August 5, 2011

Infection with Chlamydia trachomatis is the most common sexually transmitted disease in the United States and the most frequently reported infectious disease; an estimated 3 million cases occur annually. Chlamydia can be transmitted by vaginal, anal, or, less commonly, oral contact. The symptoms of chlamydia, which usually occur within 7-21 days of infection, can be very mild. Up to 50% of men, and up to 75% of women may have no symptoms at all. Women may notice an abnormal vaginal discharge, and men may have a discharge from the penis, or pain while urinating. Chlamydia can also cause inflammation of the rectum. Although often asymptomatic in women, chlamydia infection can produce chronic low-grade inflammation leading to scarring of the fallopian tubes and infertility. Other complications are discussed below.

The diagnosis of infection with C. trachomatis is made by sampling the infected area, most often vaginal or anal secretions. It is difficult to grow C. trachomatis using standard culture techniques, and there are a variety of Food and Drug Administration (FDA)-approved methods to detect chlamydia based on antigen detection and amplification of genetic material.

While acute infection of the urethra or cervix with C. trachomatis is usually not associated with significant morbidity, complications of chlamydia can be very serious. In women, pelvic inflammatory disease (PID) occurs when the infection extends to the fallopian tubes. PID can cause severe pain, requiring hospitalization and intravenous antibiotics. PID may result in scarring of the fallopian tubes, causing infertility, ectopic pregnancy, and/or chronic pelvic pain. Of those with PID, 20% will become infertile; 18% will experience debilitating, chronic pelvic pain; and 9% will have a lifethreatening tubal pregnancy. Undiagnosed PID caused by chlamydia is common, leading to screening strategies discussed below. In addition to those direct complications of infection, women infected with chlamydia have a threeto fivefold increased risk of acquiring HIV, if exposed to the virus. Men with untreated chlamydia infection may develop pain and swelling of the scrotum and testicles, known as epididymitis.

Women who develop chlamydia infection during pregnancy may transmit C. trachomatis to the fetus at birth. A newborn may develop conjunctivitis (a serious eye infection) and pneumonia. Because of this, it is recommended that all pregnant women be tested for chlamydia.

Uncomplicated infection which responds readily to several antibiotics. The most common regimens include doxycycline given for 7 days, or single-dose therapy with azithromycin. The latter drug offers the advantage of better compliance, but is more expensive. Because chlamydia and gonorrhea often occur simultaneously and have significant overlap in their clinical presentation, it is standard to test for and treat both when one is suspected in a patient.

Utilizing safe sex practices, including latex condoms, may prevent chlamydia. Women with risk factors such as multiple sexual partners, and those who are not consistently using barrier methods of birth control should be tested annually for chlamydia infection. The Centers for Disease Control and Prevention has developed recommendations for the prevention and management of chlamydia for all providers of health care. These recommendations call for screening of all sexually active females under 20 years of age at least annually, and annual screening of women aged 20 and older with one or more risk factors for chlamydia (i.e., new or multiple sex partners and lack of barrier contraception). All women with infection of the cervix and all pregnant women should be tested.

SEE ALSO: Condoms, Gonorrhea, Herpes simplex virus, Human papillomavirus, Safer sex, Sexually transmitted diseases, Syphili

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