Chlamydia

Chlamydia is a most commonly reported notifiable sexually transmitted disease. Around three million people contract Chlamydia each year. Chlamydia is one of the most dangerous sexually transmitted diseases among women. If not treated, women will develop pelvic inflammatory disease (PID) and one in five women with PID becomes infertile. Other complications of Chlamydia are premature birth, eye disease and pneumonia in infants.

Follow up:

Causative Organism & features:
Organism: Chlamydia trachomatis
Obligate intracellular bacteria
Found in cells as metabolically active, replicating reticulate bodies and inactive extracellular form elementary body.
Transimission is by elementary body. Chlamydia lacks muramic acid, so not seen on gram stain.

Reservoir
Human genital tract and eyes

High incidence: 15- to 24 year

Incubation period: 1 to 3 weeks

Pathophysiology
Chlamydia infection may cause mucopurulent cervicitis in females and urethritis in males. If the infection is not treated, it can ascend up resulting in PID in women and epididymitis & prostatitis in men. Co-infection of Chlamydia and gonorrhea is very common and should be treated for both the infection. Other diseases caused by Chlamydia trachomatis are pneumonia in the newborn and lymphogranuloma venereum, which causes genital ulcer. Chlamydia can also cause trachoma, infection of the eye, which is the leading cause of preventable infectious blindness.
Infection of the nonciliated columnar or cuboidal epithelial cells of mucosal surface leads to granulomatous response and damage.

Risk factors/Rout of transmission

  • Unprotected sexual intercourse and multiple sexual partners
  • Any kind of sexual contact: oral, anal sex or vaginal
  • Baby born to infected mother

Symptoms and Signs
80% of the women and 50% of the men are asymptomatic. Symptomatic patients complain of

Men

  • Fever
  • Burning on urination
  • Mucopurulent urethra discharge
  • Pain in the testis or tenderness of the testis
  • If rectum is infected: rectal pain and discharge

Women

  • Fever in case of PID
  • Burning on urination
  • Mucopurulent vaginal discharge
  • Painful intercourse and Postcoital bleeding
  • If rectum is infected: rectal pain and discharge
  • Symptoms of ascending infection

Newborn

  • conjunctivitis
  • discharge from the eye
  • if untreated blindness

Differential diagnosis
Gonorrhea
Urinary tract infection
Vaginal Candidiasis

Lab works
Culture and gram staining of the urethral discharge in men or cervical discharge in women gives high sensitivity and specificity.
Other tests are nucleic acid amplification technique (NAAT) and fluorescent or monoclonal antibody test

Treatment

CDC Guideline:
Recommended regimens

Azithromycin 1g orally in a single dose
Or
Doxycycline 100mg orally twice a day for 7 days

Alternative Regimens

Erythromycin base 500mg orally four times a day for 7 days
Or
Ofloxacin 300 mg orally twice a day for 7 days

Early treatment with proper antibiotics prevent complications like

In female
pelvic inflammatory disease (PID)
salpingitis
infertility
ectopic pregnancy

In men
epididymitis
prostatitis