Chlamydia Trachomatis Infections

Chlamydia Trachomatis– A constellation of sexually transmitted infections comprising urethritis, cervicitis, salpingitis, and lymphogranuloma venereum.

Causes and Incidence

The cause is the C. trachomatis bacterium, which is transmitted during intercourse with an infected individual. Newborns of infected mothers may contract associated otitis, conjunctivitis, and pneumonia during passage through the birth canal. In countries with endemic areas, contact can be spread through close contact within households. More than 4.5 million people in the United States contract chlamydial infections each year, and these infections are the most common source of sexually transmitted diseases (STDs) worldwide. Chlamydial infections also are the leading cause of infant blindness in underdeveloped countries.

Disease Process

After intimate contact with an infected individual, the Chlamydia bacterium attaches to and is then ingested by the columnar epithelial cells in various receptacle sites, where it multiplies in the host cell. Common sites are the urethra and prostate in men and the urethra and cervix in women. The rectum and pharynx are sites for both genders. Sites for infants and children include the conjunctivae and respiratory tract.

The pathogenesis after this point is unclear, but most likely an immune response is triggered, producing a patchy, inflammatory response in the submucosa. This is spread by the lymphatics to such sites as the epididymis in men and the fallopian tubes in women. Inflammatory exudate is eventually replaced by fibrous tissue, leading to strictures in the urethra, epididymis, and fallopian tubes and scarring of the conjunctivae.

Lymphogranuloma venereum produces a localized, nodular lesion that spreads regionally via the lymph system (primarily the inguinal nodes), producing other nodular lesions, which mat together and form large abscesses. If the condition is left untreated, abscesses form throughout the lymph system and often rupture through epithelial surfaces, creating draining sinuses and fistulas.

Symptoms

Manifestations vary, depending on the mucous membrane initially involved and the infecting strain of C. trachomatis.

Urethritis/cervicitis
Often asymptomatic; urinary pain and frequency; scanty mucoid urethral discharge (men), mucopurulent vaginal discharge (women); pain in scrotum with epididymitis; flank tenderness with salpingitis.

Lymphogranuloma
Early sign is lesion on penis, labia, vagina, cervix, or rectum; men then have lymphadenopathy; systemic signs include fever, chills, severe headache.

Pharyngeal infection
Asymptomatic or sore throat; red, dry tongue.

Rectal infection
Bloody diarrhea, purulent discharge.

Trachoma and conjunctivitis
Purulent discharge from eyes.

Potential Complications

Complications from untreated disease include urethral and rectal strictures, pelvic inflammatory disease, sterility, fistulas, elephantiasis, blindness, and pneumonia.

Diagnostic Tests

The primary diagnostic tools are a clinical examination with a history of exposure to an infected partner or multiple partners, and a culture of exudate that tests positive for C. trachomatis.

Treatments

Surgery – None.

Drugs
Antiinfective drugs sensitive to C. trachomatis following treatment guidelines for type and dosage issued by the Centers for Disease Control and Prevention.

General
Cautioning patient to refrain from sexual activity until he or she is free of disease, and tracing of all potentially exposed sex partners; screening of high-risk populations to treat infected individuals and reduce the reservoir; information about STDs.

_____________________________________