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.
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
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.
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.
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.
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