Chlamydia

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Chlamydia
Other namesChlamydia infection
Pap smear showing clamydia in the vacuoles 500x H&E.jpg
Pap smear showing C. trachomatis (H&E stain)
Pronunciation
Specialty Infectious disease, gynecology, urology
Symptoms None, vaginal discharge, discharge from the penis, burning with urination [1]
Complications Pain in the testicles, pelvic inflammatory disease, infertility, ectopic pregnancy [1] [2]
Usual onsetFew weeks following exposure [1]
Causes Chlamydia trachomatis spread by sexual intercourse or childbirth [3]
Diagnostic method Urine or swab of the cervix, vagina, or urethra [2]
PreventionNot having sex, condoms, sex with only one non–infected person [1]
Treatment Antibiotics (azithromycin or doxycycline) [2]
Frequency4.2% (women), 2.7% (men) [4] [5]
Deaths~200 (2015) [6]

Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis . [3] Most people who are infected have no symptoms. [1] When symptoms do appear they may occur only several weeks after infection; [1] the incubation period between exposure and being able to infect others is thought to be on the order of two to six weeks. [7] Symptoms in women may include vaginal discharge or burning with urination. [1] Symptoms in men may include discharge from the penis, burning with urination, or pain and swelling of one or both testicles. [1] The infection can spread to the upper genital tract in women, causing pelvic inflammatory disease, which may result in future infertility or ectopic pregnancy. [2]

Contents

Chlamydia infections can occur in other areas besides the genitals, including the anus, eyes, throat, and lymph nodes. Repeated chlamydia infections of the eyes that go without treatment can result in trachoma, a common cause of blindness in the developing world. [8]

Chlamydia can be spread during vaginal, anal, oral, or manual sex and can be passed from an infected mother to her baby during childbirth. [1] [9] The eye infections may also be spread by personal contact, flies, and contaminated towels in areas with poor sanitation. [8] Infection by the bacterium Chlamydia trachomatis only occurs in humans. [10] Diagnosis is often by screening which is recommended yearly in sexually active women under the age of twenty-five, others at higher risk, and at the first prenatal visit. [1] [2] Testing can be done on the urine or a swab of the cervix, vagina, or urethra. [2] Rectal or mouth swabs are required to diagnose infections in those areas. [2]

Prevention is by not having sex, the use of condoms, or having sex with only one other person, who is 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 infected people should be 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. [11] 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'. [12] [13]

Signs and symptoms

Genital disease

Inflammation of the cervix from chlamydia infection characterized by mucopurulent cervical discharge, redness, and inflammation SOA-Chlamydia-trachomatis-female.jpg
Inflammation of the cervix from chlamydia infection characterized by mucopurulent cervical discharge, redness, and inflammation
A white, cloudy or watery discharge may emerge from the tip of the penis. SOA-Chlamydia-trachomatis-male.jpg
A white, cloudy or watery discharge may emerge from the tip of the penis.

Women

Chlamydial infection of the cervix (neck of the womb) is a sexually transmitted infection which has no symptoms for around 70% of women infected. The infection can be passed through vaginal, anal, oral, or manual sex. Of those who have an asymptomatic infection that is not detected by their doctor, approximately half will develop 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. [14]

Chlamydia is known as the "silent epidemic", as at least 70% of genital C. trachomatis infections in women (and 50% in men) are asymptomatic at the time of diagnosis, [15] and can linger for months or years before being discovered. Signs and symptoms may include abnormal vaginal bleeding or discharge, abdominal pain, painful sexual intercourse, fever, painful urination or the urge to urinate more often than usual (urinary urgency). [14]

For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection. [16] Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, and inconsistent condom use. [17] Guidelines recommend all women attending for emergency contraceptive are offered chlamydia testing, with studies showing up to 9% of women aged under 25 years had chlamydia. [18]

Men

In men, those with a chlamydial infection show symptoms of infectious inflammation of the urethra in about 50% of cases. [15] 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. [15] 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. [19]

Eye disease

Conjunctivitis due to chlamydia SOA-conjunctivitis.jpg
Conjunctivitis due to chlamydia

Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis. [20] It was once the leading cause of blindness worldwide, but its role diminished from 15% of blindness cases by trachoma in 1995 to 3.6% in 2002. [21] [22] The infection can be spread from eye to eye by fingers, shared towels or cloths, coughing and sneezing and eye-seeking flies. [23] Symptoms include mucopurulent ocular discharge, irritation, redness, and lid swelling. [20] Newborns can also develop chlamydia eye infection through childbirth (see below). Using the SAFE strategy (acronym for surgery for in-growing or in-turned lashes, antibiotics, facial cleanliness, and environmental improvements), the World Health Organization aimed (unsuccessfully) for the global elimination of trachoma by 2020 (GET 2020 initiative). [24] [25] The updated World Health Assembly neglected tropical diseases road map (2021–2030) sets 2030 as the new timeline for global elimination. [26]

Joints

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 infants born to mothers with chlamydia will be born with the disease. Chlamydia can affect infants by causing spontaneous abortion; premature birth; conjunctivitis, which may lead to blindness; and pneumonia. [27] Conjunctivitis due to chlamydia typically occurs one week after birth (compared with chemical causes (within hours) or gonorrhea (2–5 days)). [28]

Other conditions

A different serovar of Chlamydia trachomatis is also the cause of lymphogranuloma venereum, an infection of the lymph nodes and lymphatics. It usually presents with genital ulceration and swollen lymph nodes in the groin, but it may also manifest as rectal inflammation, fever or swollen lymph nodes in other regions of the body. [29]

Transmission

Chlamydia can be transmitted during vaginal, anal, oral, or manual 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. [27] It is assumed that the probability of becoming infected is proportionate to the number of bacteria one is exposed to. [30]

Pathophysiology

Chlamydia bacteria 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), [31] iron, or vitamins, this has a negative consequence for chlamydia bacteria 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. [32]

The starved chlamydia bacteria can enter a persistent growth state where they stop cell division and become morphologically aberrant by increasing in size. [33] Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve. [34]

There is debate as to whether persistence has relevance: some believe that persistent chlamydia bacteria are the cause of chronic chlamydial diseases. Some antibiotics such as β-lactams have been found to induce a persistent-like growth state. [35] [36]

Diagnosis

Chlamydia trachomatis inclusion bodies (brown) in a McCoy cell culture ChlamydiaTrachomatisEinschlusskorperchen.jpg
Chlamydia trachomatis inclusion bodies (brown) in a McCoy cell culture

The diagnosis of genital chlamydial infections evolved rapidly from the 1990s through 2006. Nucleic acid amplification tests (NAAT), such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement amplification (SDA) now are the mainstays. NAAT for chlamydia may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine. [37] NAAT has been estimated to have a sensitivity of approximately 90% and a specificity of approximately 99%, regardless of sampling from a cervical swab or by urine specimen. [38] In women seeking treatment in a sexually transmitted infection clinic where a urine test is negative, a subsequent cervical swab has been estimated to be positive in approximately 2% of the time. [38]

At present, the NAATs have regulatory approval only for testing urogenital specimens, although rapidly evolving research indicates that they may give reliable results on rectal specimens.

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 methods also exist including: ligase chain reaction (LCR), direct fluorescent antibody resting, enzyme immunoassay, and cell culture. [39]

The swab sample for chlamydial infections does not show difference whether the sample was collected in home or in clinic in terms of numbers of patient treated. The implications in cured patients, reinfection, partner management, and safety are unknown. [40]

Rapid point-of-care tests are, as of 2020, not thought to be effective for diagnosing chlamydia in men of reproductive age and non-pregnant women because of high false-negative rates. [41]

Prevention

Prevention is by not having sex, the use of condoms, or having sex with only one other person, who is 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. [16] Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, and inconsistent condom use. [17] For pregnant women, guidelines vary: screening women with age or other risk factors is recommended by the U.S. Preventive Services Task Force (USPSTF) (which recommends screening women under 25) and the American Academy of Family Physicians (which recommends screening women aged 25 or younger). The American College of Obstetricians and Gynecologists recommends screening all at risk, while the Centers for Disease Control and Prevention recommend universal screening of pregnant women. [16] The USPSTF acknowledges that in some communities there may be other risk factors for infection, such as ethnicity. [16] Evidence-based recommendations for screening initiation, intervals and termination are currently not possible. [16] For men, the USPSTF concludes evidence is currently insufficient to determine if regular screening of men for chlamydia is beneficial. [17] They recommend regular screening of men who are at increased risk for HIV or syphilis infection. [17] A Cochrane review found that the effects of screening are uncertain in terms of chlamydia transmission but that screening probably reduces the risk of pelvic inflammatory disease in women. [42]

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. [43]
  5. Retest after treatment. [44]

Treatment

C. trachomatis infection can be effectively cured with antibiotics. Guidelines recommend azithromycin, doxycycline, erythromycin, levofloxacin or ofloxacin. [45] 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. [46] Agents recommended during pregnancy include erythromycin or amoxicillin. [2] [47]

An option for treating sexual partners of those with chlamydia or gonorrhea includes patient-delivered partner therapy (PDT or PDPT), which is the practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner. [48]

Following treatment people should be tested again after three months to check for reinfection. [2] Test of cure may be false-positive due to the limitations of NAAT in a bacterial (rather than a viral) context, since targeted genetic material may persist in the absence of viable organisms. [49]

Epidemiology

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Disability-adjusted life year (DALY) for chlamydia per 100,000 inhabitants in 2004
  no data
  ≤10
  10–20
  20–30
  30–40
  40–50
  50–60
  60–70
  70–80
  80–90
  90–100
  100–110
  more than 110

Globally, as of 2015, sexually transmitted chlamydia affects approximately 61 million people. [11] It is more common in women (3.8%) than men (2.5%). [51] In 2015 it resulted in about 200 deaths. [6]

In the United States about 1.6 million cases were reported in 2016. [52] The CDC estimates that if one includes unreported cases there are about 2.9 million each year. [52] It affects around 2% of young people. [53] Chlamydial infection is the most common bacterial sexually transmitted infection in the UK. [54]

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. [27]

See also

Related Research Articles

<span class="mw-page-title-main">Bacterial vaginosis</span> Excessive growth of bacteria in the vagina

Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination may occur. Itching is uncommon. Occasionally, there may be no symptoms. Having BV approximately doubles the risk of infection by a number of sexually transmitted infections, including HIV/AIDS. It also increases the risk of early delivery among pregnant women.

<span class="mw-page-title-main">Pelvic inflammatory disease</span> Infection of uterus, fallopian tubes, ovaries or the inner surface of pelvis

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

Urethritis is the inflammation of the urethra. The most common symptoms include painful or difficult urination and urethral discharge. It is a commonly treatable condition usually caused by infection with bacteria. This bacterial infection is often sexually transmitted, but not in every instance; it can be idiopathic, for example. Some incidence of urethritis can appear asymptomatic as well.

<span class="mw-page-title-main">Trichomoniasis</span> Medical condition

Trichomoniasis (trich) is an infectious disease caused by the parasite Trichomonas vaginalis. About 70% of affected people do not have symptoms when infected. When symptoms occur, they typically begin 5 to 28 days after exposure. Symptoms can include itching in the genital area, a bad smelling thin vaginal discharge, burning with urination, and pain with sex. Having trichomoniasis increases the risk of getting HIV/AIDS. It may also cause complications during pregnancy.

<span class="mw-page-title-main">Lymphogranuloma venereum</span> Sexually transmitted infection

Lymphogranuloma venereum is a sexually transmitted infection caused by the invasive serovars L1, L2, L2a, L2b, or L3 of Chlamydia trachomatis.

Nongonococcal urethritis (NGU) is inflammation of the urethra that is not caused by gonorrheal infection.

<i>Chlamydia trachomatis</i> Species of bacterium

Chlamydia trachomatis, commonly known as chlamydia, is a bacterium that causes chlamydia, which can manifest in various ways, including: trachoma, lymphogranuloma venereum, nongonococcal urethritis, cervicitis, salpingitis, pelvic inflammatory disease. C. trachomatis is the most common infectious cause of blindness and the most common sexually transmitted bacterium.

<span class="mw-page-title-main">Fitz-Hugh–Curtis syndrome</span> Medical condition

Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the formation of adhesions presenting with the clinical syndrome of right upper quadrant (RUQ) pain.

<span class="mw-page-title-main">Trachoma</span> Infectious disease that causes a roughening of the inner surface of the eyelids

Trachoma is an infectious disease caused by bacterium Chlamydia trachomatis. The infection causes a roughening of the inner surface of the eyelids. This roughening can lead to pain in the eyes, breakdown of the outer surface or cornea of the eyes, and eventual blindness. Untreated, repeated trachoma infections can result in a form of permanent blindness when the eyelids turn inward.

<span class="mw-page-title-main">Salpingitis</span> Medical condition

Salpingitis is an infection causing inflammation in the fallopian tubes. It is often included in the umbrella term of pelvic inflammatory disease (PID), along with endometritis, oophoritis, myometritis, parametritis, and peritonitis.

<span class="mw-page-title-main">Neonatal conjunctivitis</span> Medical condition

Neonatal conjunctivitis is a form of conjunctivitis which affects newborn babies following birth. It is typically due to neonatal bacterial infection, although it can also be non-infectious. Infectious neonatal conjunctivitis is typically contracted during vaginal delivery from exposure to bacteria from the birth canal, most commonly Neisseria gonorrhoeae or Chlamydia trachomatis.

<span class="mw-page-title-main">Genital herpes</span> Infection by herpes simplex viruses of the genitals

Genital herpes is a herpes infection of the genitals caused by the herpes simplex virus (HSV). Most people either have no or mild symptoms and thus do not know they are infected. When symptoms do occur, they typically include small blisters that break open to form painful ulcers. Flu-like symptoms, such as fever, aching, or swollen lymph nodes, may also occur. Onset is typically around 4 days after exposure with symptoms lasting up to 4 weeks. Once infected further outbreaks may occur but are generally milder.

<i>Chlamydia</i> (genus) Genus of bacteria

Chlamydia is a genus of pathogenic Gram-negative bacteria that are obligate intracellular parasites. Chlamydia infections are the most common bacterial sexually transmitted diseases in humans and are the leading cause of infectious blindness worldwide.

<span class="mw-page-title-main">Gonorrhea</span> Sexually transmitted infection

Gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with urination, discharge from the penis, or testicular pain. Infected women may experience burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. Complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis. Many of those infected, however, have no symptoms. If untreated, gonorrhea can spread to joints or heart valves.

<span class="mw-page-title-main">Sexually transmitted infection</span> Infection transmitted through human sexual behavior

A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex. STIs often do not initially cause symptoms, which results in a risk of passing the infection on to others. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Some STIs can cause infertility.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

Chlamydia research is the systematic study of the organisms in the taxonomic group of bacteria Chlamydiota, the diagnostic procedures to treat infections, the disease chlamydia, infections caused by the organisms, the epidemiology of infection and the development of vaccines. The process of research can include the participation of many researchers who work in collaboration from separate organizations, governmental entities and universities.

<i>Microbotryum violaceum</i> infection of <i>Silene latifolia</i> Fungal disease of a plant

Microbotryum violaceum is a host-specific anther smut (fungus) disease that infects Silene latifolia and sterilizes the host plant. When infected with this disease, the flowers generate pathogenic spores, which can then be transferred to other plants by pollinating insects. Therefore, this disease is sometimes classified as a sexually transmitted infection.

<span class="mw-page-title-main">Michel Alary</span> Canadian academic, doctor

Michel Alary is a Canadian academic, doctor of preventive medicine and a health researcher. He is a Professor of Social and Preventive Medicine at Université Laval and the director of population health research at the Research Centre of the CHU de Quebec – Université Laval. He also serves as a Medical Consultant at the Institut national de santé publique du Québec. Alary has published over 260 research papers and has produced major reports for the World Bank and UNAIDS about HIV in sub-Saharan Africa. He also evaluated the Bill & Melinda Gates Foundation's India AIDS Initiative for which his project received the Avahan Recognition Award. He has conducted epidemiological and preventive research on blood-borne infections, HIV and other Sexually Transmitted Diseases (STD) among the most vulnerable populations in developed and developing countries.

Julius Schachter was an American microbiologist at the University of California, San Francisco. He was a leading expert on Chlamydia.

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