Chlamydia. Diagnostics, Analyzes, Results And Treatment

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Chlamydia. Diagnostics, Analyzes, Results And Treatment
Chlamydia. Diagnostics, Analyzes, Results And Treatment

Video: Chlamydia. Diagnostics, Analyzes, Results And Treatment

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Video: Chlamydia: Morphology, Types, Pathogenesis, Diagnosis, Treatment 2023, February
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Chlamydia - a group of infections caused by various types of chlamydia. Affects the respiratory, cardiovascular, musculoskeletal, genitourinary systems, organs of vision. Urogenital chlamydia is a manifestation of inflammatory diseases: urethritis, prostatitis, cystitis, vulvovaginitis, cervicitis, erosion, endometritis and is detected only by specific diagnostic methods. Chlamydia is an infectious disease that is transmitted primarily through sexual contact. The causative agent of the disease is the bacterium Chlamidia trachomatis. A characteristic symptom is vitreous discharge from the genitourinary tract. Chlamydial infections are dangerous with multiple complications, including ascending urinary tract infections, infertility, neurochlamydia, joint damage, diseases of the heart and blood vessels, impotence in men. In order to diagnose the presence of this infection in the body,you need to be tested for chlamydia. Today we will talk about the most reliable ways to diagnose chlamydia.

The content of the article:

  • 1 Chlamydia
  • 2 ways of transmission
  • 3 Symptoms of chlamydia
  • 4 Diagnostics
  • 5 Types of tests for chlamydia

    • 5.1 Microscopic analysis (general smear)
    • 5.2 Reaction of immunofluorescence (RIF)
    • 5.3 Enzyme-linked immunosorbent assay (ELISA)
    • 5.4 Polymerase chain reaction (PCR)
    • 5.5 Culture for chlamydia (culture method) with determination of antibiotic susceptibility
  • 6 Indications for the detection of anti-Chlamydia antibodies of the IgG, IgA, IgM classes in the blood test by ELISA
  • 7 When to get tested after treatment for chlamydia
  • 8 Interpretation of test results for chlamydia

    • 8.1 Immunoassay
    • 8.2 PCR
    • 8.3 Sowing
  • 9 Treatment
  • 10 Complications of chlamydia

Chlamydia

Analysis for chlamydia
Analysis for chlamydia

Chlamydia trachomatis is the main causative agent of one of the most common sexually transmitted diseases - chlamydia. This infection mainly affects the genitourinary system and is most often manifested in men and women after an incubation period of 5 to 30 days, while causing a wide range of pathologies. The widespread occurrence of chlamydial infection is primarily associated with the asymptomatic course of the disease.

For a long time, covertly existing in the patient's body and not showing itself in any way, chlamydia, under unfavorable conditions for them (exposure to strong antibiotics, overheating, hypothermia, colds, increased immunity) are able to transform into the so-called L-forms - as if "falling into hibernation ", While acquiring a protective shell that allows them to exist in a" hostile "environment for them. Only during the period of immunosuppression (suppression of protective forces) is active reproduction and the so-called reversion (awakening) of chlamydia from L-forms possible. This phenomenon promotes long-term intracellular parasitism without conflicts with the host's immune system.

Transmission routes

Infection occurs through sexual contact. The non-sexual route of transmission of chlamydial infection through hands, underwear, etc., contaminated with infected discharge, does not have significant epidemiological significance, although it must also be taken into account. A high frequency of infection with chlamydia (more than 50%) has been clearly established - in newborns during childbirth when they pass through an infected birth canal, as well as intrauterine transmission of infection.

Chlamydia symptoms

Analysis for chlamydia
Analysis for chlamydia

The course of genitourinary chlamydia caused by Chlamydia trachomatis is very diverse and can take completely different forms. The most insidious is the asymptomatic course of the infection.

In men, the urethra is primarily affected, and then other organs (prostate gland, seminal vesicles, epididymis). Among the possible and dangerous complications of chlamydia in men are urethritis, chronic chlamydial prostatitis, and prostate cysts.

In women, the cervical canal is affected, after which an ascending infection may occur, involving the uterus, fallopian tubes, ovaries and peritoneum. Chlamydial infection often affects the cervix and urethra at the same time. Chlamydia from the urethra can enter the bladder, causing cystourethritis. Chlamydia, localized in the female genitourinary organs, predispose to the onset of pregnancy pathology.

Chlamydia can cause damage:

  • genitals (urethritis, prostatitis, cystitis, adnexitis, epididymitis, etc.);
  • inner ear (damage to the vestibular apparatus, etc.);
  • eye (chlamydial conjunctivitis);
  • joints (Reiter's disease);
  • rectum (chlamydial proctitis), etc.

With exacerbated forms of the disease, there is a change in the mucous membranes of the urogenital organs, mucopurulent, unpleasant-smelling discharge from the urethra, vagina, frequent urge to urinate, discomfort in the pelvic region, a feeling of fullness in the perineum, itching and severe pain in the urethra.

It is also common for people who have no clinical symptoms of discharge from the genitourinary organs. They do not notice or complain about other symptoms. Chlamydia in them is detected only during clinical studies, that is, there are cases of carriage of chlamydial infection.

Diagnostics

The combination of all modern diagnostic methods makes it possible to obtain a complete and most reliable picture of the disease. The diagnosis of chlamydia is made on the basis of medical history, assessment of clinical signs of the disease and tests for chlamydia. Due to the fact that genital chlamydia is often characterized by a low-symptom course, laboratory diagnosis of this infection is of primary importance.

Types of tests for chlamydia

  • general smear
  • culture method (sowing) with determination of antibiotic sensitivity,
  • molecular (DNA) diagnostics (polymerase chain reaction - PCR),
  • enzyme immunoassay (determination of antibodies in the blood)
  • immunofluorescent (examination of scraping under a fluorescent microscope with antigen detection) and some others.

Microscopic analysis (general smear)

Analysis for chlamydia
Analysis for chlamydia

With this type of examination, a smear is taken from the urethra in men, and in women, smears are taken simultaneously from the vagina, cervix and the external opening of the urethra. This is one of the oldest methods, but it still hasn't lost its significance.

The smear is good for its availability, since it is inexpensive, and in many state clinics it is done for free. But the probability of detecting chlamydial infection in this way is very small, only 15-20 %, since microscopic analysis can only detect the presence of an inflammatory process.

According to the results of a smear, at best, one can only suspect the presence of chlamydia, since with chlamydia, the number of leukocytes in the smear is very small or does not even exceed the norm.

Immunofluorescence reaction (RIF)

The material taken from the urethra is stained with a special substance, then examined under a special microscope (so-called fluorescent). If chlamydia is present, then they glow like fireflies in a microscope objective. The accuracy of this method is up to 60-70%.

The disadvantages of RIF are that there should be a lot of the material under study, and the disease should be already in the active stage. There are also false positive results when staphylococci are displayed instead of chlamydia. However, in the hands of professionals, RIF is one of the best methods for diagnosing urogenital chlamydia.

Immunoassay (ELISA)

Analysis for chlamydia
Analysis for chlamydia

Determination of antibodies (IgG, IgA, IgM) to chlamydia in the blood. These antibodies are produced by the body in response to infection. Antibodies to chlamydia are detected when interacting with special preparations containing chlamydial antigens, which form a strong complex with antibodies, which can be detected in different ways. In addition to the usual scrapings, blood is taken for analysis by the ELISA method.

The method not only identifies the causative agent of the disease, but also informs at what stage the chlamydia is - acute or chronic. The first antibodies appear on the 10-20th day of the disease.

Then other antibodies appear, which can indicate to the doctor about chronic chlamydia, or re-infection, or activation of previously poorly treated chlamydia. But the accuracy of this analysis for chlamydia does not exceed 60%. However, this method is indispensable when a comprehensive diagnosis of the body for chlamydia is carried out.

Polymerase chain reaction (PCR)

Polymerase chain reaction (PCR) method. This method has the highest sensitivity and reliability today - up to 100%. The analysis requires very little material, and the results are ready in a day or two. But this method also sometimes gives false positive results. To confirm the reliability of the PCR analysis, it is usually necessary to pass an analysis for chlamydia by another method, which the doctor recommends, or to conduct a second study after a month, three months and six months.

Chlamydia culture (culture method) with antibiotic susceptibility testing

Analysis for chlamydia
Analysis for chlamydia

Of all the methods for diagnosing chlamydia, this is the most expensive and time-consuming method - the test results have to wait patiently for several days. However, these shortcomings are more than compensated for: if the analysis for chlamydia by the inoculation method gives a positive result, there is no doubt about the presence of these bacteria in the body.

The advantage of this analysis is that during the sowing process it is determined from which antibiotic your infection will die. It is yours, not your wife / husband, boyfriend or girlfriend.

The essence of sowing is that the material taken from you for analysis is "sown" on a special medium. And they "grow". After a while, by the size and nature of the microbial colony, one can judge what has grown. Culture reveals chlamydia in 70-90% of cases.

The method of molecular diagnostics is the "gold standard" for chlamydia analysis all over the world. The PCR accuracy is 90-95%.

Used in combination, both of these tests for chlamydia can neutralize some of the disadvantages of each other when used separately (if chlamydia is not detected in the scrapings, antibodies will be found in the blood).

In addition, the ELISA analysis for chlamydia also provides very useful information for the doctor about the duration and severity of the infectious process in the patient's body. Treatment tactics often depend on this.

Indications for the detection of anti-Chlamydia antibodies of the IgG, IgA, IgM classes according to the blood test by ELISA

Determination of the stage of chlamydia:

    • acute, primary
    • chronic
    • activation of a dormant infection or re-infection
    • post-convalescence (residual serology)
  1. Evaluation of the effectiveness of the treatment (along with the study of the culture method and PCR)
  2. Establishing the chlamydial cause of extragenital lesions:

    • arthritis
    • pneumonia
    • eye diseases.

Advantages of ELISA analysis for chlamydia:

  • no false positive results due to interspecies cross-reaction of chlamydia;
  • lack of infectious material;
  • chemically precise structure of the antigen;

Thus, the reliability of analyzes for chlamydia largely depends on the correctness of the sampling, the frequency of studies, the clinical form of chlamydia and the duration of the chlamydial infection.

If there is a suspicion of the possibility of chlamydia or some kind of infection, a woman should contact a gynecologist, and her partner - a venereologist.

When to get tested after chlamydia treatment

Analysis for chlamydia
Analysis for chlamydia

Establishing the cure of urogenital chlamydia should be carried out taking into account the diagnostic method. A culture study conducted earlier than 10-14 days after the end of treatment for chlamydia may give a false negative result. Direct immunofluorescence test and polymerase chain reaction (PCR-DNA) method performed earlier than 3-4 weeks can give false positive results due to the possible preservation of non-viable microorganisms or their debris.

The detection of chlamydia after the indicated periods of control of the treatment of chlamydia requires the appointment of a repeated course of antichlamydia therapy with drugs of other groups.

The criteria for the cure of urogenital chlamydia in girls are negative laboratory results, the absence of clinical symptoms of the disease.

Dispensary observation of patients after treatment of chlamydia is carried out for at least 3 months.

Tips for those diagnosed with chlamydial infection:

  1. first of all, to obtain confirmation of the diagnosis by several methods of laboratory diagnostics and only after that make a decision on treatment.
  2. Chlamydia treatment should be comprehensive, taking into account the sensitivity to antibiotics and the state of the immune system.
  3. The combination of chlamydia with trichomoniasis or gardnellosis requires the first treatment of concomitant infections, and only then treatment of chlamydia.
  4. If treatment of chlamydia is still necessary, do not save on your health and be treated with modern drugs from well-known companies.
  5. Express - treatment of chlamydia like "chlamydia in 5 days" is unacceptable.

Interpretation of test results for chlamydia

The results of tests for chlamydia are usually prepared within 1-3 working days, some paid institutions provide an urgent analysis service, then the patient can receive a conclusion within a few hours after taking the material. The exception is bacteriological culture, this study takes several days, usually 5–7.

Linked immunosorbent assay

When analyzing biomaterial for chlamydia by the ELISA method, the term "titer" is used. Titers of IgG, IgA, IgM antigens are considered. The table below shows the meanings and explanations.

IgG titers

titers of IgA

titers of IgM

100-6400 50-1600 50-3200 100-1600 50-200 100-51200 50-400 100-400

In the body of a healthy person, antigens are not detected. IgM antigens appear 5 days after infection. IgG - after 10 days. IgA - in 2-3 weeks. Borderline values: titers of IgM and IgA - up to 50, IgG - up to 100 - require re-examination of the patient after 10-14 days.

PCR

It is a qualitative analysis, therefore, the form with the results may say: "found" or "not found".

Sowing

In the laboratory report, the first item will be the name of the infection found in the biomaterial. Further - its concentration, indicated in colony-forming units per milliliter (CFU / ml). One cell gives rise to the growth of a whole colony. The result of over 103 CFU / ml indicates an inflammatory process in the body caused by this pathogen.

The clinical picture of chlamydia is characterized by a latent course, absolutely asymptomatic or oligosymptomatic. The disease is dangerous because of complications leading to infertility, miscarriage, and genital lesions. Today, there are several ways to diagnose chlamydia, but none of them gives a 100% answer. If one of the tests is positive, then additional studies are required. Only a specialist can interpret the results and prescribe treatment.

Treatment

Chlamydia treatment is carried out as directed and under the supervision of a physician. The general prerequisite is the simultaneous treatment for both spouses or sexual partners. The prognosis with modern and adequate treatment is favorable.

Complications of chlamydia

Urogenital complications of chlamydia in men are chlamydial prostatitis, urethritis, epididymitis.

  • prostatitis develops when the prostate gland is involved in the infectious process. Chlamydial prostatitis is accompanied by unpleasant sensations and pain in the lower back, rectum, perineum, minor mucous or watery discharge from the urethra, difficulty urinating, impaired potency;
  • urethritis occurs with lesions of the urethra and is characterized by itching in the urethra, frequent painful urge to urinate, mucopurulent discharge. Chronic urethritis caused by chlamydia leads to urethral stricture;
  • epididymitis develops with inflammation of the epididymis, which is accompanied by high fever, swelling and redness of the scrotum, an increase in the epididymis.

Urogenital complications of chlamydia are fraught with impaired spermatogenesis and infertility for men.

Chlamydia is no less dangerous for women, causing various lesions of the female reproductive system. The ascent of chlamydial infection along the genital tract can cause inflammatory changes from:

  • cervix - endocervicitis. Chlamydia increases the risk of developing neoplastic processes in the cervix;
  • the mucous membrane of the uterine cavity - endometritis;
  • fallopian (fallopian) tubes - salpingitis;
  • appendages of the uterus - salpingo-oophoritis.

Inflammatory processes of the uterus and uterine appendages with the subsequent formation of adhesions and scars in the fallopian tubes cause tubal infertility, ectopic pregnancy, and spontaneous abortion.

Other consequences of chlamydia in men and women can be inflammation of the pharynx, rectum, kidneys, joints, lungs, bronchi, etc. One of the serious complications of chlamydia is Reiter's disease, which is characterized by a triad of clinical manifestations: conjunctivitis, urethritis, arthritis. Re-infection with chlamydia significantly increases the risk of complications.

Chlamydia of newborns, which occurs as a result of infection of a child from a sick mother during childbirth, is especially dangerous. The main forms of congenital chlamydia are:

  • chlamydial conjunctivitis (ophthalmochlamydia) - inflammation of the mucous membrane of the eyes
  • generalized form of chlamydia - damage to the heart, lungs, liver, digestive tract
  • encephalopathy accompanied by convulsions and respiratory arrest
  • chlamydial pneumonia is an extremely severe form of pneumonia with a high mortality rate.

Find out more:

  • Chlamydia treatment with Azithromycin
  • Chlamydia in men - treatment and prevention
  • Chlamydia. Chlamydia trachomatis in men - diagnosis
  • Chlamydial pneumonia in children - symptoms and treatment

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