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Chlamydia

Chlamydia is currently one of the most common sexually transmitted diseases — about 4 million cases of chlamydia occur in the USA each year. However, about half of all men and three-quarters of all women who have chlamydia have no symptoms and don't know that they have the disease. The disease is transmitted by the Chlamydia trachomatis bacterium. It can be serious but it is easily cured if detected in time. It is also, and possibly more importantly, the biggest preventable cause of blindness in the world. Blindness occurs as a complication of trachoma (chlamydia conjunctivitis). more...

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Features

Almost half of all women who get chlamydia and aren't treated by a doctor will get pelvic inflammatory disease (PID), a generic term for infection of the uterus, fallopian tubes, and/or ovaries. PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, difficulty becoming pregnant, ectopic (tubal) pregnancy, and other dangerous complications of pregnancy. Chlamydia causes 250,000 to 500,000 cases of PID every year in the U.S.

In women, chlamydia may not cause any symptoms, but symptoms that may occur include: unusual vaginal bleeding or discharge, pain in the abdomen, painful sexual intercourse, fever, painful urination or the urge to urinate more frequently than usual.

In men, chlamydia may not cause any symptoms, but symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, swollen or tender testicles, or fever.

Chlamydia in men can spread to the testicles, causing epididymitis, which can cause sterility. Chlamydia causes more than 250,000 cases of epididymitis in the USA each year.

Chlamydia may also cause Reiter's Syndrome, especially in young men. About 15,000 men get Reiter's Syndrome from chlamydia each year in the USA, and about 5,000 are permanently affected by it.

As many as half of all infants born to mothers with chlamydia will be born with the disease. Chlamydia can affect infants by causing spontaneous abortion (miscarriage), premature birth, blindness, and pneumonia.

Treatment

Fortunately, chlamydia can be effectively cured with antibiotics once it is detected. Current Centers for Disease Control guidelines provide for the following treatments:

  • Azithromycin 1 gram by mouth once, or
  • Doxycycline 100 milligrams twice daily for seven days.

Prevention

Because chlamydia is so common and because it often doesn't produce symptoms, it is especially important to take precautions against sexually transmitted disease by practicing safer sex.

Pathophysiology

Chlamydiae replicate intracellularly, within a membrane-bound structure termed an inclusion. It is inside this inclusion, which somehow avoids lysosomal fusion and subsequent degradation, that the metabolically inactive "elementary body" (EB) form of Chlamydia becomes the replicative "reticulate body" (RB). The multiplying RBs then become EBs again and burst out of the host cell to continue the infection cycle. Since Chlamydiae are obligate intracellular parasites, they cannot be cultured outside of host cells, leading to many difficulties in research.

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Limitations of screening tests for asymptomatic chlamydia
From American Family Physician, 1/1/05 by Karl E. Miller

One of the most frequently reported infectious diseases is Chlamydia, which can cause significant reproductive morbidity in women. The prevalence of chlamydial infections in adolescent and young adult women in the United States ranges from 5 to 27 percent, placing this age group at the highest risk for this infection. Various organizations have recommended screening asymptomatic young women for chlamydial infections. The goal of this screening should be to find the test that is least invasive and most acceptable for patients and health care professionals. The nucleic acid amplification tests can detect Chlamydia on genital secretions, urine specimens, and endocervical or urethral samples. These tests have been assessed in high-risk populations on symptomatic and asymptomatic patients. Shrier and associates evaluated the different test types, specimen sources, and collection methods for Chlamydia screening in asymptomatic female adolescents and young adults. In addition, they assessed the way sexual history and clinical findings affect the prediction of chlamydial infections.

Participants in the study included female patients from 16 to 25 years of age who were examined at two outpatient centers for routine gynecologic care. They were excluded from the study if they reported any symptoms consistent with a sexually transmitted disease (STD), were pregnant, had taken antibiotics within the past 21 days, had a chlamydial infection within the past six weeks, or were sexual partners with some-one known to have an STD.

Participants were interviewed about their sexual history using a standardized format. Specimen collection started with two swabs inserted into the vagina by the participants and collection of the first 30 mL of voided urine. During the pelvic examination, specimens were collected from the distal urethra, vaginal area, and endocervical canal. Testing included cultures for Chlamydia and gonorrhea, and polymerase chain reaction, ligase chain reaction, and nucleic acid amplification tests.

Out of 139 participants, all nine test results were available for 126 participants. The prevalence of Chlamydia infection in the study population was 22 percent. The sensitivities for the polymerase chain reaction and ligase chain reaction were similar, but the urine polymerase chain reaction test had a lower sensitivity. The specificities for each of the tests were 99 to 100 percent, but the urine polymerase chain reaction test's specificity was 91 percent. The positive predictive values for the tests were higher than 93 percent except for the urine polymerase chain reaction test, which was 65 percent. The negative predictive values for all of the tests were 83 to 91 percent. Combining two tests from two different specimens improved sensitivities without having a negative impact on the specificities.

The authors conclude that the sensitivity of one test from one specimen is less than was previously reported. They add that when screening for Chlamydia infection in asymptomatic adolescents and young adults, the limitations of one test type at one site must be considered.

Shrier LA, et al. Limitations of screening tests for the detection of Chlamydia trachomatis in asymptomatic adolescent and young adult women. Am J Obstet Gynecol March 2004;190:654-62.

COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2005 Gale Group

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