Prevention and treatment of chlamydia infection in newborns

Chlamydia trachomatis is the most common causative agent of sexually transmitted infections (STDs) in the United States. According to the CDC, 3 million people are infected each year. About 50% of infected men and 75% of infected women do not present or have recognizable minor symptoms of Chlamydia infection (CI) and therefore do not seek medical help. Almost 70% of women aged 15 to 24 have a CI, with the highest frequency in adolescent girls (1 in 10 infections).

C.trachomatis is a compulsory intracellular parasite, has its own cell wall, which gives it the appearance of a gram (-) bacterium and is sensitive to antibiotic therapy, although it does not not a bacteria. In women infected with chlamydia, pelvic inflammatory disease, infertility, chronic pelvic pain syndrome can be detected and the risk of tube pregnancy and mortality is potentially increased. Perinatal transmission of chlamydia usually occurs during natural delivery, but infection can also be secondary in nature, due to damage to the membranes of the fetus, direct contamination of the nasopharynx and lungs of the newborn. Cases of chlamydia infection in newborns after a cesarean are rarely seen.

35 to 50% of newborn babies whose mothers are infected with chlamydia develop conjunctivitis and 11 to 20% develop pneumonia. The initial watery mucous discharge from the eye is usually not a clear sign of chlamydial conjunctivitis in the first days of life, as the incubation period for chlamydia infection is 5 to 14 days. At this time, the discharge acquires a purulent character, there is edema of the eyelids and erythema of the conjunctiva. Without early diagnosis and prevention, the child is threatened by visual impairment and scarring changes in the cornea.

Since most cases of chlamydia infection are asymptomatic and cannot be detected, pregnant women should be examined for C.trachomatis. Symptoms, if they appear, include abnormal vaginal discharge, pain in the lower abdomen and pathological uterine bleeding. Symptoms of urethritis due to chlamydia infection include polyuria, dysuria and sterile pyuria. The CDC, the American Academy of Pediatrics (AAP) and the United States Prevention Commission recommend routine screening for C.trachomatis for all sexually active women and adolescent girls under the age of 25. The CDC also recommends that pregnant women be screened for C.trachomatis during their first prenatal visit. Women at increased risk of infection (having a new or more sexual partners, under the age of 25) should be re-examined during the third trimester.

The most effective prevention of chlamydia infection in newborns should be the identification and treatment of infected mothers. Preventing silver nitrate (1%), erythromycin (0.5%), tetracycline (1%) after delivery is not an effective way to prevent the transmission of C.trachomatis of an infected mother, as it is done locally and does not affect nasopharyngeal colonization. Such prevention is only effective in preventing the transmission of gonococci. Children of mothers not treated for chlamydia infection have a high risk of infection, but prophylactic antibiotic therapy is not shown and the effectiveness of this approach is unknown. According to the authors of the publication, in women whose prenatal control is unsatisfactory or absent, a cultural study must be carried out upon admission to hospital and newborns must be monitored until results are obtained. Infants born to infected and treated mothers are monitored for symptoms of infection.

Chlamydia infection is the most common cause of neonatal conjunctivitis which develops between 5 and 12 days of life. If gonococcal conjunctivitis is purulent, chlamydia is usually accompanied by watery discharge. Difficulties in differential diagnosis in newborns may be associated with chemical irritation with prophylactic agents used in the establishment, obstruction of the nasal passages, viruses and bacteria. For a precise etiological diagnosis, a cultural study of conjunctival exudate with cells is necessary. In anticipation of the results, preventive treatment of the newborn with an erythromycin eye ointment is justified. If the culture C. trachomatis is highlighted, oral administration of the drug is indicated. Erythromycin ethyl succinate 50 mg / kg / day, orally in 4 doses of 14 days, CDC is recommended.

Since chlamydia spreads through the lacrimal duct and into the nasopharynx, at least 33% of newborns develop chlamydial pneumonia. In cases where there is no sign of conjunctivitis, 11-20% of newborn babies of infected and untreated mothers develop pneumonia. Symptoms of the disease include jerky paroxysmal cough, tachypnea, as well as emphysema and bilateral diffuse pulmonary infiltration during radiography. Chlamydia pneumonia should be treated with macrolides inside, but repeated culture and x-ray studies are recommended for children with persistent symptoms. If left untreated, the disease lasts for weeks and months and also contributes to a significant increase in the frequency of reactive respiratory disease.

Keep in mind the side effects of erythromycin, such as hypertrophic pyloric stenosis in newborns, which is 8 times more common in children receiving oral (but not local) erythromycin between 3 and 13 days of life. The widely known gastrokinetic properties of erythromycin are believed to underlie this phenomenon. The risk of other macrolides (azithromycin or clarithromycin) in relation to this phenomenon is not known. Although erythromycin crosses the placenta, an increased risk of pyloric stenosis in newborns whose mothers received erythromycin during pregnancy has not been confirmed. Azithromycin 20 mg / kg once and for three days is an effective alternative to erythromycin, however, the AAP continues to recommend this drug for the treatment of chlamydia infection.

Screening is the cornerstone of controlling chlamydia, but the frequency of these activities remains low. Non-invasive screening methods - a urine test in sexually active men and women can increase adherence to screening. Analysis of urine samples reveals 85% of cases of chlamydia infection compared to 91% with pap smears. Higher efficiency is possible by combining the urine test and pap smears, which increases the frequency of identification of chlamydia by 9%, compared to that when using Pap smears only. Recommended screening for CDC includes routine pelvic examinations of sexually active women under the age of 25 and older if the woman is at risk for behavior. The authors of the publication believe that any sexually active subject, not using barrier contraception and / or having a new partner or more than one partner in the last 3 months, or a history of STDs, should be examined for C.trachomatis. A woman's number of sexual partners, her sexual activity and the recent change of partner may indicate that she is at risk for infection with Chlamydia or other STDs.

Thus, screening for chlamydia is indicated if the patient requires the use of contraceptives and is interested in sexual activity, suspected pregnancy, pregnancy, any history of STDs and acts of sexual violence. The most effective method of controlling chlamydia infection in newborns, after screening and treating pregnant women, is to prescribe antibiotics inside. Even if a woman was treated for chlamydia infection during pregnancy, the diagnosis of chlamydial conjunctivitis cannot be completely excluded. Caution should be exercised with regard to newborns with cough, tachypnea, wheezing, bilateral infiltration, and pulmonary emphysema.