Обзор. Хламидийная инфекция – самое частое из заболеваний, передаваемых половым путем. Даже при субклиническом течении оно представляет опасность для репродуктивной функции как женщин, так и мужчин. Для предупреждения этих последствий очень важно назначать адекватную терапию как можно раньше. Рутинный скрининг на хламидии и лечение всех беременных при выявлении Chlamydia trachomatis рекомендован ведущими руководствами по ведению больных хламидийной инфекцией.
A review. Genital chlamydial infection is the most common sexually transmitted disease. Even subclinical – low grade infection – poses threat to reproductive function of both women and men. For the prevention of untoward reproductive outcomes it is very important to administer adequate therapy as soon as possible. State-of-the-art clinical guidelines recommend routine screening for chlamydial infection and treatment of all cases of C. trachomatis infection during pregnancy.
Key words: genital chlamydial infection, prevention of infertility.
1. Lanjouw E, Ossewaarde JM, Stary A, Boag F. 2010 European guideline for the management of Chlamydia trachomatis infections. Int J STD AIDS 2010; 21: 729–37.
2. Centers for Disease Control and Prevention. Infertility Prevention Program, USA. http://www.cdc.gov/std/infertility/ipp.htm. Accessed 29 January 2009.
3. Low N. SCREen project team. Publication of report on chlamydia control activities in Europe. Euro Surveill 2008; 13 (28): pii 18924; er-ratum: Euro Surveill 2008; 13 (34) pii:18960.
4. Paavonen J, Eggert-Kruse W, Chlamydia trachomatis: impact on human reproduction.Hum Reprod Update. 1999; 5 (5): 433–47.
5. World Health Organization Task Force on the Prevention and Management of Infertility. Tubal infertility: serologic relationship to past chlamydial and gonococcal infection. Sex Transm Dis 1995; 22: 71–7.
6. Weisenfeld HC, Cates W Jr. Sexually Transmitted Diseases and Infertility. Sex Transm Dis 2008: 1511.
7. Henry-Sushet J, Loffredo V. Chlamydia and mycoplasma genital infection in salpingitis an tubal sterility. Lancet 1980; 8167: 539.
8. Gottlieb SL, Berman SM. N. Low Screening and Treatment to Prevent Sequelae in Women with Chlamydia trachomatis Genital Infection: How Much Do We Know? JID 2010; 201 (S2): S156–S167.
9. Punnonen R, Terho P, Nikkonen V et al. Chlamydial infection in infertile women by immunofluorescence. Fertil Steril 1979; 31: 656–9.
10. Moor DE, Spadoni LR, Foy HM et al. Increased frequency of serum antibodies to Chlamydia trachomatis in infertility due to distal tubal occlusion. Lancet 1982; 2 (8298): 574–7.
11. Sellors JW, Mahony JB, Chernesky MA, Rath DJ. Tubal factor infertility: an association with prior chlamydial an asymptomatic salpingitis. Fertil Steril 1988; 49: 451–7.
12. Westrӧm L. Sexually transmitted infections and infertility. Sex transm Dis 1994; 21: S32–S37.
13. Patton DL, Moor DE, Spadoni LR et аl. A comparison of fallopian tube’s response to overt and silent salpingitis. Obstet Gynecol 1989; 73 (4): 622–33.
14. Westrom L, Joesoef R, Reynolds G et al. Pelvic inflammatory disease and fertility. A cohort study of 1844 women with laparoscopically verified disease and 657 control women with normal laproscopic results. Sex Transm Dis 1992; 19: 185–92.
15. Brunham RC, Maclean IW, Binns B, Peeling RW. Chlamydia trachomatis: its role in the tubal infertility. J Infect Dis 1985; 152: 1275–82.
16. Eckert LO, Hawes SE, Wohner-Hanssen P et аl. Prevalence and correlates of antibody to chlamydial heat shock protein in women attending sexually transmitted diseases clinics and women with confirmed pelvic inflammatory disease. J Infect Dis 1997; 175(6): 1453–8.
17. Gump DW, Gibson M, Ashikaga T. Evidence of prior pelvic inflammatory disease and its relationship to Chlamydia trachomatis antibody and intrauterine contraceptive device use in infertile women. Am J Obstet Gynecol 1983; 146: 153–9.
18. Svensson I, Mardh PA, Ahlgren M, Nordenskjold M. Ectopic pregnancy and antibodies to Chlamydia trachomatis . Fertil Steril 1985; 44: 313.
19. Westrӧm L, Bengtsson LP, Mårdh PA. Incidence, trends, and risks of ectopic pregnancy in a population of women. Br Med J 1981; 82: 15–8.
20. Bakken IJ, Skjeldestad FE, Nordbo SA. Chlamydia trachomatis infections increase the risk for ectopic pregnancy: a population based, nested case-control study. Sex Transm Dis 2006: Epub.
21. Keltz MD, Gera PS, Moustakis M. Chlamydia serology screening in infertility patients. Fertil Steril 2006; 85 (3): 752–4.
22. Licciardi F, Grifo JA, Rosenwaks Z, Witkin SS. Relation between antibodies fertilization. J Assist Reprod Genet 1992; 9: 207–10.
23. Witkin SS, Kligman I, Grifo JA, Rozenwaks Z. Chlamydia trachomatis detected by polymerase chain reaction cervices of culture–negative women correlates with adverse in vitro fertilization outcome. J Infect Dis 1995; 171: 1657–9.
24. Baud D, Regan L, Greub G. Emerging role of Chlamydia and Chlamydia–like organisms in adverse pregnancy outcomes. Curr Opin Infect Dis 2008; 21: 70–6.
25. Martin DH, Koutsky L, Eschenbach DA et al. Prematurity and perinatal mortality in pregnancies complicated by maternal Chlamydia trachomatis infections. JAMA 1982; 247: 1585–8.
26. Gravett MG, Nelson HP, DeRouen T et al. Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome. JAMA 1986; 256: 1899–903.
27. Witkin SS, Askienazy-Elbhar M, Henry-Suchet J et al. Circulating antibodies to a conserved epitope of the Chlamydia trachomatis 60 kDa heat shock protein (hsp60) in infertile couples and its relationship to antibodies to C. trachomatis surface antigens and the Escherichia coli and human HSP60. Hum Reprod 1998; 13: 1175–9.
28. Wolner-Hanssen P, Mårdh PA. In vitro tests of the adherence of Chlamydia trachomatis to human spermatozoa. Fertil Steril 1984; 42: 102–7.
29. Nagel TC, Tagatz GE, Campbell BF Transmission of Chlamydia trachomatis by artificial insemination. Fertil Steril 1986; 46: 959–60.
30. Sherman JK, Jordan GW. Cryosurvival of Chlamydia trachomatis during cryopreservation of human spermatozoa. Fertil Steril 1985; 43: 664–6.
31. Eckert LO, Twin SS, Hillier SL et al. The antimicrobial treatment of subacute endometritis a proof of concept study. Am J Obstet Gynecol 2004; 190 (2): 305–13.
32. Tita ATN, Cliver SP Goepfert AR et al. Impact of interconception antibiotics on the endometrial microbial flora. Am J Obstet Gynecol 2007; 196: 226.
33. Ross J, Judlin P, Nilas L. European guideline for the management of pelvic inflammatory disease. Int J STD AIDS 2007; 18: 662–6.
34. Centers for Disease Control and Prevention. MMWR 2006; 55б: 338–42. http://www.iusti.org/regions/europe/Euro_Guideline_Chlamydia_2010.pdf.
35. Lau CY, Qureshi AK. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transmit Dis 2002; 29: 497–502.
36. Wang SA, Papp JR, Stamm WE et al. Evaluation of antimicrobial resistance and treatment failures for Chlamydia trachomatis: a meeting report. J Infect Dis 2005; 191: 917–23.
37. Schillinger JA, Kissinger P, Calvet H et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis 2003; 30: 49–56.
38. Blas MM, Canchihuaman FA, Alva IE, Hawes SE. Pregnancy outcomes in women infected with Chlamydia trachomatis: a population-based cohort study in Washington State. Sex Transm Infect 2007; 83: 314–8.
39. Pitsouni E, Iavazzo C, Athanasiou S, Falagas ME. Single-dose azithromycin versus erythromycin or amoxicillin for Chlamydia trachomatis infection during pregnancy: a meta-analysis of randomised controlled trials. Int J Antimicrob Agents 2007; 30: 213–21.
40. Rastogi S, Das B, Salhan S, Mittal A. Effect of treatment for Chlamydia trachomatis during pregnancy. Int J Gynaecol Obstet 2003; 80: 129–37.
41. Joyner JL, Douglas JM Jr, Foster M, Judson FN. Persistence of Chlamydia trachomatis infection detected by polymerase chain reaction in untreated patients. Sex Transm Dis 2002; 29: 196–200.
42. Somani J, Bhullar VB, Workowski KA et al. Farshy CEMultiple drug–resistant Chlamydia trachomatis associated with clinical treatment failure. J Infect Dis 2000; 181: 1421–7.
43. de Vries HJC, Smelov V, Middelburg JG et al. Delayed microbial cure of lymphogranuloma venereum proctitis with doxycycline treatment. Clin Infect Dis 2009; 48: e53–e56.
________________________________________________
1. Lanjouw E, Ossewaarde JM, Stary A, Boag F. 2010 European guideline for the management of Chlamydia trachomatis infections. Int J STD AIDS 2010; 21: 729–37.
2. Centers for Disease Control and Prevention. Infertility Prevention Program, USA. http://www.cdc.gov/std/infertility/ipp.htm. Accessed 29 January 2009.
3. Low N. SCREen project team. Publication of report on chlamydia control activities in Europe. Euro Surveill 2008; 13 (28): pii 18924; er-ratum: Euro Surveill 2008; 13 (34) pii:18960.
4. Paavonen J, Eggert-Kruse W, Chlamydia trachomatis: impact on human reproduction.Hum Reprod Update. 1999; 5 (5): 433–47.
5. World Health Organization Task Force on the Prevention and Management of Infertility. Tubal infertility: serologic relationship to past chlamydial and gonococcal infection. Sex Transm Dis 1995; 22: 71–7.
6. Weisenfeld HC, Cates W Jr. Sexually Transmitted Diseases and Infertility. Sex Transm Dis 2008: 1511.
7. Henry-Sushet J, Loffredo V. Chlamydia and mycoplasma genital infection in salpingitis an tubal sterility. Lancet 1980; 8167: 539.
8. Gottlieb SL, Berman SM. N. Low Screening and Treatment to Prevent Sequelae in Women with Chlamydia trachomatis Genital Infection: How Much Do We Know? JID 2010; 201 (S2): S156–S167.
9. Punnonen R, Terho P, Nikkonen V et al. Chlamydial infection in infertile women by immunofluorescence. Fertil Steril 1979; 31: 656–9.
10. Moor DE, Spadoni LR, Foy HM et al. Increased frequency of serum antibodies to Chlamydia trachomatis in infertility due to distal tubal occlusion. Lancet 1982; 2 (8298): 574–7.
11. Sellors JW, Mahony JB, Chernesky MA, Rath DJ. Tubal factor infertility: an association with prior chlamydial an asymptomatic salpingitis. Fertil Steril 1988; 49: 451–7.
12. Westrӧm L. Sexually transmitted infections and infertility. Sex transm Dis 1994; 21: S32–S37.
13. Patton DL, Moor DE, Spadoni LR et аl. A comparison of fallopian tube’s response to overt and silent salpingitis. Obstet Gynecol 1989; 73 (4): 622–33.
14. Westrom L, Joesoef R, Reynolds G et al. Pelvic inflammatory disease and fertility. A cohort study of 1844 women with laparoscopically verified disease and 657 control women with normal laproscopic results. Sex Transm Dis 1992; 19: 185–92.
15. Brunham RC, Maclean IW, Binns B, Peeling RW. Chlamydia trachomatis: its role in the tubal infertility. J Infect Dis 1985; 152: 1275–82.
16. Eckert LO, Hawes SE, Wohner-Hanssen P et аl. Prevalence and correlates of antibody to chlamydial heat shock protein in women attending sexually transmitted diseases clinics and women with confirmed pelvic inflammatory disease. J Infect Dis 1997; 175(6): 1453–8.
17. Gump DW, Gibson M, Ashikaga T. Evidence of prior pelvic inflammatory disease and its relationship to Chlamydia trachomatis antibody and intrauterine contraceptive device use in infertile women. Am J Obstet Gynecol 1983; 146: 153–9.
18. Svensson I, Mardh PA, Ahlgren M, Nordenskjold M. Ectopic pregnancy and antibodies to Chlamydia trachomatis . Fertil Steril 1985; 44: 313.
19. Westrӧm L, Bengtsson LP, Mårdh PA. Incidence, trends, and risks of ectopic pregnancy in a population of women. Br Med J 1981; 82: 15–8.
20. Bakken IJ, Skjeldestad FE, Nordbo SA. Chlamydia trachomatis infections increase the risk for ectopic pregnancy: a population based, nested case-control study. Sex Transm Dis 2006: Epub.
21. Keltz MD, Gera PS, Moustakis M. Chlamydia serology screening in infertility patients. Fertil Steril 2006; 85 (3): 752–4.
22. Licciardi F, Grifo JA, Rosenwaks Z, Witkin SS. Relation between antibodies fertilization. J Assist Reprod Genet 1992; 9: 207–10.
23. Witkin SS, Kligman I, Grifo JA, Rozenwaks Z. Chlamydia trachomatis detected by polymerase chain reaction cervices of culture–negative women correlates with adverse in vitro fertilization outcome. J Infect Dis 1995; 171: 1657–9.
24. Baud D, Regan L, Greub G. Emerging role of Chlamydia and Chlamydia–like organisms in adverse pregnancy outcomes. Curr Opin Infect Dis 2008; 21: 70–6.
25. Martin DH, Koutsky L, Eschenbach DA et al. Prematurity and perinatal mortality in pregnancies complicated by maternal Chlamydia trachomatis infections. JAMA 1982; 247: 1585–8.
26. Gravett MG, Nelson HP, DeRouen T et al. Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome. JAMA 1986; 256: 1899–903.
27. Witkin SS, Askienazy-Elbhar M, Henry-Suchet J et al. Circulating antibodies to a conserved epitope of the Chlamydia trachomatis 60 kDa heat shock protein (hsp60) in infertile couples and its relationship to antibodies to C. trachomatis surface antigens and the Escherichia coli and human HSP60. Hum Reprod 1998; 13: 1175–9.
28. Wolner-Hanssen P, Mårdh PA. In vitro tests of the adherence of Chlamydia trachomatis to human spermatozoa. Fertil Steril 1984; 42: 102–7.
29. Nagel TC, Tagatz GE, Campbell BF Transmission of Chlamydia trachomatis by artificial insemination. Fertil Steril 1986; 46: 959–60.
30. Sherman JK, Jordan GW. Cryosurvival of Chlamydia trachomatis during cryopreservation of human spermatozoa. Fertil Steril 1985; 43: 664–6.
31. Eckert LO, Twin SS, Hillier SL et al. The antimicrobial treatment of subacute endometritis a proof of concept study. Am J Obstet Gynecol 2004; 190 (2): 305–13.
32. Tita ATN, Cliver SP Goepfert AR et al. Impact of interconception antibiotics on the endometrial microbial flora. Am J Obstet Gynecol 2007; 196: 226.
33. Ross J, Judlin P, Nilas L. European guideline for the management of pelvic inflammatory disease. Int J STD AIDS 2007; 18: 662–6.
34. Centers for Disease Control and Prevention. MMWR 2006; 55б: 338–42. http://www.iusti.org/regions/europe/Euro_Guideline_Chlamydia_2010.pdf.
35. Lau CY, Qureshi AK. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transmit Dis 2002; 29: 497–502.
36. Wang SA, Papp JR, Stamm WE et al. Evaluation of antimicrobial resistance and treatment failures for Chlamydia trachomatis: a meeting report. J Infect Dis 2005; 191: 917–23.
37. Schillinger JA, Kissinger P, Calvet H et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis 2003; 30: 49–56.
38. Blas MM, Canchihuaman FA, Alva IE, Hawes SE. Pregnancy outcomes in women infected with Chlamydia trachomatis: a population-based cohort study in Washington State. Sex Transm Infect 2007; 83: 314–8.
39. Pitsouni E, Iavazzo C, Athanasiou S, Falagas ME. Single-dose azithromycin versus erythromycin or amoxicillin for Chlamydia trachomatis infection during pregnancy: a meta-analysis of randomised controlled trials. Int J Antimicrob Agents 2007; 30: 213–21.
40. Rastogi S, Das B, Salhan S, Mittal A. Effect of treatment for Chlamydia trachomatis during pregnancy. Int J Gynaecol Obstet 2003; 80: 129–37.
41. Joyner JL, Douglas JM Jr, Foster M, Judson FN. Persistence of Chlamydia trachomatis infection detected by polymerase chain reaction in untreated patients. Sex Transm Dis 2002; 29: 196–200.
42. Somani J, Bhullar VB, Workowski KA et al. Farshy CEMultiple drug–resistant Chlamydia trachomatis associated with clinical treatment failure. J Infect Dis 2000; 181: 1421–7.
43. de Vries HJC, Smelov V, Middelburg JG et al. Delayed microbial cure of lymphogranuloma venereum proctitis with doxycycline treatment. Clin Infect Dis 2009; 48: e53–e56.
Авторы
М.А.Гомберг
Кафедра кожных и венерических болезней МГМСУ
________________________________________________
M.A.Gomberg
Chair of dermatology and venerology of Moscow State University of Medicine and Dentistry