An integrative approach in a surgical inpatient setting: dermatovenereology and urogynecology

Background: Urogenital chlamydia is one of the most prevalent sexually transmitted infections, often asymptomatic and associated with infertility and pregnancy loss. Treating chlamydial cervicitis in women with cicatricial cervical deformity is particularly challenging, as structural abnormalities promote chronic infection and reduce the effectiveness of standard antibiotic therapy. Aims: To improve treatment outcomes for chlamydial infections of the lower genital tract in women with cicatricial cervical deformity through a combined approach that includes reconstructive surgery. Materials and methods: This single-center, nonrandomized, prospective study enrolled 91 women aged 18 to 45 years with laboratory-confirmed urogenital Chlamydia trachomatis infection. Participants were allocated into three groups: group A (n = 30) included women with cicatricial cervical deformity who underwent reconstructive surgery (Eltsov-Strelkov technique) combined with antibiotic therapy (doxycycline, 100 mg twice daily for 21 days); group B (n = 31) consisted of women with cicatricial cervical deformity who received antibiotic therapy alone; group C (n = 30, control) comprised women with normal cervical canal architecture treated with doxycycline only. Recurrence of chlamydial infection was assessed clinically and by polymerase chain reaction (PCR) at 1- and 12-months posttreatment. Results: At 1 month posttreatment, the efficacy of doxycycline monotherapy in women with cicatricial cervical deformity (group B) was 83.3%, compared with 96.7% in patients with normal cervical anatomy (group C). The combined approach in group A achieved a 96.8% success rate. At 12 months, a significant decrease in treatment efficacy was observed in group B, dropping to 76.7% (p<.05), while the outcomes in group A remained stable (96.8%) and were comparable to those in the control group (96.7%). Conclusions: Combining reconstructive surgery with antibiotic therapy significantly improves treatment outcomes for urogenital chlamydia in women with cicatricial cervical deformity by reducing recurrence and enhancing local immune responses.