Chlamydia 2
Chlamydia 2Chlamydia
Chlamydia is caused by the bacterium Chlamydia trachomatis, hence the name; Chlamydia The word chlamys is Greek for "cloak draped around the shoulder.� This describes how the intracytoplasmic inclusions caused by the bacterium are "draped" around the infected cell's nucleus. Scientists discovered the organism in 1907, although it probably has been infecting people for hundreds of years. Because the symptoms of the disease resemble other pathologies, chlamydia was not recognized as a sexually transmitted disease until recently. Isolation from embryonated eggs in 1957 and from cell culture in 1963 confirmed its existence as a bacterium. (Madigan) However, since the organism is an obligate intracellular parasite that exclusively infects humans (it cannot synthesize its own ATP or grow on artificial medium), it was once thought to be a virus.(Hatch) Because of Chlamydia's unique developmental cycle, it was taxonomically classified in a separate order. It can thus be found with the other well-known intracellular parasites, rickettsiae, in diagnostic manuals. Until recently, however, there were no reliable and easy tests for chlamydia. Chlamydia prevention and patient care were impeded by the lack of suitable laboratory tests for screening and diagnosis. Such tests are now available. Through education, screening, partner referral, and proper patient care public health workers and health-care practitioners can combine efforts to decrease the morbidity and costs resulting from this infection.
Chlamydia is the number one bacterial sexually transmitted disease (STD) in the United States today. Four million new cases of chlamydia occur each year. It is many times more common than gonorrhea. Chlamydia infection is primarily transmitted from person to person through contact with the mucous membranes of the vagina, urethra, rectum or mouth. The chief mode of transmission is sexual intercourse-oral, anal or genital. The infection can be present for long periods of time, even years, without any signs of infection. It's particularly common among teens and young adults. Pelvic inflammatory disease (PID), which can be caused by chlamydia, is a leading cause of infertility when left untreated. Chlamydia is usually easy to treat. However, most people with chlamydia have no symptoms. Chlamydia is an infection that is spread through sex. It is very common among teens and young adults. If it is not treated, chlamydia can damage a woman's body so she can never have children. Approximately 60 to 80% of women will have no noticeable symptoms of an infection, and when symptoms are present they are usually mild. A pregnant woman may pass the infection to her newborn during delivery, with subsequent neonatal eye infection or pneumonia. Each year up to 1 million women in the United States develop PID, a serious infection of the reproductive organs. PID is the most common cause of pregnancy-related death among poor teenagers in the inner cites and rural areas of the United States. The annuals cost estimates exceed $7 billion. As many as half of all cases of PID may be due to chlamydial infection and many of these occurring without symptoms. PID can result in scarring of the fallopian tubes, which can block the tubes and prevent fertilization from taking place. An estimated 100,000 women each year become infertile as a result of PID. A baby who is exposed to C. trachomatis in the birth canal during delivery may develop conjunctivitis (eye infection) or pneumonia.(Boston) Symptoms of conjunctivitis, which include discharge and swollen eyelids, usually develop within the first 10 days of life. Symptoms of pneumonia, including a progressively worsening cough and congestion, most often develop within three to six weeks of birth. Both conditions can be treated successfully with antibiotics. In other cases, scarring may interfere with the passage of the fertilized egg down into the uterus. When this happens, the egg may implant in the fallopian tube. This is called ectopic or tubal pregnancy. This is life threatening for the mother and results in the loss of the fetus. Because of these risks to the newborn, many doctors recommend routine testing of all pregnant women for chlamydial infection.
Chlamydia infections are not limited to women. In men, the bacteria can cause infections of the urethra, prostate gland, and rectum, as well as epididymitis, a painful inflammation of the tiny structures inside the testicles where sperm are stored. There are roughly four million cases annually, most occurring in men and women under the age of 25. Direct and indirect costs of chlamydia (mainly costs for complications) total $24 billion a year. This is most likely an underestimate, since half of people with chlamydia likely have gonorrhea too. Hence, costs to diagnose and treat the latter sexually transmitted disease must be included.
Chlamydia is known as the "silent epidemic" because three quarters of the women and half of the men with the disease have no symptoms. Possible symptoms include discharge from the penis or vagina and a burning sensation when urinating. In women, symptoms include increased vaginal discharge, burning during urination, irritation of the area around the vagina, bleeding after sexual intercourse, lower abdominal pain, and abnormal vaginal bleeding. Infection in women usually begins at the cervix. Additional symptoms for women include pain during intercourse and bleeding between menstrual periods. Doctors estimate that, in women, one-third of the chlamydial infections result in PID. Often these infections are not diagnosed until PID or other complications develop. In men, rarely, chlamydial infections may lead to pain or swelling in the scrotal area, which is a sign of epididymitis, an inflammation of a part of the male reproductive system located near the testicles. Left untreated, this condition, like PID in women, can cause infertility. C. trachomatis can cause proctitis (inflamed rectum) and conjunctivitis (inflammation of the lining of the eye). The bacteria also have been found in the throat as a result of oral sexual contact with an infected partner. In tropical climates, a particular strain of C. trachomatis causes an STD called lymphogranuloma venereum (LGV), which is characterized by prominent swelling and inflammation of the lymph nodes in the groin. Complications may follow if LGV is not treated; this infection is very rare in the United States.
In men, non-gonococcal urethritis is the main symptom. This includes clear, white, or yellow discharge from the urethra, burning and pain during urination, and tingling or itching sensations. Another infection caused by C. trachomatis, lymphogranuloma venereum, is characterized by a swelling of the lymph nodes in the groin area. In men, this can lead to proctitis and in women; it can lead to rectal narrowing. The primary stage is detected as small ulcers or vesicles which usually heal without scarring. The secondary stage, called "supperative lymphadenopathy", is characterized by chills, fever, and arthralgais. The large area of swelling in the groin is called a bubo. Finally, the tertiary stage is when rectal narrowing or draining of the sinuses occurs.(Barnes)
Untreated, chlamydia can permanently damage the reproductive organs. It is especially dangerous for women because the bacterium easily infects the warm, moist surface of the cervix. Because women are infected internally, they are more likely than men to get chlamydia from unprotected sex.
In women, damage occurs when an infection spreads from the cervix into the fallopian tubes. This can lead to pelvic inflammatory disease, which can cause infertility. Scarring in the tubes can lead to ectopic or tubal pregnancy (a life-threatening pregnancy with no chance of producing a baby). It can also cause long-lasting pain. In men, chlamydia can cause a discharge from the penis and pain when urinating. In rare cases, untreated chlamydia can lead to male infertility.
Chlamydial infection can be confused with gonorrhea because the symptoms of both diseases are similar; in some populations they occur together. The most reliable way to diagnose chlamydial infection is for a clinician to send a sample of secretions from the patient�s genital area to a laboratory that will look for the organism using one of a wide variety of quick and inexpensive laboratory tests. Although attempting to grow the organism in specialized tissue culture in the laboratory is one of the most definitive tests, it is expensive and technically difficult to do, and test results are not available for three or more days. Scientists have developed several rapid tests for diagnosing chlamydial infection that use sophisticated techniques and a dye to detect bacterial proteins. Although these tests are slightly less accurate, they are less expensive, more rapid, and can be performed during a routine checkup. These tests use a process called DNA amplification to detect the genes of the organisms in genital secretions.(Coghlan) Recently, the U.S. Food and Drug Administration approved this process for detection of C. trachomatis in urine. This is a major step in diagnosing chlamydial infection because it does not require an invasive sample; it can be used in settings where performing a pelvic examination is not convenient or not feasible, e.g., in college health units and at health fairs. Results from the urine test are available within 24 hours.
There are two kinds of tests for chlamydia. One involves collecting a small amount of fluid from an infected site (cervix or penis) with a cotton swab. These tests are universally available. New tests, which use only urine samples, will be available soon and will make testing much easier and less painful.
There has been major progress in the treatment of chlamydia with antibiotics over the past few years. A single dose of azithromycin or a week of doxycycline (twice daily) are the most commonly used treatments. (For the U.S. only) Common side effects of these treatments include diarrhea (7%), nausea (5%), abdominal pain (5%), and vomiting (2%). Doctors usually prescribe antibiotics such as a one-day course of azithromycin or a seven-day course of doxycycline to treat chlamydial infection. Other antibiotics such as erythromycin or ofloxacin also are effective. Pregnant women can be treated with azithromycin or erythromycin. Amoxicillin is also a safe alternative for treating pregnant women. Penicillin, which is often used for treating some other STDs, is not effective against chlamydial infections. New medications are being developed that should greatly simplify treatment and help control the spread of C. trachomatis in the population. A person with chlamydial infection should be sure to take all of the prescribed medication, even after symptoms disappear. If the symptoms do not disappear within one to two weeks after finishing the medicine, the patient should make a follow-up visit to the doctor or clinic. All sex partners of a person with chlamydial infection should be tested and treated to prevent reinfection and further spread of the disease. Since many Chlamydia infections are silent, reliance on absence of symptoms may not be indicative of a cured infection. It is highly recommended that you return to the clinic for a repeat Chlamydia test about three weeks after finishing the medication. This test will let you know if the treatment was effective, and if the Chlamydia infection is gone. The consequences of not promptly and properly treating a chlamydia infection can be serious: pelvic inflammatory disease, tubal pregnancy, and sterility. To be sure you are not at further risk of these complications, have another Chlamydia test after treatment is completed.
Because chlamydial infection often occurs without symptoms, people who are infected may unknowingly infect their sex partners. Many doctors recommend that all persons who have more than one sex partner, especially women under 25 years of age, be tested for chlamydial infection regularly, even in the absence of symptoms. Using condoms or diaphragms during sexual intercourse may help reduce the transmission of chlamydia. Unfortunately, literature on Chlamydia stresses treatment instead of prevention. Because Chlamydia is a completely preventable disease, this should be the focus of health care and research facilities. Prevention strategies include personal strategies, community-based strategies, and health-care provider strategies (CDC).
Personally, it is important to see a health care provider regularly. Because chlamydia is markedly asymptomatic, routine visits to a health care facility may be the only way for detection. It is also essential to refer sexual partners for testing and treatment if one has been diagnosed with chlamydia. Other behavioral changes include using condoms during sex, delaying the age of first intercourse, monogamy, discussing sexual history with partners, and educating yourself about sexually transmitted diseases and sharing this information with friends.
Community-based strategies include public awareness, HIV and STD risk reduction programs, school involvement, and targeting out-of-school adolescents through vocational training centers, detention centers, and recreation programs. Schools can provide rates of the disease, its adverse symptoms and consequences, information on treatment for sex partners, and where and how to obtain care. Role playing in health classes can also be used to stress how to tell a partner of infection and how to find care for the infection.
Health care providers need to be more aware and recognize symptoms of Chlamydia. Because most chlamydia infections look like a bladder infection, this is difficult. Similarly, providers should arrange for treatment of sex partners, counsel patients on the risk of STDs, and screen at-risk patients.(Hillis)