What Is the Treatment of Chlamydia?

Chlamydia infections are a group of infectious diseases caused by various Chlamydia infections. Can cause uterine infections in animals and humans, premature delivery, abortion, urinary tract infections, pneumonia, bronchitis, gastroenteritis, encephalomyelitis, conjunctivitis and arthritis.

Basic Information

English name: Chlamydia Infections
Visiting department: Infectious Diseases
Common causes: Humans have weak specific immunity after infection with Chlamydia, and have a short duration and are prone to repeated infections; incomplete removal can cause persistent infections

Common symptoms: Chlamydia pneumoniae infections include sore throat, hoarseness, and runny nose; Chlamydia trachomatis infections include tears and purulent discharge from the eyelids in the acute phase; non-gonococcal urethritis is frequent urgency

Causes of chlamydia infection

Chlamydia is the only prokaryote with a strict two-phase reproduction cycle. It is divided into two stages: the extracellular phase with inactive metabolism and the proliferative intracellular phase. According to its antigenic properties, morphology, and glycogen content, it is divided into: Chlamydia trachomatis, Chlamydia psittaci, Chlamydia pneumoniae, Chlamydia veterinary (non-pathogenic to humans). After chlamydia infects the human body, it first invades columnar epithelial cells and grows and reproduces in the cells, and then enters the cell proliferation of the monocyte macrophage system. As chlamydia reproduces in cells, causing the death of infected cells, the same fashion can evade the host's immune defense function and get intermittent protection. The pathogenic mechanism of chlamydia is to inhibit the metabolism of infected cells, lyse and destroy cells and cause the release of lytic enzymes, the cytotoxic effect of metabolites, causing allergies and autoimmunity. The specific immunity obtained after infection is weak, the duration is short, it is easy to be repeatedly infected, incomplete removal can cause persistent infection, and there are also a large number of asymptomatic recessive infections.

Clinical manifestations of chlamydia infection

1. Chlamydia pneumoniae infection (CP)

Chlamydia pneumoniae is a recently identified new species of Chlamydia that can cause upper and lower respiratory tract infections. CP pneumonia is not specific in symptoms and signs compared to other pneumonias. The incubation period is 10 to 65 days. The symptoms of upper respiratory tract infections such as sore throat, hoarseness, and runny nose are often seen from the beginning. Sore throat is the most common. The most common symptoms of CP appear after 1 to 4 weeks: fever and cough. From 1 to 7 days, the cough is mainly dry cough, physical examination can be heard and wet and dry rales, occasional costal pain, some patients may develop asthma. Most patients have mild symptoms, but their recovery is slow, and symptoms can last for weeks to months. When infecting the elderly and patients with chronic diseases, pneumonia is often severe, sometimes with pleural effusion, and can cause death. Chlamydia pneumoniae infection can still cause extrapulmonary symptoms such as endocarditis, myocarditis, pericarditis, nodular erythema, hepatitis, meningitis, and encephalitis.

2. Other Chlamydia infections

(1) Chlamydia trachomatis can be divided into 15 types according to its antigen, and it is A, B, Ba or C that causes trachoma. The general incubation period is about 3 to 10 days. The primary infection is more common in children. There are tears in the acute phase, purulent discharge from the eyelids, conjunctival hyperemia and follicular formation. Chronic sustainable activities for several years, mild asymptomatic or itchy eye and conjunctival foreign body sensation, often the formation of conjunctival follicles, repeated infection or concurrent bacterial infection can form corneal vascular crests and scar formation. Its severity is not related to the type of chlamydia, but to the frequency of repeated infections.

(2) Urinary genital infections are most common in adults. About 50% to 60% of non-gonococcal urethritis is caused by Chlamydia trachomatis infection. The incubation period is 6 to 14 days. Frequent urination, urgency, poor urination, urethral mucosal hyperemia and increased secretion, etc. The urination pain is not obvious and can be relieved by itself, but most patients turn to a chronic course with recurrent attacks and prostatitis. For frequent urination, dysuria, and perineal pain. Subclinical infections account for 20% to 50%. About two thirds of young people with acute epididymitis are caused by chlamydia, which can cause infertility.

75% of women with chlamydia urethritis can be asymptomatic. Cervicitis can often occur with increased vaginal purulent secretions, bleeding after intercourse, cervical hypertrophy, erosion, and follicular changes, etc., which can progress to endometritis, salpingitis, and manifest as fever, abdominal pain, and vaginal bleeding, leading to Pregnancy or ectopic pregnancy. Infection during pregnancy may cause abortion, premature delivery, stillbirth, and postpartum pelvic inflammatory disease and pass to the newborn through the birth canal to cause infection. It can cause neonatal inclusion body conjunctivitis and neonatal pneumonia. Its infection rate is as high as 50% to 70%.

(3) STD Lymphogranuloma, also known as the fourth STD, is caused by L1, L2, and L3 serotypes of C. trachomatis. STD lymphogranuloma is distributed all over the world, and it is more common in tropical and subtropical areas, such as South America, Africa, India, and Southeast Asia. Direct transmission through sexual contact. The patients were mostly young adults, with a male to female ratio of approximately 5: 1. The incubation period is usually 10-15 days, which can be shorter and longer. Systemic symptoms may be mild fever and elevated white blood cell counts, and a few patients develop reactive arthritis or meningitis. The main lesions are lymphoid tissues, which can invade the external genitalia, inguinal lymph nodes, rectum and anus. Early manifestations are primary genital pimples or ulcers, called primary sores, which are usually asymptomatic and ignored, and local lesions heal a few days later without scarring. The mid-term is also called the groin diaphragm. Inguinal lymph nodes in men are painful and swollen, forming inflammatory masses with adhesion to surrounding tissues. The swollen lymph node mass has a depressed inguinal ligament like a groove, which is called groove disease and is characteristic. The lymph nodes gradually liquefy and rupture to form multiple fistulas. Lymph node lesions in women are mostly around the rectum, often accompanied by proctitis, and abdominal pain, diarrhea, severe back pain, pus and blood in the back, back pain and so on. Late and external genital elephantiasis and rectal stenosis. Appeared 1 to 2 years later, due to external genitalia and peripheral lymphadenitis and lymphatic obstruction, elephantiasis appears. Males are mostly penis and scrotum, and women are more common in the labia majora and clitoris. Long-term inflammation, ulcers, and atrophic scars after healing of the rectum and the surrounding fistulas shrink the rectum.

(4) Caused by Chlamydia psittaci infection in parrot fever. The clinical manifestations of this disease vary widely. The incubation period is 3 to 45 days, usually 6 to 15 days. Most of them are the most common type of pneumonia or atypical pneumonia, and a few are systemic reactions such as toxemia and sepsis. Onset is usually rapid, with sudden chills and high fever. There are also patients with slow onset. The initial 3 to 4 days show general discomfort, fatigue, low fever, and loss of appetite. In the first week of onset, the body temperature was 38 ° C to 39 ° C, and in the second week, 39 ° C to 40.5 ° C, there was residual fever, chills, and persistent headache. Respiratory symptoms, dry cough, or a small amount of mucus and sputum may appear 3 to 5 days after the onset of symptoms. When the range of lung lesions is large, there may be shortness of breath, cyanosis, chest pain, and thick sputum. Pleural effusion can occur in 50% of patients, but most of them are trace. Most patients have liver and spleen involvement. Nervous system symptoms such as mania and restlessness may occur in the acute phase; gastrointestinal symptoms such as abdominal pain and constipation; severe renal failure to coma; in addition, meningeal irritation and heart damage may occur (myocarditis, endocarditis) Performance, relatively slow pulse when fever. The manifestations of pneumonia and splenomegaly are more important in the diagnosis of this disease.

Chlamydia infection check

Antigen detection

(1) Smear microscopy can be performed on eye conjunctiva, cervical swabs or scrapers for smears, and bronchoscopy of lower respiratory tract infections to take secretions or lavage fluid to detect chlamydia trachomatis inclusions in the epithelial cell cytoplasm. The method is simple, but the detection rate is less than 30%.

(2) Enzyme-linked immunosorbent assay (ELISA) detects chlamydia antigens in clinical specimens. This method is sensitive, simple and fast, but has cross-reactions with bacteria, and false positives can occur, especially in nasopharyngeal specimens.

2. Nucleic acid detection

The polymerase chain reaction (PCR) is used to detect Chlamydia DNA, which can directly identify the species and type of Chlamydia from specimens. Nucleic acid probes detect Chlamydia DNA in biopsy specimens.

3. Antibody detection

People with no complications of genital tract infections can produce low titers of antibodies; about 20% of patients with acute chlamydia urethritis do not produce antibodies. Commonly used are:

(1) The complement-combination test is suitable for the diagnosis of venereal disease lymphogranuloma, parrot fever, and chlamydia pneumoniae infection, with low sensitivity.

(2) Trace indirect immunofluorescence test This test is one of the most sensitive methods for the diagnosis of Chlamydia pneumoniae infection. If the titer of the double serum is increased by 4 times, or the titer of the single serum IgM antibody is greater than 1:16, or the titer of the IgG antibody is greater than or equal to 1: 512, the acute infection can be diagnosed.

(3) Direct fluorescent antibody detection can detect various types of specimens of Chlamydia. This method is sensitive, specific and fast, and is a diagnostic technique with strong operability and practicality.

Chlamydia infection diagnosis

1. Chlamydia pneumoniae infection has no specific manifestations in clinical and X-ray examinations, especially when -lactam treatment is ineffective, relevant pathogenic or serological examinations should be performed. Peripheral blood white blood cells are mostly normal, and erythrocyte sedimentation often increases. The diagnosis depends on pathogenic and serological tests and PCR tests.

2. The clinical manifestations of conjunctivitis, pneumonia, and genitourinary system infections caused by Chlamydia trachomatis infection lack specificity, so the diagnosis must be confirmed by pathogenic or serological examination. Neonatal chlamydia pneumonia mostly occurs 4 to 11 weeks after birth. If it is combined with inclusion body conjunctivitis, it is highly suggestive of chlamydia trachomatis infection. Etiological examination should be performed in time and other bacteria, viruses or mycoplasma infections should be excluded.

3. Chlamydia trachomatis urogenital infection is one of the important sexually transmitted diseases. People with a history of sexual disorder should consider this disease, need to do the corresponding etiology and serological examination, and distinguish them from Neisseria gonorrhoeae urethritis. The two may coexist.

4. STD lymphogranuloma needs to be distinguished from herpes simplex virus, syphilis, soft chancre and other lower limbs, lower abdomen, buttocks, external genitalia, and inguinal lymphadenopathy caused by inflammation in the anal area. History, clinical manifestations and laboratory etiology testing.

5. Parrot fever patients have persistent high fever, relatively slow pulses, severe headache, and nonspecific pneumonia with normal white blood cell counts. When there is a history of close contact with birds, parrot fever should be initially suspected. The diagnosis depends on the etiology and serology.

Chlamydia infection treatment

Tetracycline and azithromycin are preferred for the treatment of chlamydia. In addition, doxycycline, minocycline, erythromycin, rifampicin, and clarithromycin are also available. Fluoroquinolones such as levofloxacin and moxifloxacin are also effective. -lactams, aminoglycoside antibiotics, vancomycin and spectinomycin are not effective. The course of effective treatment takes 7 to 21 days. Glucocorticoids can be used concurrently in severe cases of parrot fever. At the same time with infusion, oxygen and other general treatment.

For comorbidities, such as eyelid inversion, trichiasis, urethral stricture, female infertility, etc., surgery or other comprehensive treatment measures are often required.

Chlamydia infection prognosis

Since the 20th century, chlamydia has been found to be related to cardiovascular, respiratory and nervous system diseases. About 50% of Chlamydia infections can heal on their own, but long-term chronic infections can cause sequelae of inflammatory reactions including pelvic inflammatory diseases, infertility, blindness, arthritis, asthma, and atherosclerosis.

Chlamydia infection prevention

Improving hygienic conditions and popularizing health knowledge are very important for the prevention of trachoma. Personal hygiene should be paid attention to. Towels and wash basins are not shared. Family members are treated collectively. Screening and thorough treatment of Chlamydia trachomatis infection in pregnant women can greatly reduce the chance of neonatal infection. Prevention of genitourinary system infection and sexually transmitted disease lymphogranuloma. Preventive medication for high-risk groups. For the prevention of parrot fever, attention should be paid to strengthening the customs quarantine of imported animals, and the smuggling of sick and carrier birds is strictly prohibited. Carry out health promotion, especially for those who are in frequent contact with poultry due to professional relationships, to prevent occupational infections. When an epidemic situation occurs, the source of the epidemic should be identified as early as possible, and sick birds should be executed and destroyed. The sale of chlamydia infected parrots and other bird watching birds is prohibited. Patients should be hospitalized for isolation and treatment, and pay attention to medical observation of other persons with a history of contact with sick birds. Pregnant women should avoid contact with sick birds to avoid infection and cause abortion syndrome. Chlamydia is sensitive to conventional disinfectants.