  • inflammatory diseases of the pelvic organs in women;
  • orchitis.

In addition, the ICD-X isolated anorectal chlamydial infection, pharyngitis chlamydial and chlamydial infection of other sites.

This classification is more convenient for statistical reports, which require a clear rubrification all diseases. Specialists in clinical practice often alter the ICD for greater adaptation of it for their work. So, for the appointment of adequate therapy of chlamydial infections is important to understand which of the 3 forms of urogenital chlamydia is present in the patient:

  1. Chlamydia infection of the lower divisions of the urogenital tract;
  2. Chlamydia infection of the upper parts of the urogenital tract;
  3. Persistent or recurrent urogenital chlamydiosis.

SYMPTOMS AND SIGNS OF CHLAMYDIAL URETHRITIS IN MEN

Chlamydial urethritis is not much different from any other category of urethritis. The incubation period of chlamydial urethritis in men can vary from 7 to 20 days. But it may also be more or less than this period. Chlamydial urethritis effects Sometimes a symptom of urological disease may be paresthesia. But this is quite rare. More often, there is a manifestation of the symptoms, it is absolutely not disturbing man. The only unpleasant process – it’s glassy, mucous or muco-purulent discharge and separation of watery fluid light color. The most common allocation occur in the morning. Experts urologists argue that the majority of infected women in the last time in the early stages there is only defeat of the anterior urethra. In cases of chronic urethritis nature, he becomes pervasive extent of almost half of the patients. In addition, it is very likely to develop chronic prostatitis, that is frequent urination. Identify symptoms of chlamydial urethritis in men will ureteroscopy. Changes with chlamydial urethritis, which can be seen after this study are very similar to changes in other types of urethritis. These changes do not go away even after discharge. After 10-20 days, it is quite possible signs and symptoms of the disease disappear. This is almost a third of patients. But it is worth remembering that urethritis and chlamydial urethritis, in particular, does not pass by itself. Therefore, the disease can recite with the return of symptoms.

COMPLICATIONS AND CONSEQUENCES

In patients with chlamydial urethritis can occur urogenital and extragenital lesions. Among obstetric complications are most common epididymitis, orchiepididymitis, hemorrhagic cystitis, urethral stricture, lesion of the seminal vesicles. Epididymitis, apparently a consequence of chlamydia canalicular skidding rear urethra.

Typically, they develop without noticeable subjective disorders and at normal body temperature. Clinically chlamydial epididymitis on the sluggish course of the disease, the density of the infiltrate and some bumpy surface appendage resemble tubercular lesion. According to many authors, chlamydial epididymitis rarely accompanied funikulitami. Urethral stricture after chlamydial urethritis usually cause no violations of the outflow of urine ( “wide” strictures); this is due to the fact that lacunar strokes are lined with stratified squamous epithelium, which is little susceptible to infection with chlamydia.

Chlamydia, causing inflammatory diseases of the pelvic organs, promote the development of infertility due to tubal or ectopic pregnancy and post-abortion or post-partum endometritis. Chlamydia infection of the genital organs, not only adversely affects the course and outcome of pregnancy, but may be associated with miscarriage, premature birth, untimely amniorrhea, stillbirth

Extragenital complication of chlamydial urethritis more common than recorded because of malosimptomno flow urethral chlamydia can stay undetected and patients and doctors that are accessed by patients with arthritis, subacute endocarditis, and other complications that make up a clinical picture of Reiter’s disease.

DISEASE (SYNDROME) REITER

In recent decades Reiter’s disease attracts attention of urologists, venereologists, optometrists, therapists, Dermatologists and Venereologists.

In connection with improving methods of laboratory diagnosis of chlamydial infection, is usually mixed again increased interest Reiter disease. In this disease, urethritis combined with conjunctivitis, drives, synovitis, lesions of the internal organs and skin. Depending on the time of occurrence of a particular symptom or its degree, patients are turning to the above mentioned art.

The reason remains largely unexplored. It is assumed that the causative agent of the disease in 40-60% of patients – Chlamydia oculogenitalis, on the grounds that it is diagnosed in sexual partners, and it can be isolated from the urethra, conjunctiva, synovial membranes of patients. However, Reiter’s disease in women occurs only rarely, so it is quite natural to assume that male patients have some genetic defects associated with the floor (possibly immunological). A feature of Reiter’s disease is considered dependent on some other infectious diseases. Reuters himself described this syndrome in patients with dysentery. Later it turned out that this disease can occur (and often) in patients with gonorrhea.

Urethritis patients, Reiter’s disease, acute rarely, they occur more frequently with a small amount torpidly complaints. Urethral scarce, sometimes have a whitish hue. On microscopic examination, along with white blood cells detect a large number of epithelial cells. Typical multifocal lesions of the urogenital system (prostatitis sluggishly flowing, vesiculitis, epididymitis, inflammation of the bulbourethral glands, are also possible violation of spermatogenesis). In ureteroscopy show dullness, haze mucosa, bland soft infiltration.

Affects usually several joints; especially often observed inflammation of the ankle, knee and spine. A very significant feature of the disease – a painful point in the places of attachment of tendons in large and sometimes small joints that detect on palpation.

Intensive conjunctivitis may be a transient symptom. Skin rashes are more specific than the above urethritis, conjunctivitis and drives. At the head of the penis, prepuce sometimes arise polycyclic superficial erosions, very reminiscent of cold sores (called balanoposthitis). On the skin of the soles and in other places there are characteristic rash papulopustulёznye like pustular psoriasis or papular syphilides. Celebrating a variety of internal organ involvement. More common hepatitis.

This is very urgent problem, because each year there are 3 000 000 new cases. Young people less than 24 years old, who prefer unprotected sex and have a long list of sexual partners, are located in the risk zone. Symptoms cannot be immediately. Usually it occurs about 1-3 weeks after infestation. Phenotypic picture of the disease is a combination of characteristic features. Among them:

  • ache, burning during micturition;
  • itchiness, reddening and intumescence of sexual organ;
  • secretations;
  • sore in flamed gonads.

DIAGNOSTICS

Diagnosis of chlamydial urethritis comprises standard steps for determining the type of patient urethritis, namely:

  • • Initially, the analysis of the patient’s complaints and a history of the disease (when and what symptoms of urethritis were discovered for the first time);
  • • Analysis of the patient’s history of everyday life (presence of chronic or prolonged inflammation, which operations were conducted earlier, as had sexual intercourse in the past few months, and so on);
  • • Medical examination (a urologist for men and a gynecologist for women);
  • • smear microscopy content that is taken from the urethra to determine the presence of urethritis and his views;
  • • Ureteroscopy using special medical microscope (acute urethritis is not carried out);
  • • urethrography (acute urethritis is not carried out);
  • • Urinalysis to detect the presence of impurities that can occur when urethritis of a species;
  • • Bacteriological sowings smear, which is carried out to determine the sensitivity of the pathogen to the alleged urethritis for treating antibiotic;
  • • ultrasound to detect any changes in the structure of the genitourinary system;
  • • PCR diagnostics for the detection of chlamydia. Currently, diagnosis of chlamydial urethritis based on the use of diagnostic PCR reaction and direct or indirect immunofluorescence using mono- or polyclonal antibodies labeled flyuorestseinizotiotsianatom. Clinical trials immunofluorescence reagents for rapid diagnosis of urogenital chlamydiosis showed that the immunofluorescence method is technically simple, sensitive, specific and reproducible. In Russia, this method – the only regulated for diagnosis of urogenital chlamydiosis.

The diagnostic criterion for the definition of chlamydial urethritis are the results bacterioscopic research.

To increase the effectiveness of treatment of chlamydial urethritis should refrain from sexual intercourse, and carefully monitor their hygiene. From a diet exclude alcohol, spicy and fatty foods.

TREATMENT OF CHLAMYDIAL URETHRITIS

TREATMENT OF CHLAMYDIAL URETHRITISIf chlamydial urethritis diagnosed in time, the drugs will have maximum effect. The more delayed (or ignored) the treatment of chlamydial urethritis, the lower the efficiency of drugs.

Preparations for the treatment of chlamydia can be taken orally, and introducing them into the urethra – the way the medication depends on what type of antibiotics prescribed by a doctor.

If chlamydial urethritis is already in the running form (that is struck by the interior of the epithelium), then hit the antibiotic will be difficult in the affected area. In this connection, it will require topical medications that will increase the absorbability of fabrics main antibiotic.

Because chlamydial urethritis has an infectious origin, the main method of treatment of this disease is antibiotics. The most effective treatment is doxycycline, rulid or ofloxacin. All these antibiotics prescribed by a doctor. These agents are contraindicated for pregnant women and women during lactation.

In the treatment of chlamydial urethritis used antibiotics, which most effectively fight Chlamydia – treatment have chloramphenicol, erythromycin, azithromycin, clarithromycin, and drugs from the group of fluoroquinolones.

In addition to antibiotics are often prescribed medications adrenocortical hormones (such as prednisone or dexamethasone). This is due to the fact that most antibiotics to treat chlamydia have low levels of permeability in cell membranes. Assign these drugs should only be a specialist.

As with Chlamydia often fall in body fungi, there may be additionally used antifungals. fungus treatment is carried out Nystatin, fluconazole, pimafutsin.

Treatment of chlamydial urethritis with antibiotics is well complemented by folk remedies, which accelerate the process of treatment and recovery.

Scheme chlamydial urethritis treatment depends on many factors upon which the antibiotic is selected, the duration of treatment and the concomitant drugs (immunomodulators, physiotherapy, etc.).

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