Chlamydia is one of the most common sexually transmitted infections. Although known as a name, it turns out that society is not sufficiently familiar with the specifics of the infection, the clinical picture, and possible complications. It is often called the silent epidemic because there are no complaints. However, this does not mean that complications of a different nature cannot occur.
Chlamydia are intracellular parasites that affect a specific type of mucosa. They are several types, and there are separate serotypes. Here we will meet those that affect the urogenital tract – some serotypes of Chlamydia Trachomatis. We will only specify that other types of chlamydia can cause pneumonia (C. pneumoniae), psittacosis (C. psitaci), tropical venereal disease, severe inflammatory-degenerative disease of the conjunctiva, and cornea – Trachoma (other serotypes of C. trachomatis).
The sexually transmitted chlamydia infection affects both men and women. A person is infected only through sexual contact (including oral or anal contact), ie. can not be transmitted through shared towels, linen, swimming pools, etc. In the presence of chlamydial infection in pregnant women during childbirth, the newborn may become infected and cause conjunctivitis or neonatal pneumonia (other than that caused by C. pneumoniae).
What are the symptoms of urogenital chlamydia infection?
As already mentioned, the infection can occur without any complaints, and with an impressive frequency – 80% of women and 20-30% of men are carriers of chlamydia without symptoms. This is the reason for the spread of the infection and the late search for medical help – in connection with complications. Not infrequently, the diagnosis comes from the manifestation of symptoms in the partner. If complaints do occur, they are usually present within 1-2 weeks of infection.
In women, the initial symptoms are inflammatory – they cover part of the reproductive system – the cervix (endocervicitis). It usually affects the urethra (urethritis). The vagina is not affected due to the peculiarities of the epithelium. The symptoms are non-specific and can be seen in other infectious agents. They include increased vaginal discharge, itching, low abdominal pain, pain during sexual intercourse, less frequent bleeding, burning when urinating, frequent urge to urinate. During menstruation, manipulations affecting the uterus infection can affect the upper parts of the genital system and cause inflammation of the lining of the uterus and fallopian tubes – also often with poor symptoms – mild pelvic pain, sometimes bleeding.
In men, complaints include whitish watery discharge, most commonly as a morning drop, redness around the opening of the urethra, burning when urinating, and more frequent urges.
What tests are needed for the diagnosis of chlamydia?
As with any disease, the patient’s complaints and examination data play an important role in clarifying the diagnosis. However, for its exact placement, some tests are needed to prove the presence of chlamydia. This will subsequently determine the course of treatment.
Testing for C. trachomatis is recommended in patients with urogenital, anorectal, and ocular symptoms; patients with proven other sexually transmitted infections (STIs) due to the presence of coinfections in parallel with chlamydia; in sexual contact with persons with STI. Screening is recommended for all women under the age of 25, for all pregnant women, and for those at increased risk of acquiring the infection. Screening tests are not routinely recommended in men.
The fight against chlamydial pelvic inflammatory disease is a fight against infertility in general, as all inflammatory processes that cause infertility (about 70%) are due to Chlamydia trachomatis.
Chlamydial infection is subject to antibiotic treatment, which is carried out mainly with tetracycline preparations. They are divided into two main groups – with normal radiation and depot preparations. Preparations with normal radiation are: Oxytetracycline and Tetracyclin at a dose of 2 g per day, divided into four doses for 14-21 days. From the group of depot tetracyclines, Doxycyclin is used twice 100 mg for 7-21 days. After that, a serological control must be carried out and, if necessary, a new course is applied. The courses can be more depending on the effect of the infection. In case of contraindications for taking tetracyclines, macrolides (Erythromycin) are used in a dosage of 2 g per day, divided into four doses. The treatment periods are the same as for tetracycline preparations.
Other antichlamydial drugs are: tirase inhibitors – Ciprofloxacin (twice 500 mg) and Ofloxacin (twice 200 mg daily).
Quinolones are chemotherapeutics also used to treat chlamydia. Modern sulfonamides combined with Trimethoprim (Biseptol®) have high activity in vitro, but the effect in clinical trials is weaker.
The partner should always be treated due to the venereal nature of the disease.
In recent years, there has been an increase in resistance to antibiotic therapy and many people are unable to completely clear the infection, which creates problems in their social life. Antibiotic use during pregnancy is very limited, and the side effects are quite unpleasant for patients, which necessitated the development of new methods of gene therapy against Chlamydia trachomatis. The University of Waterloo, Canada, is working on a new method of treating chlamydia that, in addition to cleansing, reduces the risk of infection.
The new treatment consists of the use of modified siRNA (small interfering RNA) nanoparticles, which target the PDGFR-beta gene located in the female genital tract. This gene synthesizes a protein that serves as a mediator between the bacterium and the epithelial cell. Targeted therapy with PDGFR-beta alone will produce less of the binding protein. Thus, the bacterium will bind to fewer host cells and the chance of infection will decrease. If the bacterium still manages to penetrate the epithelial cells, the nanoparticles are programmed to enter the infected cells and induce autophagy (a cellular process that breaks down unnecessary or dysfunctional components, in this case, the bacterium). In short, this nanotechnology will reduce the possibility of infecting the cells, and already infected cells will kill the bacteria and thus the spread will be limited to a minimum. At the moment, this is just an experiment that may become a reality in the near future.
The success of treatment depends on the correct diagnosis, timely initiation of appropriate etiological therapy, sufficient duration, and mandatory treatment of sexual partners. For now, the most important prevention remains the restriction of indiscriminate relationships, the choice of sexual partners and compliance with the rules of safe sex, and at the first symptoms – timely examination and consultation in specialized offices and laboratories.