Chlamydia infection overview: Difference between revisions
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==Overview== | ==Overview== | ||
The term ''Chlamydia'' refers to an infection by any one of the species in the bacterial genus ''[[Chlamydia (bacterium)|Chlamydia]]''—''[[Chlamydia trachomatis]]'', ''[[Chlamydia suis]]'' or ''[[Chlamydia muridarum]]''—, but of these, only ''C. trachomatis'' is found in humans.<ref>{{cite web |url=http://www.chlamydiae.com/docs/Chlamydiales/diagram/taxondiag.htm|title= www.chlamydiae.com (professional) - Taxonomy diagram|accessdate=2007-10-27 |format= |work=}}</ref> | The term ''Chlamydia'' refers to an infection by any one of the species in the bacterial genus ''[[Chlamydia (bacterium)|Chlamydia]]''—''[[Chlamydia trachomatis]]'', ''[[Chlamydia suis]]'' or ''[[Chlamydia muridarum]]''—, but of these, only ''C. trachomatis'' is found in humans.<ref>{{cite web |url=http://www.chlamydiae.com/docs/Chlamydiales/diagram/taxondiag.htm|title= www.chlamydiae.com (professional) - Taxonomy diagram|accessdate=2007-10-27 |format= |work=}}</ref> | ||
Chlamydia is a common [[sexually transmitted disease]] (STD) caused by the gram negative bacterium, ''[[Chlamydia trachomatis]]''. Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States and a major infectious cause of human eye and [[genital]] disease.<ref name=ccc>[http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm Chlamydia fact sheet from the Centers for Disease Control and Prevention]</ref> ''Chlamydia trachomatis'' was first discovered in 1907 by Halberstaedter and von Prowazek.<ref name="pmid17523388">{{cite journal| author=Budai I| title=Chlamydia trachomatis: milestones in clinical and microbiological diagnostics in the last hundred years: a review. | journal=Acta Microbiol Immunol Hung | year= 2007 | volume= 54 | issue= 1 | pages= 5-22 | pmid=17523388 | doi=10.1556/AMicr.54.2007.1.2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17523388 }} </ref> Chlamydia must be differentiated from other genital tract infections such as [[Gonorrhea]] infection, [[bacterial vaginosis]], vaginal [[candidiasis]], infection with ''[[Trichomonas vaginalis]]'', and [[mycoplasma]] infection.<ref name=def> Genital Tract Chlamydia infection. BMJ. http://bestpractice.bmj.com/best-practice/monograph/52/diagnosis/differential.html. Accessed on December 27, 2015</ref> In 2014, the incidence of chylamydia was estimated to be 439 cases per 100,000 individuals in the United States.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref> Almost two-thirds of new chlamydia infections occur among youth aged 15-24 years. It is estimated that 1 in 20 sexually active young women aged 14-24 years has chlamydia.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref> Females are more commonly affected with chlamydia infection than males. The female to male ratio is approximately 1.52 to 1.<ref name=abc> Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection#cite_note-LancetEpi2012-26. Accessed on December 29, 2015</ref> Common risk factors in the development of [[chlamydia]] infection include unprotected sexual activity, multiple sexual partners, age, men who have sex with men, and low socio-economic status.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref><ref name="pmid18159391">{{cite journal| author=Navarro C, Jolly A, Nair R, Chen Y| title=Risk factors for genital chlamydial infection. | journal=Can J Infect Dis | year= 2002 | volume= 13 | issue= 3 | pages= 195-207 | pmid=18159391 | doi= | pmc=PMC2094865 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159391 }} </ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> According to the 2015 Sexually Transmitted Diseases Treatment Guidelines by the CDC, screening for chlamydia is recommended for sexually active under 25 years, women over 25 who are at increased risk, all pregnant women under 25 years, pregnant women over 25 who are at increased risk, men who have sex with men, and individuals with HIV.<ref name=abc> Screening Recommendations Referenced in Treatment Guidelines and Original Recommendation Sources. CDC. http://www.cdc.gov/std/tg2015/screening-recommendations.htm. Accessed on January 6th, 2016</ref> If left untreated, chlamydia can cause [[pelvic inflammatory disease]] in women and [[epididymitis]] and [[orchitis]] in males.<ref name=abc> Chlamydia trachomatis. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_trachomatis. Accessed on December 22, 2015</ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> Common complications of chlamydia among women include [[cervicitis]], [[infertility]], [[ectopic pregnancy]], and chronic pelvic pain. Complications of chlamydia in men include [[proctitis]], [[epididymitis]], and [[sterility]]. Other complications of chlamydia include an increased risk of acquiring [[HIV]] and [[reactive arthritis]].<ref name=ddd> Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016 </ref> Prognosis of chlamydia is generally good with adequate treatment. Specific areas of focus when obtaining a history from the patient include number and type of sexual partners (new, casual, or regular), contraception use, and previous history of chlamydia infection or other sexually transmitted diseases.<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref><ref name=ddd> Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016 </ref><ref name="pmid18159391">{{cite journal| author=Navarro C, Jolly A, Nair R, Chen Y| title=Risk factors for genital chlamydial infection. | journal=Can J Infect Dis | year= 2002 | volume= 13 | issue= 3 | pages= 195-207 | pmid=18159391 | doi= | pmc=PMC2094865 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159391 }} </ref> The majority of women with chlamydia infection are asymptomatic or present with minimal symptoms.<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref><ref name=ddd> Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016 </ref> Common symptoms of chlamydia infection among women include abnormal vaginal bleeding or discharge, abdominal pain, painful sexual intercourse, painful urination, and urinary urgency. Symptoms of chlamydia infection among men include penile discharge and pruritus, testicular pain or swelling, and pain during urination.<ref name=cde> Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection. Accessed on January 11, 2016</ref> Physical examination of women with chlamydia infection is usually remarkable for a cloudy, yellow mucoid cervical discharge, friable appearance of the cervix, and cervical motion tenderness.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016</ref><ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> Common physical examination findings of chlamydia infection among men include a clear or white urethral discharge, testicular tenderness, and testicular swelling.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016</ref><ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> | Chlamydia is a common [[sexually transmitted disease]] (STD) caused by the gram negative bacterium, ''[[Chlamydia trachomatis]]''. Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States and a major infectious cause of human eye and [[genital]] disease.<ref name=ccc>[http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm Chlamydia fact sheet from the Centers for Disease Control and Prevention]</ref> ''Chlamydia trachomatis'' was first discovered in 1907 by Halberstaedter and von Prowazek.<ref name="pmid17523388">{{cite journal| author=Budai I| title=Chlamydia trachomatis: milestones in clinical and microbiological diagnostics in the last hundred years: a review. | journal=Acta Microbiol Immunol Hung | year= 2007 | volume= 54 | issue= 1 | pages= 5-22 | pmid=17523388 | doi=10.1556/AMicr.54.2007.1.2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17523388 }} </ref> Chlamydia must be differentiated from other genital tract infections such as [[Gonorrhea]] infection, [[bacterial vaginosis]], vaginal [[candidiasis]], infection with ''[[Trichomonas vaginalis]]'', and [[mycoplasma]] infection.<ref name=def> Genital Tract Chlamydia infection. BMJ. http://bestpractice.bmj.com/best-practice/monograph/52/diagnosis/differential.html. Accessed on December 27, 2015</ref> In 2014, the incidence of chylamydia was estimated to be 439 cases per 100,000 individuals in the United States.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref> Almost two-thirds of new chlamydia infections occur among youth aged 15-24 years. It is estimated that 1 in 20 sexually active young women aged 14-24 years has chlamydia.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref> Females are more commonly affected with chlamydia infection than males. The female to male ratio is approximately 1.52 to 1.<ref name=abc> Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection#cite_note-LancetEpi2012-26. Accessed on December 29, 2015</ref> Common risk factors in the development of [[chlamydia]] infection include unprotected sexual activity, multiple sexual partners, age, men who have sex with men, and low socio-economic status.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref><ref name="pmid18159391">{{cite journal| author=Navarro C, Jolly A, Nair R, Chen Y| title=Risk factors for genital chlamydial infection. | journal=Can J Infect Dis | year= 2002 | volume= 13 | issue= 3 | pages= 195-207 | pmid=18159391 | doi= | pmc=PMC2094865 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159391 }} </ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> According to the 2015 Sexually Transmitted Diseases Treatment Guidelines by the CDC, screening for chlamydia is recommended for sexually active under 25 years, women over 25 who are at increased risk, all pregnant women under 25 years, pregnant women over 25 who are at increased risk, men who have sex with men, and individuals with HIV.<ref name=abc> Screening Recommendations Referenced in Treatment Guidelines and Original Recommendation Sources. CDC. http://www.cdc.gov/std/tg2015/screening-recommendations.htm. Accessed on January 6th, 2016</ref> If left untreated, chlamydia can cause [[pelvic inflammatory disease]] in women and [[epididymitis]] and [[orchitis]] in males.<ref name=abc> Chlamydia trachomatis. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_trachomatis. Accessed on December 22, 2015</ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> Common complications of chlamydia among women include [[cervicitis]], [[infertility]], [[ectopic pregnancy]], and chronic pelvic pain. Complications of chlamydia in men include [[proctitis]], [[epididymitis]], and [[sterility]]. Other complications of chlamydia include an increased risk of acquiring [[HIV]] and [[reactive arthritis]].<ref name=ddd> Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016 </ref> Prognosis of chlamydia is generally good with adequate treatment. Specific areas of focus when obtaining a history from the patient include number and type of sexual partners (new, casual, or regular), contraception use, and previous history of chlamydia infection or other sexually transmitted diseases.<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref><ref name=ddd> Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016 </ref><ref name="pmid18159391">{{cite journal| author=Navarro C, Jolly A, Nair R, Chen Y| title=Risk factors for genital chlamydial infection. | journal=Can J Infect Dis | year= 2002 | volume= 13 | issue= 3 | pages= 195-207 | pmid=18159391 | doi= | pmc=PMC2094865 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159391 }} </ref> The majority of women with chlamydia infection are asymptomatic or present with minimal symptoms.<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref><ref name=ddd> Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016 </ref> Common symptoms of chlamydia infection among women include abnormal vaginal bleeding or discharge, abdominal pain, painful sexual intercourse, painful urination, and urinary urgency. Symptoms of chlamydia infection among men include penile discharge and pruritus, testicular pain or swelling, and pain during urination.<ref name=cde> Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection. Accessed on January 11, 2016</ref> Physical examination of women with chlamydia infection is usually remarkable for a cloudy, yellow mucoid cervical discharge, friable appearance of the cervix, and cervical motion tenderness.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016</ref><ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> Common physical examination findings of chlamydia infection among men include a clear or white urethral discharge, testicular tenderness, and testicular swelling.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016</ref><ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> Transvaginal ultrasound, pelvic MRI, and laboratory nucleic acid amplification tests (NAAT) may be used in the diagnosis of chlamydia infection. | ||
==Historical Perspective== | ==Historical Perspective== | ||
Revision as of 20:41, 15 January 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]
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Overview
The term Chlamydia refers to an infection by any one of the species in the bacterial genus Chlamydia—Chlamydia trachomatis, Chlamydia suis or Chlamydia muridarum—, but of these, only C. trachomatis is found in humans.[1] Chlamydia is a common sexually transmitted disease (STD) caused by the gram negative bacterium, Chlamydia trachomatis. Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States and a major infectious cause of human eye and genital disease.[2] Chlamydia trachomatis was first discovered in 1907 by Halberstaedter and von Prowazek.[3] Chlamydia must be differentiated from other genital tract infections such as Gonorrhea infection, bacterial vaginosis, vaginal candidiasis, infection with Trichomonas vaginalis, and mycoplasma infection.[4] In 2014, the incidence of chylamydia was estimated to be 439 cases per 100,000 individuals in the United States.[5] Almost two-thirds of new chlamydia infections occur among youth aged 15-24 years. It is estimated that 1 in 20 sexually active young women aged 14-24 years has chlamydia.[5] Females are more commonly affected with chlamydia infection than males. The female to male ratio is approximately 1.52 to 1.[5] Common risk factors in the development of chlamydia infection include unprotected sexual activity, multiple sexual partners, age, men who have sex with men, and low socio-economic status.[5][6][7] According to the 2015 Sexually Transmitted Diseases Treatment Guidelines by the CDC, screening for chlamydia is recommended for sexually active under 25 years, women over 25 who are at increased risk, all pregnant women under 25 years, pregnant women over 25 who are at increased risk, men who have sex with men, and individuals with HIV.[5] If left untreated, chlamydia can cause pelvic inflammatory disease in women and epididymitis and orchitis in males.[5][7] Common complications of chlamydia among women include cervicitis, infertility, ectopic pregnancy, and chronic pelvic pain. Complications of chlamydia in men include proctitis, epididymitis, and sterility. Other complications of chlamydia include an increased risk of acquiring HIV and reactive arthritis.[8] Prognosis of chlamydia is generally good with adequate treatment. Specific areas of focus when obtaining a history from the patient include number and type of sexual partners (new, casual, or regular), contraception use, and previous history of chlamydia infection or other sexually transmitted diseases.[9][8][6] The majority of women with chlamydia infection are asymptomatic or present with minimal symptoms.[9][8] Common symptoms of chlamydia infection among women include abnormal vaginal bleeding or discharge, abdominal pain, painful sexual intercourse, painful urination, and urinary urgency. Symptoms of chlamydia infection among men include penile discharge and pruritus, testicular pain or swelling, and pain during urination.[10] Physical examination of women with chlamydia infection is usually remarkable for a cloudy, yellow mucoid cervical discharge, friable appearance of the cervix, and cervical motion tenderness.[5][9] Common physical examination findings of chlamydia infection among men include a clear or white urethral discharge, testicular tenderness, and testicular swelling.[5][9] Transvaginal ultrasound, pelvic MRI, and laboratory nucleic acid amplification tests (NAAT) may be used in the diagnosis of chlamydia infection.
Historical Perspective
Chlamydia trachomatis was first discovered in 1907 by Halberstaedter and von Prowazek.[3] The inclusion bodies of Chlamydia trachomatis were first described in 1942.[5]
Pathophysiology
C. trachomatis is naturally found living only inside human cells. Chlamydia can be transmitted during vaginal, anal, or oral sex, and can be passed from an infected mother to her baby during vaginal childbirth.
Causes
Chlamydia is a common sexually transmitted disease (STD) caused by the gram negative bacterium, Chlamydia trachomatis.
Differentiating Chlamydia infection from other diseases
Chlamydia must be differentiated from other genital tract infections such as Gonorrhea infection, bacterial vaginosis, vaginal candidiasis, infection with Trichomonas vaginalis, and mycoplasma infection.[4]
Epidemiology and Demographics
In 2014, the incidence of chylamydia was estimated to be 439 cases per 100,000 individuals in the United States.[5] The incidence of chlamydia in women has increased greatly between 1987 and 2003 from 79 to 467 cases per 100,000 individuals.[9] Almost two-thirds of new chlamydia infections occur among youth aged 15-24 years. It is estimated that 1 in 20 sexually active young women aged 14-24 years has chlamydia.[5] Females are more commonly affected with chlamydia infection than males. The female to male ratio is approximately 1.52 to 1.[5] The prevalence of chlamydia among non-Hispanic african americans is 6.7 times the prevalence among non-Hispanic whites.[5]
Risk Factors
Common risk factors in the development of chlamydia infection include unprotected sexual activity, multiple sexual partners, age, men who have sex with men, and low socio-economic status.[5][6][7]
Screening
According to the 2015 Sexually Transmitted Diseases Treatment Guidelines by the CDC, screening for chlamydia is recommended for sexually active under 25 years, women over 25 who are at increased risk, all pregnant women under 25 years, pregnant women over 25 who are at increased risk, men who have sex with men, and individuals with HIV.[5]
Natural History, Complications and Prognosis
If left untreated, chlamydia can cause pelvic inflammatory disease in women and epididymitis and orchitis in males.[5][7] Common complications of chlamydia among women include cervicitis, infertility, ectopic pregnancy, and chronic pelvic pain. Complications of chlamydia in men include proctitis, epididymitis, and sterility. Other complications of chlamydia include an increased risk of acquiring HIV and reactive arthritis.[8] Prognosis of chlamydia is generally good with adequate treatment.
Diagnosis
History and Symptoms
A detailed and thorough sexual history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include number and type of sexual partners (new, casual, or regular), contraception use, and previous history of chlamydia infection or other sexually transmitted diseases.[9][8][6] The majority of women with chlamydia infection are asymptomatic or present with minimal symptoms.[9][8] Common symptoms of chlamydia infection among women include abnormal vaginal bleeding or discharge, abdominal pain, painful sexual intercourse, painful urination, and urinary urgency. Symptoms of chlamydia infection among men include penile discharge and pruritus, testicular pain or swelling, and pain during urination.[10]
Physical Examination
Patients with chlamydia infection are usually well-appearing. A fever may be present. Physical examination of women with chlamydia infection is usually remarkable for a cloudy, yellow mucoid cervical discharge, friable appearance of the cervix, and cervical motion tenderness.[5][9] Common physical examination findings of chlamydia infection among men include a clear or white urethral discharge, testicular tenderness, and testicular swelling.[5][9]
Laboratory Findings
Laboratory tests used in the diagnosis of chlamydia infection include nucleic acid amplification tests (NAAT) such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement assay (SDA). NAAT for chlamydia infection may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine.[10]
Ultrasound
Transvaginal ultrasound may be helpful in the diagnosis of chlamydia infection when pelvic inflammatory disease has occurred. Findings on ultrasound suggestive of pelvic inflammatory disease include thickened/dilated fallopian tubes, incomplete septa in the fallopian tube, increased vascularity around the fallopian tubes, and the cogwheel sign.[5]
Other Imaging Findings
Other imaging studies for chlamydia infection include pelvic MRI, which demonstrates an ill-defined adnexal mass containing fluid with various signal intensities.[5]
Treatment
Medical Therapy
The mainstay of therapy for chlamydia is antimicrobial therapy. Recent sex partners (i.e., individuals having sexual contact with the patient within the 60 days preceding onset of symptoms or chlamydia diagnosis) should also be referred for evaluation, testing, and treatment.
Primary Prevention
Effective measures for the primary prevention of chlamydia infection include practicing abstinence, avoidance of high-risk sexual behaviors such as unprotected sex or multiple sexual partners, and use of latex condoms.[5][7]
Secondary Prevention
Secondary prevention of chlamydia infection includes early detection and treatment of sexually transmitted diseases.[9]
References
- ↑ "www.chlamydiae.com (professional) - Taxonomy diagram". Retrieved 2007-10-27.
- ↑ Chlamydia fact sheet from the Centers for Disease Control and Prevention
- ↑ 3.0 3.1 Budai I (2007). "Chlamydia trachomatis: milestones in clinical and microbiological diagnostics in the last hundred years: a review". Acta Microbiol Immunol Hung. 54 (1): 5–22. doi:10.1556/AMicr.54.2007.1.2. PMID 17523388.
- ↑ 4.0 4.1 Genital Tract Chlamydia infection. BMJ. http://bestpractice.bmj.com/best-practice/monograph/52/diagnosis/differential.html. Accessed on December 27, 2015
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015
- ↑ 6.0 6.1 6.2 6.3 Navarro C, Jolly A, Nair R, Chen Y (2002). "Risk factors for genital chlamydial infection". Can J Infect Dis. 13 (3): 195–207. PMC 2094865. PMID 18159391.
- ↑ 7.0 7.1 7.2 7.3 7.4 Mishori R, McClaskey EL, WinklerPrins VJ (2012). "Chlamydia trachomatis infections: screening, diagnosis, and management". Am Fam Physician. 86 (12): 1127–32. PMID 23316985.
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016
- ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 Miller KE (2006). "Diagnosis and treatment of Chlamydia trachomatis infection". Am Fam Physician. 73 (8): 1411–6. PMID 16669564.
- ↑ 10.0 10.1 10.2 Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection. Accessed on January 11, 2016