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Chlamydia trachomatis

Etiology: - risk factors - age <= 25 years - new or multiple sexual partners - unprotected sex Epidemiology: - exclusively a human pathogen - major cause of sexually transmitted disease & perinatal infection - at least 20 serotypes of Chlamydia trachomatis - prevalence 4.2% in adolescents, grades 7-12 1.9% in whites, 5.9% in Latinos, 12.5% in blacks - prevelance 2% in younger people [15] Pathology: - vaginal flora dominated by Lactobacillus iners associated with increased risk for Chlamydia trachomatis infection, compared with flora dominated by Lactobillus crispatus (RR-2.6) [21] Clinical manifestations: 1) subacute presentation 2) disorders of Chlamydia trachomatis in both sexes - urethritis - proctitis - conjunctivitis (trachoma) - lymphogranuloma venereum 3) disorders Chlamydia trachomatis in men - epidydimitis 4) disorders Chlamydia trachomatis in women a) cervicitis - mucopurulent cervix - friable cervix b) endometritis - inter menstrual or post-coital bleeding - lower abdominal pain c) acute salpingitis d) bartholinitis 5) infrequent manifestations a) endocarditis b) peritonitis c) periappendicitis Laboratory: 1) culture for Chlamydia trachomatis - culture in mammalian cell lines 2) Chlamydia trachomatis antigen in specimen - ELISA - direct fluorescent antibody slide test 3) Chlamydia trachomatis DNA, Chlamydia trachomatis rRNA or GenProbe a) probably test of choice for genitourinary infection b) endocervical or urethral swab [1,13] c) urine is adequate specimen [8] d) rectal & oropharyngeal specimens as indicated 4) chlamydia rapid test (point-of-care test) a) self-collected vaginal swab b) specificity 99%, sensitivity 84% 5) Chlamydia+gonorrhea point of care test [22] - results available in 30 minutes - allows one visit diagnoisis & treatment 6) Chlamydia trachomatis serology of limited use a) complement fixation tests b) micro-immunofluorescence 1] measures antibodies by sero specificity & immunoglobulin class 2] may be useful in infant pneumonia & salpingitis 7) urinalysis may show pyuria without bacteriuria 8) test of cure not indicated except in pregnancy [1] 9) retest after 3 months for possible repeat infection [1] Differential diagnosis: 1) Neisseria gonorrhoeae: a) generally more prululent discharge b) cannot be distinguished on clinical grounds [1] 2) Ureaplasma urealyticum 3) Herpes simplex Complications: 1) pelvic inflammatory disease 2) ectopic pregnancy 3) tubal infertility 4) blindness (most common cause of infectious blindness) [16] Management: 1) antibiotics a) doxycycline 100 mg PO BID for 7 days - treatment of choice, 100% effective [17] - more effective than azithromycin for rectal chlamydia - 21 days of therapy for acute proctitis (treat as lymphogranuloma venereum) b) azithromycin 1 g PO single dose (pregnant) [9] 97% effective [17] c) erythromycin 500 mg PO QID for 7 days (pregnant) d) sulfisoxazole 500 mg PO QID for 7 days e) ofloxacin (Floxin) 300 mg PO BID for 7 days f) pelvic inflammatory disease - ceftriaxone 250 mg IM single dose - ceftriaxone 2 g IM single dose plus probenecid 1 g PO once - another 3rd generation cephalosporin plus doxycycline 100 mg PO BID for 14 days 2) sexual partners should be offered evaluation & treatment [1] 3) follow-up 1 week after treatment 4) screening - all sexually active women < 25 years of age [1,8,10,14] - high risk women of any age [1,8,10,14] - yearly screening with Pap Smear for asymptomatic women aged 15-25 [1,4,5,6] 5) behavioral counseling for sexually-active women < 25 years of age & older women at risk [14] Notes: - experimental vaccine effective in humanized mice [16] - vaccine consists of nanoparticles that complex a synthetic & biodegradable adjuvant with ultraviolet light-inactivated C trachomatis - nanoparticles are taken up by mucosal epithelial cells - vaccine was applied to mucosal surfaces (uterus or nasal) of mice [16]

Related

Chlamydia DNA Chlamydia trachomatis rRNA

General

Chlamydia

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KINGDOM: monera DIVISION: SCHIZOMYCETES

References

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  8. Journal Watch 25(1):10, 2005 Centers for Disease Control and Prevention (CDC). Chlamydia screening among sexually active young female enrollees of health plans--United States, 1999-2001. MMWR Morb Mortal Wkly Rep. 2004 Oct 29;53(42):983-5. PMID: 15514579 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5342a1.htm
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  10. Meyers DS, Halvorson H, Luckhaupt S; U.S. Preventive Services Task Force. Screening for chlamydial infection: an evidence update for the U.S. Preventive Services Task Force. Ann Intern Med. 2007 Jul 17;147(2):135-42. Epub 2007 Jun 18. Review. Summary for patients in: Ann Intern Med. 2007 Jul 17;147(2):I44. PMID: 17576995 - U.S. Preventive Services Task Force. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2007 Jul 17;147(2):128-34. Epub 2007 Jun 18. Summary for patients in: Ann Intern Med. 2007 Jul 17;147(2):I44. PMID: 17576996 - corresponding NGC guideline withdrawn Jan 2013
  11. Prescriber's Letter 15(6): 2008 Expedited Partner Therapy (EPT) for Chlamydia and Gonorrhea Detail-Document#: 240601 (subscription needed) http://www.prescribersletter.com
  12. Schoeman SA et al Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ 2012;345:e8013 PMID: 23236032 http://www.bmj.com/content/345/bmj.e8013
  13. Papp JR et al Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae. MMWR. Weekly, March 14, 2014 / 63(RR02);1-19 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm
  14. Zakher B et al Screening for Gonorrhea and Chlamydia: An Update for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 23 September 2014 PMID: 25244000 http://annals.org/article.aspx?articleid=1906845 - LeFevre ML et al Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med. Published online 23 September 2014 PMID: 25244227 http://annals.org/article.aspx?articleid=1906847 - O'Connor EA et al Behavioral Sexual Risk-Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 23 September 2014 PMID: 25243895 http://annals.org/article.aspx?articleid=1906844 - U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014 Dec 16;161(12):902-10. PMID: 25243785
  15. Torrone E et al Prevalence of Chlamydia trachomatis Genital Infection Among Persons Aged 14-39 Years - United States, 2007-2012 MMWR. September 26, 2014 / 63(38);834-838 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6338a3.htm PMID: 25243785
  16. Komaroff AL Major Step Toward a Vaccine for Chlamydia trachomatis. NEJM Journal Watch. Junly 9, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Stary G et al. A mucosal vaccine against Chlamydia trachomatis generates two waves of protective memory T cells. Science 2015 Jun 19; 348:aaa8205. PMID: 26089520 http://www.sciencemag.org/content/348/6241/aaa8205
  17. Geisler WM et al Azithromycin versus Doxycycline for Urogenital Chlamydia trachomatis Infection. N Engl J Med 2015; 373:2512-2521. December 24, 2015 PMID: 26699167 http://www.nejm.org/doi/full/10.1056/NEJMoa1502599 - Quinn TC, Gaydos CA Treatment for Chlamydia Infection - Doxycycline versus Azithromycin. N Engl J Med 2015; 373:2573-2575. December 24, 2015 PMID: 26699174 http://www.nejm.org/doi/full/10.1056/NEJMe1513001
  18. Workowski K. In the clinic. Chlamydia and gonorrhea. Ann Intern Med. 2013 Feb 5;158(3):ITC2-1. Review. PMID: 23381058
  19. World Health Organization (WHO). 2016 WHO Guidelines for the treatment of Chlamydia trachomatis. http://apps.who.int/iris/bitstream/10665/246165/1/9789241549714-eng.pdf
  20. Wiesenfeld HC Screening for Chlamydia trachomatis Infections in Women. N Engl J Med 2017; 376:765-773. February 23, 2017 PMID: 28225683 http://www.nejm.org/doi/full/10.1056/NEJMcp1412935
  21. van Houdt R, Ma B, Bruisten SM et al Lactobacillus iners-dominated vaginal microbiota is associated with increased susceptibility to Chlamydia trachomatis infection in Dutch women: a case-control study. Epidemiology. Sexually Transmitted Infections article. Online Sept 26, 2017 PMID: 28947665 http://sti.bmj.com/content/early/2017/08/30/sextrans-2017-053133
  22. Van Der Pol B, Taylor SN, Mena L et al Evaluation of the Performance of a Point-of-Care Test for Chlamydia and Gonorrhea. JAMA Netw Open. 2020;3(5):e204819. PMID: 32407506 Free Article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765941
  23. Dombrowski JC et al. Doxycycline versus azithromycin for the treatment of rectal chlamydia in men who have sex with men: A randomized controlled trial. Clin Infect Dis 2021 Feb 19. PMID: 33606009 https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciab153/6144986