Chlamydia: Difference between revisions

Chlamydia, or more specifically a chlamydia infection, is a

Prevention is by not having sex, the use of condoms, or having sex only with persons who are not infected.^[1] Chlamydia can be cured by antibiotics with typically either azithromycin or doxycycline being used.^[2] Erythromycin or azithromycin is recommended in babies and during pregnancy.^[2] Sexual partners should also be treated and the infected people advised not to have sex for seven days and until symptom free.^[2] Gonorrhea, syphilis, and HIV should be tested for in those who have been infected.^[2] Following treatment people should be tested again after three months.^[2]

Chlamydia is one of the most common sexually transmitted infections, affecting about 4.2% of women and 2.7% of men worldwide.^[4][5] In 2015 about 61 million new cases occurred globally.^[9] In the United States about 1.4 million cases were reported in 2014.^[3] Infections are most common among those between the ages of 15 and 25 and are more common in women than men.^[2][3] In 2015 infections resulted in about 200 deaths.^[6] The word chlamydia is from the Greek χλαμύδα, meaning "cloak".^[10][11]

Signs and symptoms

Genital disease

Women

Chlamydial infection of the cervix (neck of the womb) is a sexually transmitted infection which of the lab-tested infections show no symptoms for 5-30% of women . The infection can be passed through vaginal, anal, or oral sex. If the infection spreads to the cervix, it may cause acute or asymptomatic pelvic inflammatory disease (PID), causing symptoms of cervical tenderness and pelvic pain. Chlamydial infection can lead to Pregnancy complications like pre-term delivery(18-44%), infant chlamydial pneumonia(3-16%) and more serious complications.^[12]

Chlamydia is known as the "silent epidemic", as in women it may not cause any

For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection.[14] Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, and inconsistent condom use.^[15] Guidelines recommend all women attending for emergency contraceptive are offered Chlamydia testing, with studies showing up to 9% of women aged <25 years had Chlamydia.^[16]

Men

In men, those with a chlamydial infection show symptoms of infectious inflammation of the urethra in about 50% of cases.^[13] Symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, testicular pain or swelling, or fever. If left untreated, chlamydia in men can spread to the testicles causing epididymitis, which in rare cases can lead to sterility if not treated.^[13] Chlamydia is also a potential cause of prostatic inflammation in men, although the exact relevance in prostatitis is difficult to ascertain due to possible contamination from urethritis.^[17]

Eye disease

Chlamydia may also cause reactive arthritis—the triad of arthritis, conjunctivitis and urethral inflammation—especially in young men. About 15,000 men develop reactive arthritis due to chlamydia infection each year in the U.S., and about 5,000 are permanently affected by it. It can occur in both sexes, though is more common in men.^{[citation needed]}

Infants

As many as half of all

Chlamydia can be transmitted during vaginal, anal, or oral sex or direct contact with infected tissue such as conjunctiva. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.[24]

Pathophysiology

Chlamydiae have the ability to establish long-term associations with host cells. When an infected host cell is starved for various nutrients such as amino acids (for example, tryptophan),^[26] iron, or vitamins, this has a negative consequence for Chlamydiae since the organism is dependent on the host cell for these nutrients. Long-term cohort studies indicate that approximately 50% of those infected clear within a year, 80% within two years, and 90% within three years.^[27]

The starved chlamydiae enter a persistent growth state wherein they stop cell division and become morphologically aberrant by increasing in size.^[28] Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve.

There is debate as to whether persistence has relevance. Some believe that persistent chlamydiae are the cause of chronic chlamydial diseases. Some antibiotics such as

The diagnosis of genital chlamydial infections evolved rapidly from the 1990s through 2006.

Because of improved test accuracy, ease of specimen management, convenience in specimen management, and ease of screening sexually active men and women, the NAATs have largely replaced culture, the historic gold standard for chlamydia diagnosis, and the non-amplified probe tests. The latter test is relatively insensitive, successfully detecting only 60–80% of infections in asymptomatic women, and often giving falsely-positive results. Culture remains useful in selected circumstances and is currently the only assay approved for testing non-genital specimens. Other method also exist including: ligase chain reaction (LCR), direct fluorescent antibody resting, enzyme immunoassay, and cell culture.^[33]

Rapid point-of-care tests are, as of 2020, not thought to be effective for diagnosing chlamydia in men of reproductive age and nonpregnant women because of a high false-negative rates.^[34]

Prevention

Prevention is by not having sex, the use of condoms, or having sex only with partners who are not infected.^[1]

Screening

For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection.

In the United Kingdom the National Health Service (NHS) aims to:

1. Prevent and control chlamydia infection through early detection and treatment of asymptomatic infection;
2. Reduce onward transmission to sexual partners;
3. Prevent the consequences of untreated infection;
4. Test at least 25 percent of the sexually active under 25 population annually.^[36]
5. Retest after treatment.^[37]

Treatment

C. trachomatis infection can be effectively cured with antibiotics. Guidelines recommend azithromycin, doxycycline, erythromycin, levofloxacin or ofloxacin.^[38] In men, doxycycline (100 mg twice a day for 7 days) is probably more effective than azithromycin (1 g single dose) but evidence for the relative effectiveness of antibiotics in women is very uncertain.^[39] Agents recommended during pregnancy include erythromycin or amoxicillin.^[2][40]

An option for treating sexual partners of those with chlamydia or

Following treatment people should be tested again after three months to check for reinfection.[2]

Epidemiology

Globally, as of 2015, sexually transmitted chlamydia affects approximately 61 million people.^[9] It is more common in women (3.8%) than men (2.5%).^[43] In 2015 it resulted in about 200 deaths.^[6]

In the United States about 1.6 million cases were reported in 2016.^[44] The CDC estimates that if one includes unreported cases there are about 2.9 million each year.^[44] It affects around 2% of young people.^[45] Chlamydial infection is the most common bacterial sexually transmitted infection in the UK.^[46]

Chlamydia causes more than 250,000 cases of epididymitis in the U.S. each year. Chlamydia causes 250,000 to 500,000 cases of PID every year in the United States. Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed.^[24]

References

External links

• Chlamydia at
  Curlie
• Chlamydia Fact Sheet from the CDC

Wikipedia's health care articles can be viewed offline with the Medical Wikipedia app.

Wikimedia Commons has media related to Chlamydia infections.