Sexually Transmitted Diseases - I. I. Mavrov 2005

Sexually Transmitted Diseases
Extragenital Chlamydiosis

Chlamydial proctitis (proctitis chlamydialis). Patients with chronic Urogenital Chlamydiosis may develop proctitis originating from a urogenital source of infection. Clinical manifestations of rectal chlamydial infection are usually very mild (itching and a burning sensation in the perianal area), often accompanied by abrasions and fissures. Some patients may develop polypoid growths around the anus. As a rule, chlamydial proctitis follows a latent, asymptomatic course.

Chlamydial pharyngitis (pharyngitis chlamydialis). Acute chlamydial pharyngitis in adults is very rare; it occurs more frequently in infants. In such cases, the mucosa of the nasopharynx is hyperemic and somewhat tender. Chronic chlamydial infection of this localization is typically characterized by mild clinical symptoms, which are generally restricted to focal mucosal hyperemia and, in some instances, a follicular reaction. Chlamydial pharyngitis can develop as a complication of ophthalmochlamydiosis due to the spread of the infectious agent from the conjunctival sac along the epithelium or via secretions through the nasolacrimal duct into the nasopharynx.

Chlamydial inflammation in the nasopharynx may be accompanied by eustachitis, less frequently by otitis, as well as by involvement of various PARTS OF THE Respiratory system. We have observed cochlear neuritis in patients with urogenital chlamydial infection.

Chlamydial cystourethritis (cystourethritis chlamydialis), or urethrocystitis, is observed predominantly in women. It is less common in men whose Urethra is infected with chlamydia. Occasionally, patients with chlamydial urethritis develop not only cystitis but also Pyelonephritis.

In most cases, the clinical picture resembles chronic cystitis, presenting with lower abdominal pain and frequent, painful urination. Depending on the specific presentation, patients may complain of lower back pain, malaise, urogenital discharge, and, in some instances, unexplained fever.

Chlamydial pyelonephritis (pyelonephritis chlamydialis). Chlamydial urogenital infection is sometimes complicated by pyelonephritis, which may be preceded by chlamydial inflammation in the urethra or Prostate Gland. Typically, chlamydial pyelonephritis runs a chronic course, lasting for a long time (years) and frequently recurring.

The disease is very often underestimated. Signs of pyelonephritis may be limited to mild fatigue, pallor, headache, and poor appetite. During exacerbations, patients report a dull ache in the lumbar region, a burning sensation during urination, and occasionally frequent urges to urinate.

Urinalysis results vary significantly from case to case. Mild proteinuria is most commonly observed. Leukocyte counts can fluctuate widely, sometimes failing to reach the levels seen in acute pyelonephritis even during active flare-ups. In progressive cases, albuminuria and Hematuria may be detected. The severity of hematuria ranges from microhematuria to gross macroscopic hematuria, driven by marked inflammatory hyperemia.

Diagnosing chlamydial pyelonephritis is relatively straightforward given a characteristic medical history, clinical signs, and urinalysis data. In chronic chlamydial pyelonephritis, as with pyelonephritis of other etiologies, an elevation in systolic and diastolic Blood pressure may be detected. Hypertension occurs in approximately 40% of patients. The presence of hypertension in patients with chlamydial pyelonephritis is always a poor prognostic sign. These patients require ongoing urine monitoring, functional renal testing, and, when necessary, radiological imaging.

Chlamydial Conjunctivitis (conjunctivitis chlamydialis) in adults typically results from transferring the pathogen via the hands from the urogenital Organs to the conjunctival sac of the eye (of the patient or their sexual partner). Ophthalmochlamydiosis is also frequently the consequence of direct eye infection during orogenital contact. Cases are known of gynecologists and venereologists contracting the infection after examining patients with urogenital chlamydia, as well as ophthalmologists being infected by patients.

Epidemic outbreaks of ophthalmochlamydiosis can occur through The Use of shared Water reservoirs (“pool conjunctivitis,” “swimmer's conjunctivitis”). Cases of eye infection have also been reported in individuals in close contact with patients suffering from ophthalmochlamydiosis (most commonly infants).

Chlamydial eye infection in infants can be complicated by the involvement of other organs via the canalicular spread of the pathogen through the nasolacrimal duct, causing rhinitis, nasopharyngitis, eustachitis, acute otitis, as well as deeper respiratory tract infections. Ocular chlamydial infection is invariably accompanied by overt conjunctivitis. Primary chlamydial infection of the respiratory system, including chlamydial Pneumonia, is most frequently observed in infants.

Chlamydial pneumonia (pneumonia chlamydialis) develops in approximately half of infants with conjunctivitis. At the same time, chlamydial respiratory tract infection can be the primary manifestation of an infant's infection and may not be accompanied by an inflammatory process of the same Etiology in the conjunctival sac.

Chlamydial pneumonia is diagnosed in 10–20% of children born to mothers with a urogenital chlamydial infection. Often, when a Diagnosis of “viral pneumonia” is made, the true causative agents are chlamydia. Chlamydial pneumonia is characterized by A number of distinct features. The initial symptoms appear at varying intervals after birth—from 4–5 days to several months. A delayed onset may be linked to the asymptomatic course of an infection acquired during childbirth, followed by its reactivation under METABOLISM/18.html">The Influence of various factors (stress, secondary infection, depletion of maternal humoral defense factors, etc.).

The disease develops gradually and assumes a chronic character. Initially, signs of rhinitis appear, followed by tachypnea and a dry, paroxysmal cough. The cough may be staccato (pertussis-like). Occasionally, brief episodes of apnea may occur. Body Temperature remains normal.

Auscultation reveals disseminated crepitation. The borders of the Lungs are expanded. The Liver and Spleen are palpable due to diaphragmatic displacement. Sometimes, severe pulmonary ventilation disorders occur, manifesting as cyanosis and a reduced pO₂ level. Radiographs show a pattern characteristic of diffuse interstitial pneumonia and Atelectasis. Histopathological examination reveals mixed cellular infiltration of the lung tissue with alveolar obliteration and necrotizing bronchiolitis.

Chlamydial pneumonia is accompanied by eosinophilia and elevated serum IgG and IgM levels; it is also characterized by the accumulation of specific Antibodies in the patient's serum in quantities sufficient for diagnosing the infection via widely available serological Methods.

Without etiological Treatment, the disease persists for many months and years. Spontaneous recovery is possible in the absence of complications. The most dangerous are pneumonias of mixed chlamydial and bacterial or viral nature (including chlamydial-cytomegaloviral infections), where timely diagnosis dictates treatment efficacy. Although cases of airborne transmission of the infection have not been described in the literature, this possibility must be taken into account during hospitalization and when interacting with sick children.