| What is Chlamydia? | • C trachomatis infection affects the cervix, urethra, salpinges, uterus, nasopharynx, and epididymis
• It is the most commonly reported bacterial sexually transmitted infection (STI) in the USA and a leading cause of infertility in women
• C trachomatis infection causes other diseases as well, including conjunctivitis, pneumonia or pneumonitis, afebrile pneumonia syndrome (in infants born vaginally to infected mothers), Fitz-HughCurtis syndrome, and trachoma (the world’s leading cause of acquired blindness) |
| How is screening for chlamydia? | • Routine Chlamydia screening of sexually active young women is recommended to prevent consequences of untreated chlamydial infection (eg, pelvic inflammatory disease(PID), infertility, ectopic pregnancy, and chronic pelvic pain) |
| How is pathophysiology of chlamydia? | • Infection of the genital tract is the most common clinical presentation
• The incubation period is 1-3 weeks
• Approximately 50% of infected males and 80% of infected females are asymptomatic, but infection may cause a mucopurulent cervicitis in females and urethritis in males
• Ascending infection can result in PID in women and is the most common cause of epididymitis in men younger than 35 years. Of women with PID, 5-10% develop perihepatitis (Fitz-Hugh-Curtis syndrome) |
| How is etiology of chlamydia? | • Chlamydial transmission usually is caused by sexual contact through oral, anal, or vaginal intercourse
• Neonatal infection (eg, conjunctivitis or pneumonia) may occur secondary to passage through the birth canal of an infected mother |
| What are risk factors for Chlamydia? | • Multiple sexual partners or a new unknown sexual partner status
• Age 15-24 years (especially age younger than 19 years)
• Poor socioeconomic conditions (eg, homelessness)
• Exchange of sex for drugs or money
• Single marital status
• Intercourse without a barrier contraceptive
• History of a previous STI or current coinfection with another STI
• Having been a foster child (males only)
• Chlamydia is most prevalent in persons aged 15-24 years
• Acquisition rates are comparable for the 2 sexes
• Women are more likely to be asymptomatic than men (80% vs 50%); however, they are also more likely to develop long-term complications (eg, PID and infertility) |
| How is clinical presentation of Chlamydia? | wide spectrum of diseases, including cervicitis, salpingitis, endometritis, urethritis, epididymitis, conjunctivitis, and neonatal pneumoniamost men and women whoare infected are asymptomatic; thus, diagnosis is delayed until a positive screening result is obtained or a symptomatic partnerdiscovered
The following may be noted in all patients with chlamydial infection:
• Possible history of STI’s
• Dysuria
• Yellow mucopurulent discharge from the urethra |
| How is clinical presentation of chlamydia in females? | • Vaginal discharge
• Abnormal vaginal bleeding (postcoital or unrelated to menses)
• Dyspareunia
• History of sexual activity without condoms or condom failure
• Proctitis, rectal discharge, or both in cases of receptive anal intercourse
• Slow onset and progression of lower abdominal pain
• Fever (in pelvic inflammatory disease [PID])
• No symptoms (in 80%) |
| How is clinical presentation of chlamydia in males? | • Urethral discharge
• History of sexual activity without condoms or condom failure
• Proctitis, rectal discharge, or both in cases of receptive anal intercourse
• Unilateral pain and swelling of the scrotum
• Fever
• No symptoms (in 50%) |
| How is clinical presentation of chlamydia in newborns? | • Symptoms of pneumonia (if present), beginning at 1-3 months
• Symptoms of conjunctivitis (if present), developing at 1-2 weeks
• In pneumonia, cough and fever (though the classic description is afebrile)
• In conjunctivitis, eye discharge, eye swelling, or both |
| How is clinical presentation in pregnant? | The following may be noted in pregnant diagnosed with or suspected
of having a chlamydial infection:
• Injected conjunctivae
• Mucopurulent discharge from the eyes
• Bilateral involvement of the eyes |
| What are complications of chlamydia? | • Infertility in women
• Ectopic pregnancy
• Fitz-Hugh-Curtis syndrome (perihepatitis)
• Pregnant women: untreated neonatal conjunctivitis can result in blindness
• Reiter’s syndrome
• Miscarriage, preterm delivery, and urethral scarring in men |
| What are lab tests in chlamydia? | • Endocervical, urethral, rectal, or oropharyngeal specimens should be obtained and assayed for C trachomatis infection in both males and females based on the patient’s sexual practices obtained by history
• In infants with suspected chlamydial pneumonia, perform a nasopharyngeal swab for Chlamydia culture. Antigen/DNA detection test, chlamydial culture, or both, using scrapings from the palpebral conjunctiva |
| How is tx of chlamydia? | • 1st line: doxycycline ; azithromycin
• 2nd line: erythromycin, penicillin
• Duration 10 days
• Chlamydial conjunctivitis and pneumonia are usually treated for a total of 14 days
• Control post treatment: 1 month |
