Chlamydia in humans. Questions. Causes of chlamydia disease

Infection can occur through any type of sexual contact: oral, genital, anal. Therefore, the only way to protect yourself from infection is to remain faithful to your sexual partner or to correctly use reliable means of protection.

Infection with chlamydia during each unprotected sexual contact occurs on average in a quarter of cases. However, women are more susceptible to this infection and are therefore more likely to become infected.

Vertical route of transmission of infection. With this type of infection, transmission of chlamydia occurs during childbirth - during the passage of a newborn through a woman’s birth canal. Intrauterine infection of the fetus during pregnancy has not yet been identified.

Symptoms of chlamydia

Chlamydia develops in stages. As a rule, the evolution of the disease occurs in three stages: infection, the stage of clinical manifestations, and the stage of development of complications. Let's look at each symptom separately.
Infection occurs when an infection is transmitted. As a rule, infection occurs through unprotected sexual contact. In the first days there may not be any pathological symptoms or new sensations. However, already in the first week, mild itching may occur in the mucous membranes of the genital organs or urethra. As a rule, these scant symptoms do not allow one to suspect chlamydia.

Clinical manifestations - more often this stage of the disease is manifested by an increase in symptoms of urethritis.

Manifestations of chlamydia in women

Urethritis - in this condition, inflammation of the urethra becomes increasingly worrisome. Each urination may be accompanied by pain and pain. In the intervals between urination, pain and discomfort in the urethra decrease, but persist.

Cervicitis is an inflammation of the cervical canal. This condition may be accompanied by pain in the lower abdomen, bleeding during the intermenstrual period, and painful sensations during genital sexual intercourse.

Proctitis is pain in the anus. In this case, the pain increases sharply every time you have a bowel movement. In some cases, pathological mucopurulent discharge may be observed from the anus.

Pharyngitis - with inflammation of the pharynx, there is pain when swallowing, swelling of the mucous membrane of the pharynx. In some cases, mucopurulent discharge is detected on the surface of the mucosa.

Manifestations of chlamydia in men

Urethritis is manifested by burning and pain when urinating. However, prolonged presence of urethritis in men can cause the formation of scar tissue and narrowing of the lumen. Therefore, treatment of chlamydial urethritis must be timely and adequate.

Inflammation of the testicles and epididymis (orchiepididymitis) - manifested by an increase in the size of the testicle and its epididymis. Inflammation of these organs is accompanied by severe pain and local inflammation. The consequences of orchiepididymitis can be male infertility and a decrease in testosterone levels.

Prostatitis – with this lesion, inflammation of the prostate gland occurs. Damage to this organ occurs several weeks after infection as the infection moves upward through the urinary tract. When the prostate becomes inflamed, a number of noticeable changes occur: pain in the perineum, difficulty urinating, decreased libido, increased discharge from the urethra. In the case of a long-term process, the structure of the prostate tissue is disrupted, which disrupts the process of sperm formation and can cause male infertility.

Methods for laboratory diagnosis of chlamydia

Diagnosis of chlamydial infection of the genital organs is a rather difficult problem. The difficulty of identifying this pathogenic microorganism is associated with the peculiarities of its life activity and functioning. First of all, it should be pointed out that chlamydia is an intracellular microorganism. This means that chlamydia is able to enter cells and live in the host cell. The host cells most often are the epithelial cells of the mucous membranes of the genital organs of men and women. It is with this intracellular form of life that numerous relapses of chronic diseases of the genitourinary organs are associated. That is, chlamydia remains inside the cells, and when favorable conditions arise for it, it again leaves the host cell, causing an exacerbation of the chronic inflammatory process.

Numerous attempts to treat chronic infections of the genitourinary organs, including those caused by chlamydia, lead to chronicity of the process and the emergence of resistant forms of the pathogenic microorganism. Very often, other infections caused by opportunistic microorganisms are combined with chlamydial infection. Opportunistic microorganisms are present in the human body normally, but with a decrease in immune defense they can cause the development of infectious inflammatory diseases. A decrease in immune defense can be caused by a variety of factors, including chronic persistent intracellular chlamydia.

So, conditionally, all methods for diagnosing chlamydia can be divided according to the principles underlying this or that method. Today the following methods are used:

• rapid tests
• smear
• immune fluorescence reaction (RIF)
• serological methods (complement fixation reaction - RSK)
• enzyme immunoassay (ELISA)
• cultural method (bacteriological culture)
• DNA methods (polymerase chain reaction - PCR, ligase chain reaction - LGC, transcription amplification - TA, DNA probe method)

Let's look at each of the methods in more detail. Today it is impossible to single out the best method for diagnosing chlamydia, since each method has advantages and disadvantages. And for maximum efficiency in identifying the pathogenic microorganism - chlamydia - the most appropriate methods in a particular clinical situation should be combined.

Express tests –

Express tests or mini-tests are sold in pharmacies and are intended for use at home. Rapid diagnostic tests are based on the immunochromatography method. That is, when chlamydia gets on the sensitive part of the test device, the microorganisms bind to antibodies and stain the test strip. Thus, if the result is positive, two colored stripes are visible in the results reading window. Such tests are carried out quickly, are not expensive, but can only serve as a guide. The sensitivity of these tests varies between 20-50%. That is, the probability of detecting chlamydia, provided that it really is, is no more than 20-50%. Thus, the result of the rapid test cannot be trusted. If a person suspects that a chlamydia infection has occurred, it is necessary to consult a medical specialist and undergo a full examination.

Smear from the mucous membrane (microscopy) – advantages and disadvantages of the method

Where do they take a smear from and how to take it correctly?
By smear we mean an examination under a microscope of the secretions of the genital and urinary tracts of men and women. In women, a smear is taken from the walls of the vagina, from the cervix and from the external opening of the urethra. In men, a swab is taken from the urethra or prostate secretions are examined. Examination of prostate secretions in men is necessary because the male urethra is much longer than the female, and chlamydia can be found in the upper part of the urethra. When the microorganism is in the upper part of a man's urethra, it will not be transferred to the swab because the swab is taken from the lower part of the urethra. When secreting the prostate secretion, the existing chlamydia, localized in various hard-to-reach parts of the urethra, are washed away by the prostate secretion and end up on the smear.

It should be remembered that to test for chlamydia it is necessary to take scrapings from the genitourinary tract. This must be done because chlamydia are intracellular microorganisms, and when scraped, the cells in which chlamydia live appear on the smear.

Sensitivity of the method, advantages and disadvantages
This method is quite old, but has not lost its relevance. Microscopic examination of a smear is quite simple to perform, inexpensive and quick. However, the sensitivity of this method for detecting chlamydial infection is low, amounting to only 15-30%. However, even this method should not be neglected. Since a smear can reveal a picture of a chronic inflammatory process and suspect the presence of chlamydial infection. The number of leukocytes in a smear in the presence of chronic chlamydial infection can be normal or slightly increased.

Immune fluorescence reaction (IFR) – advantages and disadvantages of the method

The immune fluorescence reaction is a very complex and time-consuming method. Carrying out this method requires a highly qualified laboratory doctor, the presence of sophisticated equipment - a fluorescent microscope and special reagents. To carry out an immune fluorescence reaction, a smear from the urethra is stained with special fluorescent dyes. As a result, chlamydia in the smear appears glowing. Provided that the personnel are sufficiently qualified and the swab is taken correctly for diagnosis, the immunofluorescence method is very accurate and sensitive. Many professionals use this particular method to confirm chlamydia. However, today the number of professionals capable of using this method is low, so its sensitivity is usually estimated at 70%. This is due to the fact that fluorescent dyes can stain not only chlamydia, but also staphylococci, streptococci, and other opportunistic microorganisms. Only a highly professional doctor can distinguish which microorganism is stained with a luminous dye.

It must be remembered that chlamydia detected in a smear by immunofluorescence reaction can be alive or dead, which remained after treatment, and the body has not yet had time to utilize them. The disadvantages of the immunofluorescence reaction also include the fact that it detects only one type of chlamydia. However, this circumstance could be overcome by developing appropriate fluorescent reagents. But today, with the development of science and technology, other methods have appeared that have also been successfully used to diagnose chlamydia.

The indisputable advantage of the immunofluorescence reaction method is the high speed of execution - no longer than one hour. Due to this circumstance, the immunofluorescence reaction method can be recommended for rapid or express diagnostics for the detection of chlamydia.
However, it should be remembered that to detect chlamydia, it is necessary not just discharge from the genitourinary organs, but scraping from these organs so that chlamydia-carrying cells get into the material being studied.

Serological methods (complement fixation test) – advantages and disadvantages of the method

Most often, a standard serological method is used to diagnose chlamydial infection - the complement fixation test (CFT). To carry out this reaction, special antibodies are used that bind to chlamydia. These chlamydia + antibody complexes are then identified. This group of methods is very simple to perform, is carried out very quickly, but gives a high frequency of false positive results. This means that chlamydia is found where there is none. Due to this circumstance, the sensitivity and specificity of the method is low. Serological methods are generally uninformative for detecting acute infection, since the concentration of chlamydial antigens is low. However, the complement fixation reaction can be used as a screening test when a comprehensive and rapid examination is required for the presence of a wide range of pathogens of various infectious diseases. For serological methods, venous blood is collected in the morning, on an empty stomach.

Enzyme-linked immunosorbent assay (ELISA) – advantages and disadvantages of the method

The enzyme immunoassay method detects not the microorganism itself - chlamydia, but antibodies to chlamydia. Anti-chlamydial antibodies can be of three classes - IgG, IgM, IgA. In this case, antibodies are detected in the blood or in the discharge of the genital organs. The undeniable advantage of the method is its ability to identify the severity of the process, that is, to find out whether the infection is acute, chronic or a relapse of poorly treated. The disadvantage of the method is low sensitivity - only 60%. Another disadvantage is the possibility of detecting infection only 20-30 days after infection. This interval from the moment of infection to the possibility of detecting chlamydial infection using enzyme immunoassay is due to the fact that antibodies are formed by 20-30 days from the start of the development of the infectious-inflammatory process.

However, this method is quite simple and inexpensive. However, there is a high probability of false positive results. This means that infection is detected where there is none. To date, the World Health Organization has not included the enzyme immunoassay method in the list of the most informative methods for detecting chlamydia. Despite this circumstance, many laboratories perform this technique.
DNA diagnostic methods: PCR research, DNA probes, ligase chain reaction - advantages and disadvantages of methods
What methods are classified as DNA diagnostic methods?
These methods detect the genetic material of chlamydia in the secretions of the genitourinary organs of men and women. DNA diagnostic methods include polymerase chain reaction (PCR), ligase chain reaction (LCR), DNA probes and transcriptional amplification (TA).

Polymerase chain reaction method very sensitive – up to 99%. However, to carry it out, it is necessary to have a specially equipped PCR laboratory and highly qualified personnel. When carrying out PCR, sterility must be maintained at all stages - from collecting the material to the stages of the analysis itself. Since the entry of foreign genetic material into the sample at any stage can lead to false positive results. To carry out PCR, special reagent kits from various manufacturers are used. The sensitivity and specificity of kits may vary between manufacturers. To date, Roche kits are considered the most sensitive PCR kits for diagnosing sexually transmitted infections.

For an accurate diagnosis, a scraping is taken from the genitourinary organs, since otherwise the genetic material of chlamydia may not get into the biological sample being studied.

The PCR method is currently being actively improved and implemented, so new modifications are constantly appearing. Depending on the modification of the method, the time spent on analysis varies. Typically this time ranges from one day to 3-4 hours.

If there are any doubts about the reliability of the PCR analysis result, it is usually recommended to undergo examination using another method or take a repeat test for PCR diagnostics after a short period of time (a month, three months, etc.).

DNA probe method also highly specific, however, less sensitive than PCR. The DNA probe method is not very informative in detecting chronic chlamydial infection. The DNA probe method is most sensitive in the presence of chlamydial infection in the cervical canal of women. In this case, its sensitivity is superior to both the culture method and the enzyme immunoassay.

Ligase chain reaction– a new and highly effective method for detecting chlamydial infection. The ligase chain reaction method can detect chlamydia in the urine of women. Sensitivity and specificity are very high - 95% and 100%, respectively. The ligase chain reaction method is superior to all other methods, including culture, in its sensitivity and specificity. Also, for the ligase chain reaction method, there is no need for special collection of material for analysis, since you can simply collect urine. However, the method is very labor-intensive and requires highly qualified personnel and a specially equipped laboratory.

Transcription amplification method is under development. However, its sensitivity and specificity will be very high. This method may become the new “gold standard”.
In general, all DNA diagnostic methods are very accurate and informative. Unfortunately, mass implementation of these methods is currently impossible due to the lack of professionals and expensive equipment for laboratories. Therefore, DNA diagnostic methods can only be found in large medical centers or specialized laboratories.

Cultural method (bacteriological culture) – advantages and disadvantages of the method

This method is the most time-consuming and labor-intensive. The essence of bacteriological sowing is that the discharge from the genitourinary organs of a man or woman is sown on a special nutrient medium. This nutrient medium is strictly specific, that is, only chlamydia grows on this medium. Next, the inoculated material is placed for several days in a special incubator, where the necessary conditions for the growth of the microorganism culture are maintained. If chlamydia is present in the inoculated secretion of the genitourinary organs, then it will grow in the form of special colonies that will be visible on the surface of the nutrient medium.

The advantage of the culture method is that it never gives false positive results. That is, if the result of the culture method is positive, then chlamydia is undoubtedly present in the human body. Also, using the cultural method, the sensitivity of the microorganism to antibiotics is determined. That is, they determine which antibiotic will be destructive specifically for the chlamydia that live in the body of this particular person. You should know that the sensitivity of a microorganism to antibiotics is strictly individual. This means that the chlamydia of one sexual partner can die from the action of one antibiotic, and the chlamydia of the second sexual partner will die under the influence of a completely different antibacterial drug.

The disadvantage of the cultural method is its duration - several days, labor intensity and high cost. To carry out bacteriological cultures, you need a specially equipped laboratory (as well as for PCR), highly qualified personnel and expensive culture media.
For the cultural method, it is extremely important to correctly take biological material for sowing. For sampling, special instruments are used that scrape off some of the epithelial cells of the genitourinary organs, since chlamydia lives in these cells.

Due to the exceptional specificity of bacteriological culture, this method is called the “gold standard” in identifying various infections, including chlamydial infections.

Today, the most sensitive and specific methods for detecting chlamydial infection are considered to be the culture method, PCR method, LCR method and TA. We would add here the immunofluorescence reaction method, but only in the hands of high-class professionals.

When can chlamydia be considered cured?

In order to determine the effectiveness of the treatment, it is necessary to carry out special diagnostics after the course of treatment.

Tetracyclines:
Tetracycline - this drug in the treatment of chlamydia is prescribed in a dosage of 500 mg four times a day. The course of treatment can be 7-14 days.
Doxycycline - used in a dosage of 100 mg twice a day. The course of treatment is also 7-14 days.
Macrolides:
Azithromycin - the first dose of the drug in a dosage of 1 g. Next, the drug is prescribed in a dosage of 500 mg once a day. The course of treatment is 5-7 days.
Erythromycin – 500 mg. Twice a day for 10 days
Midecamycin – 400 mg. Three times a day for 10 days.
Fluoroquinolones:
Ofloxacin - 200 mg per day for 9 days.

In antibacterial treatment, it is important to conduct a full examination of the patient before prescribing treatment - this will avoid serious complications and side effects. Only the attending physician can adequately prescribe a treatment regimen and monitor the effectiveness of the therapy. Therefore, self-medication for chlamydia is unacceptable, as it can cause significant harm to your health.

Immune stimulation

First of all, normalization of immunity is achieved through a reduction in neuropsychic stress and a rational daily routine. An active lifestyle, balanced nutrition and a positive attitude have a significant impact on the body.

However, in the treatment of an infectious-inflammatory process, these recommendations are supplemented by the prescription of immunostimulating drugs:
vitamins from the antioxidant group (A, C, E). These vitamins reduce the toxic effects of infectious agents on the body. Timely and adequate quantitative intake of these vitamins into the body contributes to the active restoration of damaged tissues.

Immunal - this herbal preparation stimulates the activity of immune cells. Thanks to this, the processes of eliminating infection from the body and restoring damaged tissues are more active.
Immunostimulating therapy is prescribed by the attending physician according to an individual regimen. The use of these drugs is possible only after eliminating possible contraindications.

Prevention of chlamydia

The best way to prevent chlamydia is to avoid factors that can lead to infection.
Decrease in the number of sexual partners. Promiscuous sexual intercourse greatly increases the risk of infection.
For casual sex, it is necessary to use a condom.
If maintaining marital fidelity is impossible or your regular sexual partner does not inspire trust, then it is necessary to conduct an annual bacteriological and serological examination for sexually transmitted infections.
If you are diagnosed with chlamydia, you must begin treatment immediately.
During the treatment period, all sexual contacts must be stopped. Using a condom does not provide 100% protection. Oral or anal sexual intercourse is no less dangerous for infection with chlamydia than genital intercourse.
After a full course of treatment, it is necessary to carry out a mandatory diagnosis of cure. Only after chlamydial infection has been ruled out is it possible to stop treatment and resume sexual intercourse.

Chlamydia is a disease included in the list of the most dangerous sexually transmitted infections. It is classified as a “new” disease, since chlamydia began to be identified only a few decades ago. The disease occurs hidden, but despite its apparent harmlessness, it causes enormous damage to health and affects the course of pregnancy and the health of the newborn if chlamydia is detected during pregnancy.

Appointment with a gynecologist, urologist - 1000 rubles. Consultation with a doctor based on test results or ultrasound - 500 rubles.

If untimely or absent treatment, chlamydia causes complications. In women this is infertility, in men it is epididymitis (inflammatory process in the testes). Other complications of chlamydia include Reiter's syndrome, , salpingitis, endometritis and many others.

What is chlamydia: causes and characteristics of infection

The frequency of infection with chlamydia is lower than that of gonorrhea, but, nevertheless, chlamydia is practically the most common sexually transmitted disease. Every year there are about 200 million new infections with chlamydia. The cause of chlamydia is the chlamydia bacteria - Chlamydia trachomatis.

Invading the body, chlamydia primarily affects the human genitourinary system and urogenital tract. In this case, chlamydia can occur as a single infection or in combination with other infections of the genitourinary system: trichomoniasis, bacterial vaginosis.

When chlamydia enters the body, it can successfully resist the immune system and live there for many years, but not harm the carrier until a certain point. At the same time, “dormant chlamydia” is still dangerous - an infected person acts as a carrier capable of infecting other people.

Now almost 1 billion people are carriers of chlamydia. As soon as circumstances change - for example, the immune system weakens, chlamydia immediately becomes more active.

How can you become infected with chlamydia: once is enough

The widespread distribution of the disease is explained by the fact that its symptoms are often not pronounced, and the patient may not be aware of the presence of chlamydia for a long time.

Sexual route: vaginal, anal and oral! Chlamydia is a sexually transmitted disease and can therefore be contracted during unprotected vaginal or anal intercourse. There is a possibility of transmission of chlamydia through oral sex, which increases significantly in the presence of damage to the mucous membranes.

Is it possible to become infected with chlamydia if “it only happened once”? Clinical studies show that transmission of chlamydia occurs in 30-50% of cases of unprotected sexual contact, if sexual intercourse with an infected partner occurs no more than once. When chlamydia is detected in a person, it is imperative to check a regular sexual partner, since the risk of infection with regularly repeated sexual intercourse is almost 100%.

During childbirth . There is a high risk of transmitting chlamydia from mother to child during childbirth, when the newborn passes through the birth canal. In this case, infection of the eyes and mouth occurs.

The incubation period of infection ranges from – 1 week to – 2 months, during which time the infection spreads in the body. In 45% of men and 65% of women, the disease does not give any manifestations during this period and can only be detected through laboratory testing of biomaterials.

With acute chlamydia, men and women experience different symptoms. At the same time, the female body is more susceptible to infection - infection occurs faster and the consequences are more serious.

How does chlamydia manifest in women?

Manifestations of chlamydia in women at various stages of infection boil down to the following symptoms:

• Vaginal discharge. They have a mucous structure and may contain pus. May have an unpleasant, pungent odor.
• Pain appears during urination, a cutting or burning sensation.
• During menstruation, sharp pain in the genital area may occur.
• The appearance of bleeding between menstruation, blood may be both pure and mixed with mucus.
• Low-grade fever temperature, general weakness of the body, similar to the sensations during a cold.

Even one of the symptoms is an alarm bell, in which case you should definitely contact a gynecologist and get tested for chlamydia.

How does chlamydia manifest in men?

In men, the manifestation of chlamydia is comparable to the symptoms of urethritis, and in the first stages, many do not pay attention to the problem, believing that everything is caused by inflammation after a cold or other “trifling” factors.

Chlamydia in men can cause the following symptoms:

• Transparent mucous discharge from the urethra.
• The presence of pus in the urine and its cloudiness.
• The color of the urine changes, and bloody discharge may appear, which may also be present in the seminal fluid during ejaculation.
• Urination is accompanied by a burning or stinging sensation.
• Spontaneous pain in the pelvic area, lower back, scrotum.
• A low-grade fever is observed (the temperature rises from 37.1 to 38 degrees).
• General physical malaise.

It happens that chlamydia in men forms local colonies without general infection of the body. Focal accumulations without the development of an infectious disease are caused by strong immunity and antibody resistance to the effects of chlamydia. However, the man remains infectious.

Oral chlamydia and its symptoms

When infected with chlamydia during oral sex or when transmitting bacteria through household means through dishes, etc. Oral chlamydia develops, affecting the oral cavity, throat, and nasopharynx. In this case, the following symptoms of the disease may be observed:

• Constantly unpleasant smell from the mouth.
• The nasopharynx becomes covered mucous deposits.
• Gradually, the mucus moves to the upper palate and tongue.
• There is nasal congestion and difficulty breathing.
• Enlarged tonsils, swelling of the back of the throat.
• Loss of taste due to mucus on the taste buds of the tongue.
• Pain when pressing on the mucous membrane of the throat, palate or tongue.
• Difficulty breathing due to a swollen throat.
• Attacks of suffocation most often occur in the evening or during hot periods.

Over time, the patient loses taste sensitivity, and eating is accompanied by pain that appears when food passes through the sore throat. A constant unpleasant sensation in the mouth develops. Spasmodic, involuntary twitching of the tongue is acceptable.

Since the symptoms of chlamydia are quite vague and often resemble manifestations of other diseases, it is necessary to consult a doctor in case of any deviations (discharge, itching, burning). For women it is, for men – .

Complications

Chlamydia often causes serious illnesses, which are a complication of the disease if treatment is improper or ineffective. In particular, the following consequences were identified:

• Reiter's syndrome– the most serious complication, during which symptoms of urethritis, conjunctivitis and arthritis develop. In the final stages, deformation of the joints occurs - the cause of disability for life.
• Orchiepididymitis– the disease is fraught with male infertility due to the destruction of Leydig cells, which contribute to the spermogenesis procedure.
• Urethral stricture– due to the appearance of scars on the tissue caused by the attack of chlamydia, the urethra narrows and is pinched, which ends sharp pain when urinating. To correct the situation, surgical intervention is performed.
• Chronic prostatitis– chlamydia has a complex negative effect on the prostate, promotes narrowing of the ducts, reduces the production of prostate secretions, lowers the level of testosterone production, which leads to a decrease in potency.

The complications described above appear in the stages of advanced chlamydia if treatment is not started on time. In most cases, complications can be avoided.

Chlamydia during pregnancy

Chlamydia has a serious impact on the course of pregnancy and can cause a wide range of problems and malfunctions in the female body. Depending on at what stage of pregnancy chlamydia began, you may encounter the following consequences:

• Blastopathy - the death of the fertilized egg occurs, which ends , .
• Embryopathy – abnormalities in the development of the fallopian tubes;
• Premature birth.

If chlamydia was suffered before pregnancy, it can cause failure of nidation of the fertilized egg, which in the vast majority of cases leads to . Taking into account all the risks, testing for chlamydia is mandatory when planning pregnancy, as well as at various stages of bearing a child, if signs and symptoms of the presence of chlamydia in the body appear.

Even if chlamydia did not cause significant problems during pregnancy, chlamydia can be passed on to the baby during childbirth. The most serious complication in newborns resulting from maternal chlamydia is neonatal chlamydial pneumonia. This disease is difficult to treat, has many complications and high mortality statistics. Children born to a mother with chlamydia must be tested for infection between 1 and 3 months of age.

How is chlamydia diagnosed: tests for chlamydia

To date, several effective methods for diagnosing chlamydia have been developed, which make it possible to determine the presence of an infectious pathogen even if it is present in the sample in minimal quantities. A smear, scraping from the surface of the genital organs, blood, seminal fluid, etc. can be used as the test material. Diana Medical Center does not use rapid tests to diagnose chlamydia, which provide false results.

Basic and most highly effective techniques.

• Immunofluorescence reaction (RIF);
• Enzyme-linked immunosorbent assay (ELISA);
• Polymerase chain reaction (PCR);
• Culture for chlamydia.
  

Striving for maximum accuracy and information content, preference is given to high-tech methods:

Enzyme-linked immunosorbent test (ELISA)

The technique makes it possible to fairly accurately determine the stage of the disease and chlamydial origin, as well as the presence of microorganisms in other organs not related to the genitourinary system. It has a relatively high research accuracy - up to 60%. It can be effectively carried out only after the development of specific antibodies to chlamydia has begun - 5-20 days from the moment of infection.

This is due to the fact that ELISA and RIF - enzyme-linked immunosorbent assay and immunofluorescence reaction research are not aimed at identifying the causative agent of chlamydia itself, but at detecting specific antibodies to this particular antigen. This is achieved through the controlled formation of antigen-antibody complexes, which in the case of the RIF method are labeled with a fluorescent substance, which makes the resulting complexes luminous. This makes them easier to detect during microscopic examination of the material.

During the research, the concentration of antibodies of the IgM, IgA, IgG groups produced by the body during protection against chlamydial infection at different stages of infection of the body is determined. The research takes quite a bit of time and is inexpensive.

Polymerase chain reaction (PCR)

It is highly effective and allows us to say with 100% probability whether there is chlamydia in the body or not. The study is based on the technology of detecting chlamydia DNA in a sample taken - scraping from the urethra, prostate secretion, ejaculate, urine sediment, saliva, blood and other biomaterials. Determining the results, depending on the equipment used, takes up to 3 days.

By triggering the reaction of duplicating DNA segments, a specialist can, in a short period of time, obtain the genetic chain of an infectious pathogen that is a million times longer in comparison with the primary segment. This allows chlamydia to be identified with 100% accuracy.

The technique is highly accurate; obtaining incorrect results is only possible if the sampling technology or transportation of the biomaterial is violated.

Chlamydia culture

Microbiological testing is 90% accurate in identifying chlamydia in the body.

By inoculating a sample of biological material on a special nutrient medium and creating favorable conditions for reproduction and growth, after some time it is possible to obtain a full-fledged colony of the pathogen. In this case, it is not difficult to identify the infection by simple microscopic examination. The advantage of this technique is the possibility of testing the sensitivity of the pathogen to various antibiotics. This allows you to choose the most effective drug for the treatment of chlamydia.

Treatment of chlamydia

Since the causative agent of chlamydia is an intracellular bacterium, antibacterial drugs are used in the treatment of the disease (etiotropic therapy). Antibiotics are selected that destroy microorganisms of the identified group. Only a competent specialist can prescribe suitable medications based on the tests performed and after identifying the type of chlamydial bacteria, the affected area and the progress of the disease.

In addition, if there are concomitant infections, antibiotics, antifungals, and immunomodulators can be used. If there is a large amount of discharge, antimicrobial agents will be required.

As a rule, drugs are prescribed in the form of tablets, injections, and can be used locally in the form of vaginal suppositories for women. In most cases, several medications and auxiliary agents are combined, which also reduce the possibility of developing complications or intoxication of the body. Treatment is carried out at home. After completing the course of therapy, after 2-3 weeks a repeat test for chlamydia is done and if no bacteria are found, the treatment can be considered successful.

An important nuance is the need to notify the sexual partner about the presence of chlamydial infection, since with a high probability the partner may be infected with chlamydia, which will also require treatment using the same drugs and techniques. Doctors recommend that both partners be tested at the same time and treated together. This will avoid secondary infection.

Prevention of chlamydia

To reduce the risk of chlamydia and the development of chlamydia, it is recommended to adhere to simple rules of personal and intimate hygiene, as well as caution in choosing sexual relations. Protect against chlamydia:

• Using a condom during sexual intercourse.
• Refusal of casual relationships in favor of one permanent partner.
• Compliance with the rules of personal intimate hygiene, especially after visiting public baths and saunas.

It is recommended to be tested annually for chlamydia and other sexually transmitted infections ( , STDs) and non-sexually. It is also mandatory to take the test when planning a pregnancy and repeat it during pregnancy.

The use of contraception and compliance with moral standards when engaging in sexual activity will significantly reduce the risk of infection with chlamydia and the subsequent development of chlamydia in men and women.

Where is chlamydia treated in St. Petersburg

Highly qualified specialists located in St. Petersburg guarantee the accuracy of the study, the shortest possible time for completing the analysis, an accessible interpretation of the result and the development of a safe treatment strategy for the identified disease.

The commercialization of medicine, difficulties in diagnosing and treating chlamydia, and “sensational” reports in the press give rise to a large amount of speculation regarding this disease. In the city it has become difficult to meet a patient with complaints of urogenital infection who would not have been diagnosed with chlamydia at some medical center. It has become commonplace for a patient to visit several laboratories and decide to begin treatment based on the preponderance of “positive” or “negative” conclusions. In the treatment of chlamydia, the range of offers is also quite wide: one doctor confidently treats chlamydia with a course of tetracycline, another prescribes treatment for $200. People faced with a diagnosis of chlamydia show a natural desire to learn more about this disease, but often either cannot obtain the necessary information, or it is very opportunistic. We hear questions from almost every patient: is the information about almost universal infection with chlamydia correct? Are there reliable methods for diagnosing this disease? Is it necessary to be treated for chlamydia? Is it even possible to recover from it?
The purpose of this brochure is to help the reader understand the “mysterious” disease. We have selected 30 of the most frequently asked questions and tried to answer them from the perspective of modern ideas about chlamydial infection.

Etiology, epidemiology, clinic

What is chlamydia?

Urogenital chlamydia is an infectious disease caused by chlamydia, transmitted primarily through sexual contact, affecting the urogenital tract and other organs, having mild symptoms and a high tendency to become chronic.

Chlamydia has only appeared in recent years, or has it existed before?

Of course, chlamydia existed before, but the ability to diagnose this infection appeared only relatively recently. What was previously called simply “inflammation”, “urethritis”, etc. in a certain percentage of cases it was associated with chlamydial infection. The prevalence of chlamydia in the population does not stand still. In particular, the liberalization of sexual relations, a decrease in the age at which sexual activity begins, and a low culture of using contraceptives contribute to an increase in the number of people infected with chlamydia among the population of a particular region (city, state).

Chlamydia of all types (C. trachomatis, C. psittaci, C. pneumoniae, C. pecorum) found in humans are pathogenic. They are not representatives of the normal human flora. The detection of chlamydia indicates the presence of an infectious process. The absence or erasure of clinical symptoms of the disease is a characteristic sign of chlamydial infection and does not indicate the absence of the pathogenic effect of chlamydia on the body.

C. trachomatis is of the greatest practical interest from a therapeutic point of view, and in the following presentation we will talk specifically about this type of chlamydia.

What is persistence of chlamydia?

Persistence is a long-term association of chlamydia with the host cell, in which chlamydia are in a viable state, but the protective mechanisms of the macroorganism do not allow chlamydia to enter the stage of active growth and reproduction.

What is the prevalence of urogenital chlamydia?

According to the latest data obtained using the most accurate method - polymerase chain reaction (PCR) on a large material, the proportion of chlamydial infection in the general spectrum of urogenital infections is 3-30%. The frequency of detection of chlamydia in gynecological patients is from 20 to 40%. In population screening studies, chlamydia is found in 5-10% of sexually active adults.
According to our data, the frequency of detection of chlamydia in the genitourinary tract in urogenital patients in Bishkek is 16%.

What other diseases can be confused with urogenital chlamydia?

Urogenital tract infections such as ureaplasmosis, mycoplasmosis, gonorrhea and trichomoniasis may have a clinical picture similar to chlamydia.

Is it possible to become infected with chlamydia at the same time as trichomonas, ureaplasma, etc.?

Chlamydia can cause mixed or mixed infections with a number of pathogens (Trichomonas, gonococci, Ureaplasma, Mycoplasma, Gardnerella, etc.). Treatment of mixed infections has certain features, therefore, if chlamydia is detected, it is useful to conduct an examination for the presence of these pathogens.

What is the probability of becoming infected with urogenital chlamydia through sexual contact with a person infected with chlamydia?

The risk of infection is estimated at 60% on average. The probability of infection is determined by:

• virulence of the pathogen strain;
• localization and activity of the infectious process in the patient;
• the state of immunity and genetic predisposition of the partner who had contact with the infected person;
• the presence of other infections that create favorable conditions for infection with chlamydia (trichomoniasis, ureaplasmosis, gonorrhea, etc.);
• in women, the ratio of sex hormones affecting the condition of the vaginal mucosa, cervix and endometrium; Thus, taking hormonal contraceptives increases the likelihood of infection.

The risk of infecting a regular partner is much higher.

How long after exposure to chlamydia infection can symptoms develop?

The incubation period is 1-4 weeks (average 3 weeks). However, obvious manifestations of infection may not develop. In this case, only laboratory diagnostic methods will identify the infection.

How long must pass after infection with chlamydia for laboratory tests to show a positive result?

PCR analysis makes it possible to detect chlamydia 1-3 weeks after infection. Acute-phase antibodies to chlamydia (IgM, IgA) appear in the blood on the 15-20th day, and IgG on the 20-30th day from the moment of infection. Thus, if a month after contact with an infected person laboratory tests give a negative result, we can assume that no infection has occurred.

Is it possible to get chlamydia through non-sexual contact?

There is no consensus on the possibility of infection with C. trachomatis through non-sexual contact. The possibility of a non-sexual route of infection is supported by cases of familial chlamydia, when in a family where the husband and wife are sick with urogenital chlamydia, chlamydia is also found in representatives of the older and younger generations, causing damage to the genitourinary system, respiratory organs (tracheobronchitis, pneumonia), and visual organs (conjunctivitis), joints (arthritis).

How to protect yourself from chlamydia infection?

Casual sexual intercourse plays a major role in the spread of chlamydia. Using a condom during sexual contact with a person infected with chlamydia will prevent infection in most cases. To prevent infection of the newborn during childbirth, antibiotic therapy is necessary in the third trimester of pregnancy. Compliance with the rules of personal hygiene will help to avoid the transmission of chlamydia through household means.

Is it possible to be only a carrier of chlamydial infection, but not be sick?

Chlamydia is asymptomatic in 46% of men and 67% of women. Thus, among people who consider themselves healthy, there are inevitably chlamydia carriers in whom the infection occurs in a latent form. The absence of clinical manifestations does not mean the absence of harmful effects of chlamydia on the body. Chlamydia causes especially great harm to the reproductive system of women.

What is the mechanism of the pathogenic effect of chlamydia on the body?

The pathogenesis of urogenital chlamydia is based on a slow infectious process, accompanied by the formation of scars on the mucous membrane. If the infection spreads to the fallopian tubes, the scarring process can lead to obstruction of the tubes, which is often the cause of ectopic pregnancy. Another sad consequence of chlamydia can be infertility due to complete blockage of the tubes.

Is chlamydia dangerous for men?

The most common form of chlamydia in men - urethritis - may not cause much inconvenience to the patient, but chlamydia can also cause more serious diseases - inflammation of the epididymis, prostate, joints, which can result in reproductive dysfunction and decreased ability to work.

What are the clinical signs of chlamydia?

Chlamydia primarily affects columnar epithelial cells of the genitourinary tract, respiratory tract, and conjunctiva. Chlamydia is characterized by blurred clinical picture.

Some of the most frequently occurring symptoms include the following:

• cervicitis:
• specific mucopurulent discharge from the genital tract, without a strong odor, swelling, hyperemia of the cervix;

• urethritis:
• dysuria, itching, scanty discharge;

• salpingitis:
• pain in the lower abdomen, increased leucorrhoea before menstruation, infertility due to obstruction of the tubes;
• chronic prostatitis:
• pain in the perineum, frequent urge and pain when urinating,
• vulvovestibulovaginitis
• in prepubertal girls: frequent urination, itching in the genital tract, discharge;
• chronic recurrent diseases of the upper respiratory system:
• frequent colds with complications and prolonged cough.
• pneumonia
• in newborns: a chronic course without fever with attacks of whooping cough, shortness of breath and cyanosis, developing 4-10 weeks after birth;
• conjunctivitis: in adults
• chronic catarrhal or follicular form with exacerbation 3-4 times a year, often passing without any treatment; in newborns: occurs 5-10 days after birth with an acute or subacute onset in the papillary form with purulent discharge without damage to the cornea;
• Reiter's syndrome: characterized by a triad of symptoms - arthritis, urethritis, conctivitis; develops in men aged 16-35 years; there is a hereditary predisposition;
• mucous discharge from the rectum, anorectal pain;
• inflammation of the epididymis - swelling of the testicles, pain in the scrotum, in case of acute infection - fever.

Diagnostics

What laboratory research methods are used to diagnose chlamydia?

Laboratory methods for diagnosing chlamydia in descending order of accuracy can be arranged in the following sequence: cultural method - polymerase chain reaction (PCR) method - enzyme-linked immunosorbent assay (ELISA) - direct immunofluorescence method (DIF) - immunochromatographic (IC) and enzymatic methods - cytological method.

What laboratory tests are necessary and sufficient to make a diagnosis of chlamydia?

In most cases, it is necessary and sufficient to study by PCR or PIF the material from the site of possible localization of chlamydia (scraping from the urethra, cervix, pharynx, conjunctiva; urine, prostate juice, etc.) and determine the IgG titer in a blood sample from a vein. In the case of fresh acute urethritis or cervicitis, the use of express systems “Chlamigen”, “Chlami-Chek”, etc. is justified. It is advisable to study IgM, IgA in the case of an acute infectious process when IgG gives weakly positive titers.

What does the antibody titer (IgG, IgA and IgM) against chlamydia indicate?

In chronic urogenital chlamydia, moderate IgG titers (1:200 - 1:400), moderate IgA (1:100 - 1:200) and low IgM titers (1:100 and below) are more often observed. High titers of IgM, IgA and low titers of IgG indicate an early stage of the infectious process. The titer value does not always indicate the intensity of the inflammatory process or the stage of the disease. There is an opinion that a high titer of antibodies during urogenital infection has a more favorable prognosis, preventing the spread of infection to the upper parts of the genitourinary system and reducing the risk of infection of the fetus during pregnancy.

Table 11. Level of specific immunoglobulins of various classes at various stages of chlamydial infection

Disease stage	IgG titer range	IgA titer range	IgM titer range
Primary/acute (determined IgM)	100-6400	50-1600	50-3200
Chronic (determined by Ig G, Ig A)	100-1600	50-200
Reactivation/reinfection (determined IgG, IgA)	100-6400	50-400
Condition after convalescence (determined IgG)	100-400

What does an IgG titer of 1:50 indicate?

Such a titer may occur:
during the initial stage of chlamydial infection;
with chlamydial infection against the background of immunodeficiency;
after effective therapy, residual antibody levels;
in case of a nonspecific reaction (no chlamydial infection).
Due to the ambiguity in the interpretation of this result, it is recommended to repeat the analysis after 1-2 weeks or examine the level of IgA, IgM, or perform the analysis using another method (PCR, PIF).

Chlamydia studies performed using different methods have yielded different results. Which analyzes should you trust?

The more accurate the method it is obtained, the more reliable the result. However, opposite results do not always contradict one another. For example, a positive result for PCR and a negative result for antibodies to chlamydia can occur at a very early stage of infection, when the body has not yet begun to produce antibodies in sufficient quantities, or when the immune response is weakened. On the other hand, in the case of ophthalmochlamydia or pulmonary chlamydial infection, a blood test for anti-chlamydial antibodies will give a positive result, but a genitourinary smear test may not reveal the presence of chlamydia.

Treatment

Can chlamydia be cured?

Chlamydia is curable.
Acute forms of chlamydia are easier to treat. In the treatment of chlamydia, it is important to choose the right antibiotic and not violate the prescribed regimen (frequency of administration, duration of course). Failure to comply with these rules contributes to the development of chlamydia resistance to this antibiotic and the infection becoming chronic, which is much more difficult to treat. In cases of chronic infection, one course of treatment may not be enough. A second course of treatment is usually carried out two months after the previous course. This interval is necessary for the transition of chlamydia from the inactive form to the reproduction stage.

Is treatment necessary if tests for chlamydia are positive and there are no complaints?

• the presence of clinical symptoms of chlamydia;
• antibody titer (IgG) to chlamydia
• antibody titer (IgM) to chlamydia
• positive result of PCR analysis;
• positive result of mutual fund analysis;
• positive result of rapid tests.

If there is only one positive response, dynamic observation is recommended, followed by laboratory monitoring after 2-3 weeks.

One of the sexual partners was diagnosed with chlamydia. Is it necessary to treat chlamydia for the second partner if he has no complaints?

This is necessary because an untreated partner may represent a reservoir of infection and lead to re-infection of the newly treated partner. Immunity does not develop after suffering from chlamydia. Repeated reinfection can create the illusion of a stubbornly incurable infection.

What antibiotics are most effective against chlamydia?

Antibiotics of the macrolide group have the greatest activity against chlamydia: sumamed, vilprafen, macropen, rovamycin, erythromycin; group of fluoroquinolones: ofloxacin (Zanocin, Tarivid); tetracycline groups: doxycycline. Many doctors believe that for effective treatment of chlamydia, a course of antibiotic therapy should be at least 20 days.

Is it enough to use only an antibiotic to treat chlamydia?

Treatment with an antibiotic alone is usually effective for acute, fresh infections. In the case of chronic chlamydia, in which the activity of the immune system is reduced, treatment with an antibiotic alone may not give a positive result. In the case of a mixed infection, for example, when chlamydia is combined with trichomoniasis, treatment of chlamydia should be preceded by the elimination of the accompanying pathogenic flora (trichopolus).

What drugs other than antibiotics are used to treat chlamydia?

Chlamydia is an insidious disease from which no one is immune. The absence of an obvious clinical picture leads to the fact that a person does not notice his illness, allowing bacteria to destroy the body. How dangerous the pathology is and what impact it has on health is important and needs to be understood.

General description of the disease

Modern medical statistics indicate that the incidence of chlamydia is widespread throughout the world. How dangerous is chlamydia? First of all, because its symptoms are practically invisible, a person is most often unaware of his illness. Chlamydia is a sexually transmitted disease. Today it is especially important to convey to young people knowledge about protected sexual intercourse and the need to use barrier methods of contraception if there is no complete confidence in the health of the partner.

Regular diagnostics will help a person to identify pathology in a timely manner and begin treatment in order to prevent undesirable consequences. Despite the obvious absence of signs of chlamydia, the development of the infection should not be allowed to take its course, as this will lead to the development of complications.

The most common type of disease is considered to be urogenital, which can lead to infertility in both women and men. Chlamydia is dangerous, as is clearly demonstrated by the list of vital body systems that the disease affects:

• respiratory;
• cardiovascular;
• visual;
• musculoskeletal.

Pathogens

Chlamydia is a group of infections caused by chlamydia bacteria. They can live in the human body for a long time, without manifesting themselves, but gradually causing damage to health. Modern medicine knows about 15 types of chlamydia, which destroy the body's protective functions. Once natural barriers are weakened, the virus begins to multiply and spread. Chlamydia often develops against the background of other infections, which can enhance the overall clinical picture. This course of the disease requires immediate medical intervention and comprehensive treatment. Chlamydia is activated against the background of infections such as syphilis, thrush, gonorrhea and other sexually transmitted diseases.

Routes of infection

From the basic description of the disease, it becomes clear why chlamydia is dangerous and how it is transmitted from person to person.

The main routes of transmission of the disease:

1. Sexual. The most common way to become infected with chlamydia, especially in the absence of a regular sexual partner and the practice of unprotected sex.
2. Transmission during childbirth. If the expectant mother suffers from this disease, then there is a high risk of passing it on to the baby during childbirth.
3. Household way. A person can become infected through personal hygiene products and bedding. The risk of infection this way is extremely low.
4. From an animal. Feline chlamydia is dangerous to humans in very rare cases. If your pet is sick, it should not be left without proper treatment; this will reduce the risk of its own infection.

Doctors note that vigilant monitoring of one’s own health helps to detect an infection in time. As a rule, the first signs can be seen within a couple of weeks after infection, if you pay attention to them.

Symptoms of chlamydia

In addition to urogenital chlamydia, a person is susceptible to major infection with this bacterium. The same strain can cause pathology in various organs, and the main symptoms of the disease directly depend on this. In order to detect a urogenital infection in time, a man or woman should listen to their own health and pay attention to the following alarming symptoms:

1. Subjective discomfort in the genital area.
2. Pain, itching and burning during urination.
3. Increased sensitivity of the mucous membranes of the genital organs, possible inflammation.

If these signs are left unattended, they will gradually disappear, and the person will become a carrier of the infection without knowing it.

How dangerous is chlamydia in the eyes? This type of disease is easier to detect, as the eyes begin to fester and conjunctivitis appears. Chlamydia can be suspected if conventional treatment does not produce results or frequent relapses occur.

It is important to understand why chlamydia is dangerous for women. First of all, there is also the absence of clear symptoms, which leads to uncontrolled damage to the body. Statistics show that about 70% of sick women are unaware of their problem and do not fight the infection in any way.

It is important to pay attention to the following signs:

1. Uncharacteristic vaginal discharge with an unpleasant odor and yellow color.
2. Bloody discharge between days of menstruation.
3. Itching and burning in the genital area.
4. Pain when urinating.
5. Pain in the pelvic area, which intensifies before menstruation.
6. Increase in temperature if intoxication of the body has occurred.

It is important to understand that a visual examination by a doctor will not be enough to determine the disease. It is necessary to report all subjective sensations and undergo a full examination.

Chlamydia during pregnancy

Is chlamydia dangerous during pregnancy? This issue requires separate consideration in order to correctly identify the risks for the expectant mother and her child. For a woman who is pregnant and has a disappointing diagnosis, the development of chlamydia in the body can lead to the following consequences:

1. Miscarriage or arrest of fetal development.
2. Inflammation of the fallopian tubes and pelvic organs.
3. Narrowing of the urethra.

Separately, it should be noted why chlamydia is dangerous for a child during pregnancy:

1. The disease provokes placental insufficiency, and lack of oxygen leads to fetal hypoxia (the severity varies for everyone).
2. The level of supply of nutrients to the fetus decreases, which affects its development.
3. Infection of the child with chlamydia.

It is now clear why chlamydia is dangerous during pregnancy, but you should never panic. Any woman in an interesting position should undergo a full examination and, if necessary, take all measures to reduce the risks and bear a healthy baby.

In men, the development of chlamydia also occurs without obvious symptoms; the disease does not make exceptions based on gender. The first manifestations are observed a few weeks after infection and quickly pass, which allows the pathology to unhinderedly destroy the body.

It is important for a man to pay attention to a number of alarming symptoms:

1. Pain when urinating.
2. Glassy discharge.
3. Change in urine color.
4. Purulent or bloody discharge from the urethra.
5. Pain in the genital area and lower back.
6. In case of intoxication, an increase in body temperature is possible.

Despite the absence of obvious symptoms, the disease can lead to serious consequences. How dangerous is chlamydia for men?

1. Development of erectile dysfunction.
2. Diseases of the cardiovascular system.
3. Proctitis.
4. Inflammation of the joints.
5. Infertility.

It is important to undergo a timely examination by a doctor in order to maintain men's health and feel confident.

Childhood chlamydia

This diagnosis is rare in children. Infection occurs mainly during birth from the mother. The small organism reacts very sharply to bacteria, which leads to the development of:

1. Pneumonia.
2. Bronchitis.
3. Conjunctivitis.

The baby's visual organs are the most vulnerable to chlamydia. If infection has occurred, it is easy to notice by sticky eyelids and characteristic discharge. The newborn body is not able to provide full resistance to pathogenic bacteria, so damage occurs faster and leads to more severe complications.

In cases of pneumonia, the infant often requires artificial ventilation. Due to the increased vulnerability of children's health, the baby must be under competent medical supervision from the moment of birth until the period when there is confidence that the danger has passed. It is important to prevent the development of chlamydia in a chronic form.

Diagnosis and treatment of the disease

For timely diagnosis of the disease, you must consult a doctor. For men, this issue will be dealt with by a urologist, for women - by a gynecologist. It is these specialists who will give further referrals for examination and additional consultations with other specialists (including a venereologist).

The polymerase chain reaction (PCR) diagnostic method is recognized as the most accurate diagnostic method, the accuracy of which is about 95%. The following is used as biological material for research:

1. In men: urine, blood, semen.
2. In women: blood, discharge and scrapings from the vagina.

If pathogenic microorganisms are detected in the body, only the attending physician should prescribe the correct therapy, based on the results of laboratory tests. There is no single scheme; each case is individual and requires separate consideration.

If we consider complex treatment in general, it includes the following drugs:

1. Immunomodulators.
2. Enzymes.
3. Antibiotics.
4. Interferon.
5. Probiotics.
6. Hepatoprotectors.

The drugs are administered intravenously or intramuscularly into the body, which allows for better results. In addition to drug therapy, the patient must be attentive to his diet, diversifying it with fortified foods.