Many pregnant women are puzzled, they say, why assign them tests for sexual infections? Why should I be reinsured when everything is all right? Unfortunately, in our time these diseases are quite common and often asymptomatic. But there are some among them that can negatively affect the course of pregnancy, the process of delivery and the health of the baby. Especially dangerous in this regard is chlamydia, the impact on pregnancy is always unpredictable and sometimes the situation ends extremely badly. That is why this disease deserve a separate conversation.
What is this disease?
Chlamydia is an infectious disease caused by chlamydia. These causative agents have both the properties of the virus and the bacteria, in addition, they have a very complex cycle of development inside the cell and outside it. Chlamydia can easily enter the body cells and destroy them, causing a strong inflammatory reaction leading to adhesions and a sharp decrease in the immune system.
Because of this specific intracellular process of chlamydia reproduction, treatment with simple antibiotics is not capable of completely eliminating the infection. A primary infection, moreover, generally occurs often without symptoms and presumably leads to the flow of the disease into a chronic form. Sometimes, after improper treatment, a persistent, i.e., "sleeping" infection develops from time to time. Such a disease causes altered forms of the pathogen, resistant to the action of antibiotics. The main consequences of chlamydia are a complex of inflammatory diseases of the genitourinary system in women and men, developing infertility, as well as arthritis, conjunctivitis, pneumonia and even cardiovascular damage.
Influence on the course of pregnancy.
Chlamydia often leads to the inability to endure pregnancy - spontaneous miscarriages are repeated. But even if the pregnancy continues, intrauterine infection of the fetus often occurs, or, in consequence, infection of the newborn. Among doctors, there are different opinions about possible complications in the child after the mother's chlamydial infection. Some believe that the negative impact on pregnancy and fetal status is minimal, since the fetus is protected by a fetoplacental barrier, others - that it is possible the development of very serious disorders.
There is an opinion that chlamydia leads to the formation of fetal malformations during primary infection or exacerbation of the infectious process in the first trimester of pregnancy. Also, the disease forms a placental-placental insufficiency, infection - in the second half of pregnancy. Consequences of chlamydia during labor can be: early discharge of amniotic fluid, weakness of birth forces.
Methods of diagnostics.
In total there are several methods for laboratory clinical diagnosis of chlamydia. They include:
• crops or culture method;
• Molecular diagnostics that allow to reveal the elements of the DNA of the pathogen in the isolated material under study;
• detection of antibodies in the blood (enzyme immunoassay);
• examination of the scraping using a fluorescence microscope and detection of the antigen, in this case - chlamydia.
These methods are a generally accepted standard all over the world, but they sometimes cause doubts. This is due to their high manufacturability and cost, with the requirements of strict compliance with all sanitary and hygienic standards (multiple air filtration, isolated laboratory type, absolutely sterile equipment and clothing of medical staff, etc.), with expensive imported reagents. So, the slightest inaccuracies in technology sometimes lead to a false positive result, unjustified methods of treatment. The same applies to the analysis of crops for chlamydia: if the required technology is not followed, they also sometimes give a certain percentage of incorrect results, only more often false-negative.
According to the majority of specialists who are engaged in sexually transmitted diseases, the highest percentage of the correctness and reliability of the research results in the simultaneous use of two known, inexpensive and widely used methods of diagnosis. This is a method of direct immunofluorescence based on the detection of chlamydia in vaginal scrapings and an enzyme immunoassay that determines antibodies to infectious agents in the blood. For this, blood from the vein is surrendered. Both of these methods cover some of the shortcomings that each of them has individually. It also provides information useful to the doctor about the severity and duration of the infectious process in the patient's body. The tactics of treatment depend on this in the future.
Treatment.
Despite the fact that pregnancy can be adversely affected by chlamydia, it is not worth interrupting it after finding the disease. Even if the clamidiosis was detected in the early stages of pregnancy. True, it will require compulsory treatment according to a special generally accepted scheme. Chronic form of chlamydia (when antibodies of type G are found in the blood) are treated at 20 and 30 weeks of pregnancy. In acute process (when antibodies of type M are found in the blood), treatment is carried out after 12 weeks of pregnancy.
Foreign doctors adhere to the view that if there are no clinical manifestations (characteristic discharges, pain, etc.) and the activation of infection in the course of laboratory studies, there are no grounds for prescribing an antibiotic to a pregnant woman. After all, each person is a carrier of many pathogenic and conditionally pathogenic microorganisms. Carrying is not always an indication for treatment. Only with visible activation of infection can appropriate therapy be conducted.
In the treatment of chlamydial infection, antibiotics of the tetracycline group are used. During pregnancy preference is given to ofloxacin and macrolides of the last generation. It is also necessary to correct the immune status, while the specificity of the infection is always taken into account.
Recently, a new drug has become popular - the human antichlamydia immunoglobulin. It contains antibodies against chlamydia, therefore the clamidiosis for pregnancy has a minimum effect. During the whole treatment, it is necessary to take medicines that support the work of the liver, and also to prevent the outbreak of an external fungal infection. Sometimes there is a need to supplement the treatment with enzymes, and then to restore the microflora take eubiotics - lactobacilli and bifidobacteria.