Chlamydia Trachomatis - Sexually Transmitted Disease

CHLAMYDIA TRACHOMATIS

C. trachomatis is a bacterium that requires attachment to the hostcell, invasion, intracellular growth, and replication. This require-ment for intracellular growth, which is similar to that of viruses, has made the identification and laboratory testing more diffi-cult than for organisms that grow and replicate independently, but advances have made diagnosis and screening much more available.

Clinical Manifestations

In women, the most frequent clinical manifestation is PID, but symptoms often are so subtle that pathologic progression can occur without detection. Long-term effects may include chronic pain, increased risk for ectopic pregnancy, postpartum endometritis, and infertility.

Transmission of infection from an infected pregnant woman to her vaginally born infant is common. About 20% to 50% of infected infants develop chlamydial conjunctivitis, and about 20% develop chlamydial pneumonia (Schacter & Grossman, 2001).

Although men infected with Chlamydia are frequently asymp-tomatic, they easily transmit the infection to their sexual partners.Urethritis is the most common illness associated with infection in the heterosexual man with symptoms. Among homosexual men, the rectum is the common site of infection

Assessment and Diagnostic Findings

Chlamydia should be suspected in cases of gonorrhea, nongonor-rheal urethritis, PID, and epididymitis. Diagnostic tools include cell culture techniques and a relatively wide range of nonculture techniques, including immunologic assays, DNA probes, and enzyme-sensitive tests.

Medical Management

Treatment of chlamydial infection is usually administration of doxycycline or azithromycin. Neither of these antibiotics is rec-ommended during pregnancy. CDC guidelines should be used to determine alternative therapy for the patient who is pregnant or allergic or who has complicated chlamydial infection. The patient and the sexual partner must be treated.

Prevention and Patient Education

The target group for preventive patient teaching about C. tra-chomatis is the adolescent and young adult population. Absti-nence, postponing the age of initial sexual exposure, limiting the number of sexual partners, and use of condoms for barrier pro-tection should be promoted. It should also be stressed that screen-ing for Chlamydia and treating infection at an early stage are important to decrease disease progression common to women and to decrease the likelihood of infection in infants.