Clinical Consequences of Immune Response to CT Upper Genital Tract Infection in Women

[摘要] C. TRACHOMATIS(CT) infections of the upper genital tract in women are either acute, sub acuteor chronic. CT infection has a tendency to be chronic, latent and persistent as a consequence of thehost immune reaction to CT major outer membrane protein, 57 Kd heat shock protein and lipopolysaccharide.Chlamydial persistence can be induced as a result of inflammatory and/or immune regulatedcytokines, Interferon γ depletion of tryptophan causes a stress response involving development ofabnormal forms with increased levels of stress response proteins which maintain host immune responseswith continuous fibrin exudate.The main clinical consequences are acute and chronic pelvic inflammatory disease, with infertility,ectopic pregnancy and, less frequently, chronic pelvic pain as late sequelae.PID, when acute, is marked by bilateral pelvic pain, plus other infectious signs in typical cases:fever, leucorrhea, red and purulent cervix. In 50% cases, infectious signs are slight or absent or thereis an atypical clinical situation. Laparoscopy is the key for diagnosis. It allows the surgeon to have adirect look at the pelvic organs and perform microbiologic and histologic sampling. In severe cases,laparoscopy allows the surgeon to aspirate the purulent discharge and successfully treat pelvic abscesses.Chronic PID usually is clinically silent. It is in most cases discovered some years after the onset ofCT infection, in women operated on for tubal infertility or ectopic pregnancy. Further studies, toevaluate treatments efficiency in chronic cases and factors leading to ectopic pregnancy or to recurrence,are indicated.

[学科分类] 妇产科学