LEVEL OF SEX HORMONES AND THE SEVERITY OF HYPERPLASTIC PROCESSES IN THE GENITAL TRACT IN WOMEN WITH CHRONIC CHLAMYDIAL INFECTION

Purpose of the study. To evaluate the role of chronic chlamydial infection in the genesis of proliferative processes in the female genital area.

Materials and methods. The study involved 267 women aged from 27 to 43 years. Depending on the severity of the pathological process in the genital tract and the presence of the Chlamydia trachomatis infection, 6 groups were distinguished: 1st — 30 somatically healthy women without pathologies of the female reproductive system; 2nd and 3rd — those with inflammatory processes in the reproductive organs of non-chlamydial (36) and chlamydial nature (38); 4th and 5th — those with proliferative processes in the pelvic organs of non-chlamydial (50) and chlamydial nature (58); 6th — patients with cervical cancer (55). The PCR and ELISA (Chem Well, USA) methods were used to identify the presence of Chlamydia trachomatis. The concentration of estradiol (E) and progesterone (P) (ELISA) in the blood, as well as their ratio (E/P), was determined. The as-obtained data were compared with the results of cytomorphological and ultrasound studies.

Results. Proliferative processes in the genital tract are accompanied by a change in the level of female sex hormones, in particular, by a sharp decrease in progesterone in the luteal phase of the cycle against the background of absolute or relative hyperestrogenism. These changes are more pronounced in women with chronic chlamydial infection. A connection between the presence of the infectious agent in question and the severity of hyperplastic processes in the female genital tract is established. A comparison of the obtained morphological data with the blood progesterone content in women without Chlamydia trachomatis showed that an increase in the severity of disorders correlates with a decrease in the level of female hormones. In women infected with Chlamydia trachomatis, the severity of hyperplastic processes shifts to the right, i. e. towards normal progesterone values. Therefore, even at maximal progesterone concentrations close to the reference values, a greater severity of pathological changes is observed.

Conclusion. The obtained results demonstrate the undeniable role of chronic chlamydial infection in initiating a hormonal imbalance towards absolute or relative hyperestrogenia with a severe progesterone deficiency. A causal relationship of the Chlamydia trachomatis infectious agent with the severity of hyperplastic processes in the pelvic organs is established. It is concluded that the detection of chlamydial infection should be considered as an essential element in the screening and prevention of hyperplastic processes.

1. Lukach A. A. Inflammatory nfectious conception development hiperplastic process genitals. Ural Medical Journal. 2010;5 (70):156–159 (In Russian).

2. Sheshukova N. A., Makarov I. O., Ovsyannikova Т. V. Prevention of endometrial hyperplastic processes. Reproductive endocrinology. 2012;6(8):18–22 (In Russian).

3. Sinchikhin S. P., Mamiev O. B., Sinchikhina M. E. Urogenital chlamydia as a medical and social problem (literature review). Dermatology. Supplement to the journal Consilium Medicum. 2009;1:43–48 (In Russian).

4. Sinchikhin S. P., Mamiev O. B., Stepanyan L. V., Elderova K. S., Magakyan O. G. Some modern aspects of inflammatory diseases of the pelvic organs. Consilium Medicum. 2015;17(6):8–11 (In Russian).

5. Price M. J., Ades A. E., De Angelis D., Welton N. J., Macleod J., Soldan K., et al. Risk of pelvic inflammatory disease following Chlamydia trachomatis infection: analysis of prospective studies with a multistate model. American Journal Epidemiology. 2013;178(3):484–492. http://doi.org/10.1093/aje/kws583

6. Mårdh P.-A. Tubal factor infertility, with special regard to chlamydial salpingitis. Current Opinion in Infectious Diseases. 2004 Feb;17(1):49–52. http://doi.org/10.1097/00001432–200402000–00010

7. Morin-Papunen L., Rantala A. S., Unkila-Kallio L., Tiitinen A., Hippeläinen M., Perheentupa A., et al. Metformin Improves Pregnancy and Live-Birth Rates in Women with Polycystic Ovary Syndrome (PCOS): A Multicenter, Double-Blind, Placebo-Controlled Randomized Trial. J Clin Endocrinol Metab. 2012 May 1;97(5):1492–1500. http://doi.org/10.1210/jc.2011–3061

8. Makarov E. V., Nesterov A. S., Davidyan B. J., Bogdasarov A.Yu. Changes in morphological structure of cervical cancer in chronic urogenital infections. Ulyanovsk Medical Biological Journal. 2011;2:62–67 (In Russian).

9. Prilepskaya V. N., Rudakova E. B., Kononov A. V. Ectopia and erosion of the cervix uteri. Moscow: Medpress-information, 2002. 176 p. (In Russian).

10. Guskova N. K., Frantsiyants E. M., Guskova E. A., Vereskunova M. I., Shatova U. S., Moiseenko T. I. Experimental model as evidence of impaired ovarian function of hormone for chlamydia. University News North-Caucasian Region. Natural sciences series. 2017;4–2(196–2):20–25 (In Russian).

11. Frantsiyants E. M., Bandovkina V. A., Guskova N. K., Komarova E. F. Effect of ascending chlamydial infection at level of sex hormones in the blood of women with inflammatory and proliferative processes genitals. Fundamental research. 2013; (7–2):419–422 (In Russian).

12. Litvin O. E. Morphological features of cervical lesions in women with chlamydial infection. Venereologist. 2007;2:11– 17 (In Russian).